TCORS 2.0: Center for the Assessment of Tobacco Regulations (CAsToR)

Pilot + Feasibility

2020 Funding Cycle Awardees

View other award years: 202220212019

Please note: Listing describes appointments and affiliations at the time of award. Please check our Trainees page for current appointments and affiliations.

Title: “Determinants of tobacco use transitions among smokers and dual users of cigarettes and e-cigarettes”
PI: Dr. Andrew Brouwer, Assistant Research Scientist at University of Michigan
Abstract and accomplishments +
Dr. Andrew Brouwer
Dr. Andrew BrouwerUniversity of Michigan
Abstract
Introduction: The introduction of e-cigarettes has dramatically changed the landscape of tobacco products and product-use patterns in the US. Although e-cigarettes have the potential to promote smoking cessation, their real-world impact remains uncertain. A systems approach can help to understanding transitions between different patterns of tobacco and nicotine product use. Aims: The aims of this project are to leverage frequent follow-up data from the University of Wisconsin Center for Tobacco Research and Intervention’s Exhale cohort of cigarette users and dual users of cigarettes and e-cigarettes (2015-2017) to 1) determine how transition rates between cigarette and e-cigarette use depend on sociodemographic, smoking behavior, smoking dependence, and smoking biomarker measures as well as 2) time since one’s last transition. A supplementary aim is to develop a continuous spline estimator to facilitate estimation of the impact of continuous variables on transitions. Anticipated Results: We expect to quantify how transition rates between different tobacco use states depend on sociodemographics, smoking behavior, smoking dependence, smoking biomarkers, and the length of time since one’s last transition. Implications: Understanding rates and determinants of product-use transitions of cigarettes and e-cigarettes will help to determine what kinds of tobacco control policy will be effective and aid in future projections of use and incidence of downstream health effects.
Accomplishments
August 2022: Dr. Brouwer was co-author on an article resulting from his pilot project work. The article, published in Nicotine & Tobacco Research, is entitled “Associations of demographics, dependence, and biomarkers with transitions in tobacco product use in a cohort of cigarette users and dual users of cigarettes and e-cigarettes”. November 2022: : In this project, we leveraged a multistate transition model, which is a type of continuous-time Markov chain model, to estimate the underlying transition hazard rates that collectively inform observed transition patterns as well as hazard ratios (HRs) comparing subgroups. In this cohort, dual users were more likely to quit smoking than cigarette-only users, but the overall impact was small because most dual users returned to cigarette-only use. Moreover, e-cigarette dependence promoted continued dual use rather than smoking cessation. E-cigarette users motivated by harm or toxicity reduction or because of restrictions on where or when they could smoke had reduced rates of smoking relapse. Cigarette dependence and spousal smoking were barriers to cigarette cessation for dual users, while using e-cigarettes first in the morning, motivation to quit smoking, and sensory, social, and emotional enjoyment of e-cigarettes (secondary dependence motives) were facilitators of smoking cessation among dual users. The longer participants remained cigarette-only or dual users, the lower their propensity to transition to the other patterns of use, stabilizing around 8-12 months post-transition. This project supported, in part, one published paper and two in preparation, four conference posters, several webinars and an instructional workshop, a U54 center renewal proposal, and a planned R21 proposal submission.
 
