Item 39 - Ordinance Prohibiting the Sale of Flavored Tobacco Products

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ER Carey et al Addictive Behaviors Reports 8(2018)95 101 confirmed curiosity,intention to use,and peer influence are significant independent of susceptibility (Pierce et al., 2005), warranting further and appropriate items to consider in measuring susceptibility to e-ci- examination of factors leading Hispanic adolescents to be more curious garettes, cigarettes,hookah, and cigars among this adolescent popula- about these products. Despite a higher reported prevalence of sus- tion.Across products,we observed minor differences in the strength of ceptibility to e-cigarettes and cigarettes among Hispanic adolescents,no each item.Specifically,curiosity had the weakest relationship with the significant interactions were observed between ethnicity and suscept- underlying susceptibility construct across all products, peer influence ibility in predicting future use.Although more Hispanic adolescents are had the strongest relationship with susceptibility to e-cigarettes, ci- susceptible to e-cigarettes and cigarettes than their non-Hispanic peers garettes, and hookah, and future intentions had the strongest re- (and Hispanic adolescents endorse curiosity about products more than lationship with susceptibility to cigars.While all three factors may be non-Hispanic peers), the relationship between the measure of suscept- influential in determining adolescent susceptibility to tobacco products, ibility itself and ever use of e-cigarettes and cigarettes is consistent intervention efforts to alter susceptibility may need to be tailored by across ethnic groups.This suggests that tailoring interventions designed product. to ameliorate susceptibility among Hispanics to address curiosity might We observed almost 30% of adolescents were susceptible to a-ci- be particularly useful. garettes at baseline,a prevalence nearly double that of each individual combustible product.Adolescents may be more susceptible to e-cigar- 4.1. Strengths and limitations ettes than other products, and more research is needed to investigate factors driving increased susceptibility, like the appeal of flavors One study limitation is the low prevalence of ever users at future Ambrose et al., 2015) or increased television and digital media mar- time points for specific products,like hookah and cigars.This prevented keting(Duke et al.,2014;Mantey,Cooper,Clendennen,Pasch,&Perry, examination of susceptibility to these products separately at baseline 2016;Pierce et al.,2017).As expected,we observed susceptibility to e- regarding future use; thus, we cannot draw conclusions about specific cigarettes and combustible products predicts product use at time points predictive validity of susceptibility to individual combustible products. 6, 12, and 18 months in the future. This is consistent with previous Still, our examination of combustible products as a whole provides research(Bold et al.,2017;Cole et al.,2017;Jackson,1998;Jackson& evidence for susceptibility as a predictor of product use among ado- Dickinson, 2004; Nodora et al., 2014; Pierce et al., 1996, 2005; lescents. Additionally, our three-item construct only includes a single Spelman et al.,2009;Strong et al.,2015;Unger et al., 1997)and sug- measure of intentions to use tobacco in the future, rather than both gests targeting and lessening susceptibility through intervention efforts measures originally considered by Pierce et al.(2005),which may limit remains a significant factor in preventing initiation of multiple forms of the ability to make comparisons between our susceptibility measures product use among adolescents. and those used in other studies.Next,this study population is limited by Of note, the declining magnitude of the odds ratios predicting in- geography,so findings may not be generalizable to adolescents outside itiation from any combustible product over time was not statistically Texas. Finally, despite utilizing measures adapted from established different from each other, based on a comparison of their 95% con- surveys(Hyland et al.,2017)and thorough cognitive testing,self-report fidence intervals.In contrast,the declining odds ratios for susceptibility of data may lead to response bias. to e-cigarette use over time show a significant drop in influence on ever Despite limitations, this study is strengthened by the large,diverse use at 18 months from susceptibility assessed at baseline.This suggests population of Texas adolescents, which provided adequate power to that by 18 months when compared to 6 and 12 months, other factors examine specific associations across ethnic groups and products. The exert a stronger influence on experimentation relative to susceptibility complex survey design and use of analyses accounting for sampling status assessed 18 months earlier. In turn, this suggests that assessing weights and clustering within schools yield results representative of the susceptibility to e-cigarettes more frequently may be necessary to in- overall population of urban Texas adolescents in grades 6, 8, and 10. form the development of targeted long-term interventions, as is iden- This study's longitudinal design and breadth of tobacco products allows tification of other factors that may be proximally related to e-cigarette for investigation of all products concurrently, within the same popu- use.lation and across time points, permitting temporal conclusions about Congruous with our second hypothesis,we found the measurement the role of susceptibility on future initiation, and extending past re- of each susceptibility construct across products applied equally well search,which has yet to examine multiple product types longitudinally across ethnic groups. Results among groups were consistent with the among the same cohort. entire population,with minor differences.Among Hispanic adolescents, intention to use had the strongest relationship with susceptibility to 4.2. Conclusions cigarettes, while peer influence had the strongest relationship among non-Hispanic adolescents.In contrast,peer influence had the strongest Susceptibility is a key construct for predicting future initiation of relationship with susceptibility to cigars among Hispanic adolescents, tobacco;past research has examined its validity relevant to cigarettes, while intention to use had the strongest relationship among non- but not among contemporary adolescent populations and the changing Hispanic adolescents. Additionally, ethnicity was significant to the landscape of tobacco products.This study confirms the appropriateness measurement of susceptibility to e-cigarettes as a whole;the differences of the measurement of susceptibility (Pierce et al., 2005) across four in the model when considering ethnicity suggest that while the mea- products(e-cigarettes,hookah,cigars,and cigarettes)and ethnic groups surement of susceptibility to e-cigarettes is valid across ethnic groups, (Hispanic versus non-Hispanic), and the utility of susceptibility in the meaning of the construct may vary slightly depending on ethnicity. predicting future tobacco product use among adolescents.Implications Thus,while it is appropriate to utilize the same susceptibility measure for intervention and research emphasize the importance of suscept- across ethnic groups, specific influences may be more relevant to pre- ibility in predicting initiation of product use and the need to investigate dicting susceptibility for Hispanics vs. non-Hispanics depending on factors influencing susceptibility to specific products,like e-cigarettes, product type, and specifically, susceptibility to e-cigarettes should be especially among Hispanic adolescents. considered separately by ethnicity. While we expected Hispanic adolescents would have a higher pre- Compliance with ethical standards valence of susceptibility to each product than non-Hispanic adolescents, this was observed only for e-cigarettes and cigarettes, with curiosity Ethical approval about these products endorsed more often among Hispanic adolescents. This is consistent with previous research (Margolis et al., 2016), and TATAMS was approved by the University of Texas Health Science notable, as curiosity predicts future experimentation with smoking Center at Houston Institutional Review Board (HSC-SPH-13-0377).All 100