Title: “Modeling the Effects of E-cigarette Use on Smokers with Comorbid Major Depression”
PI: Dr. Jamie Tam, Assistant Professor at Yale University
Abstract and accomplishments +
Dr. Jamie Tam
Dr. Jamie TamYale University
Abstract
Introduction: Smoking rates remain unacceptably high among those with mental health conditions, including those with major depression (MD). E-cigarettes have the potential to alter this trajectory, but their long-term impact on the health of vulnerable populations is unknown. Aims: Aim 1: Develop a Microsimulation Model of Smoking and Major Depression (MDS).
Aim 2: Simulate e‐cigarette use patterns and smoking‐related mortality among adults with MD from 2020‐2100. Methods: This study will adapt a previously developed smoking and major depression model to account for e-cigarette use and its potential effects on smoking among people with MD. The resulting microsimulation model would integrate smoking initiation and cessation inputs generated by the Cancer Intervention and Surveillance Modeling Network (CISNET) smoking history generator (SHG), as well as recently published MD incidence, recovery, and recurrent parameters to simulate individual-level trajectories of smoking and MD in the population. Using available literature estimates, three key e-cigarette use parameters would be evaluated for the MD population: (1) the effect of current cigarette smoking on subsequent e-cigarette initiation, (2) the effect of current e-cigarette use on subsequent smoking initiation, and (3) the effect of current e-cigarette use on smoking cessation. Anticipated Results: Estimates of projected smoking and vaping prevalence and related mortality and life years lost associated with e-cigarette use in the population with MD, with plausible parameter ranges evaluated for best case “optimistic” scenario and worst case “pessimistic” scenarios from 2020-2100. Implications: This simulation model would integrate the best available epidemiological data and inputs to help the FDA understand the range of possible outcomes associated with e-cigarette use in a specific vulnerable population: adults with current MD. The model would eventually be applied to examine the impact of FDA policies on this specific population, including regulations that affect the design, content, and appeal of e-cigarettes and cigarettes.
Accomplishments
July 2022: Dr. Tam’s pilot project research helped in her being awarded a K01 Grant, “Health and economic impact analysis of a reduced nicotine cigarette policy on vulnerable populations”. through the National Institute on Drug Abuse.November 2022: During this process, I found that the parameters calibrated from the MDS compartmental model could not be directly transferred to the MDS microsimulation model. Calibration increased smoking initiation parameters while decreasing cessation parameters. It also resulted in greater age variation of depression trajectories such as recurrence and recovery. The result is a microsimulation model of smoking and major depression that will eventually be made publicly available.
 
Title: “Impact of prohibiting characterizing flavors in nicotine vaping products”
PI: Dr. Kai-Wen Cheng, Assistant Professor at Governors State University
Abstract and accomplishments +
Dr. Kai-Wen Cheng
Dr. Kai-Wen ChengGovernors State University
Abstract
Introduction: Flavors in Nicotine Vaping Products (NVPs) have particularly strong appeal to youth and young adults, vulnerable subgroups for initiating tobacco use and experimenting with multiple products. Among both youth and adults, flavors continue to be a significant factor explaining the use of NVPs. Recently, several state and local jurisdictions, including Michigan, Minneapolis, Boston, Berkeley, Oakland, and San Francisco, have implemented characterizing flavor bans on NVPs. Bans at the state and local level provide an opportunity to assess the impact of prohibiting characterizing flavors on use of flavored and non-flavored nicotine products. Aims: Estimate the impact of characterizing flavor ban on NVPs on use, discontinued use, and switching between products. Study the impact of the current characterizing flavor ban on sales/purchase/use of restricted flavored and unrestricted flavored and non-flavored nicotine products. Methods: Synthetic control and difference-in-difference approaches will estimate whether and to what extent prohibiting characterizing flavors a) reduced sales, purchase, and use of restricted flavored products; b) increased sales, purchase, and use of unrestricted other products; c) increased switching to other unrestricted products; and d) decreased use of any nicotine products. Anticipated Results: Hypotheses include that the prohibition of flavored NVPs will (1) decrease sales/purchase/use of flavored NVPs, (2) increase sales/purchase/use of non-flavored NVPs, (3) increase sales/purchase/use of flavored other products (e.g. mentholated cigarettes and flavored cigars), and (4) decrease use of any nicotine products. Implications: The assessment of prohibiting characterizing flavors on NVPs is timely and significant, as the FDA intends to prohibit characterizing flavors in all types of NVPs. Furthermore, this study will advance the science of impact analysis by providing accurate estimates that can be applied to evaluate the economic impact of prohibiting characterizing flavors in all nicotine products, such as cigarettes, cigars, and NVPs.
Accomplishments
October 2022: I used 2019 Nielsen Scanner data from Kilts Marketing Data Center Archive of the Nielsen Company at the University of Chicago Booth School of Business. The findings indicated that flavored NVP sales declined significantly in WA, MA, and Rl after the implementation of non-flavored and/or flavored NVP sales restrictions in response to the EVALI outbreak in 2019. Potential displacements, such that individuals switched to non-restricted tobacco flavored NVPs and/or non-restricted retail channels, were identified. Findings indicated a significant increase in non-restricted tobacco flavored NVP sales after the flavor ban. Results also indicated that after WA imposed a flavor ban, weekly sales for the Washington-Oregon border area increased significantly by 69.4 (6%), 1169.7 (39%), and 2.4 (2%) (all p-values <0.01) for tobacco flavored, menthol/mint flavored, and other flavored NVPs, respectively, compared to sales in the non-border area. Similarly, after MA imposed an NVP sales ban, sales for the border areas in surrounding states, including New York, New Hampshire, Vermont, and Connecticut, increased significantly by 1637.16 (56%), 5196.78 (51%), and 276.74 (79%) (all p-values <0.01) for tobacco flavored, menthol/mint flavored, and other flavored NVPs, respectively, compared to sales for their non-border counterparts. Finally, after RI imposed its NVP flavor ban, sales from the border area in Connecticut increased significantly by 843.5 (47%), 1191.75 (16%), and 61.31 (18%) (all p-values <0.01) for tobacco flavored, menthol/mint flavored, and other flavored NVPs, respectively, compared to sales for their non-border counterparts. November 2022: A manuscript “Cross State Border Nicotine Vaping Products Purchase – Early Evidence from State Emergency Sales Restrictions in 2019” with Alex C. Liber and David T. Levy. Several more manuscripts and presentations are under preparation.
 
Title: “Examine and model the impact of e-cigarette ban”
PI: Dr. Yong Yang, Assistant Professor at University of Memphis
Abstract and accomplishments +
Dr. Yong Yang
Dr. Yong YangUniversity of Memphis
Abstract
Introduction: Flavor bans have been under discussion over years and have been recently heightened. The outbreak of lung injury associated with e-cigarette use in 2019 has led the Food and Drug Administration (FDA), several cities and states to consider banning all or some e-cigarette sales. At the beginning of 2020, FDA banned the sale of fruit and mint flavored e-cigarettes but the ban did not apply to menthol and tobacco flavored products. A key challenge for FDA and other tobacco control regulators is how to regulate flavors effectively to maximize public health gains while minimizing related public health losses. Agent-based models (ABM), as a promising systems science tool, have the potential to help to achieve the right public health balance. However, An ABM to examine the impact of a flavor ban demands a comprehensive knowledge of tobacco use behavior at the individual level. In this study, we propose to expand and strengthen our knowledge on tobacco/e-cigarette use behavioral change responding to flavor ban policy, and the knowledge will be tailored and ready to use for an ABM. Aims: Aim 1: Assess the empirical changes in different types of e-cigarette and other tobacco use by key subpopulations in several states that have recently implemented flavor bans. Aim 2: Use discrete choice experiments to estimate people’s responses to hypothetical presentations of the major different types of vaping or flavored product bans. Methods: For Aim 1, we will use an online crowdsourcing platform to conduct surveys in several selected states. Besides basic demographics, perceptions of the relative risk of different types of tobacco products, we will collect the current (30 days preceding the survey) and previous (before the flavor ban enforcement) status on smoking and vaping, quit motivation, accessibility, retailer environment, social support for tobacco use, and residential zip code as a proxy of the neighborhood. Multinomial logistic regression models will be used to analyze the determinants of participants’ tobacco use change. For Aim 2, we will a series of the discrete choice experiment (DCE) to estimate consumer response to hypothetical flavor bans. We aim to examine several flavor-related ban policies. For the DCE data, we will take each option among the choice set as an observation and use multinominal logistic regression models to estimate the effect of each attribute on a user’s demand for tobacco/e-cigarette products. Anticipated Results: Aim 1 will provide the actual patterns of tobacco use change under various empirical policies context, and Aim 2 will provide stated preferences of tobacco use change under various hypothetical policies environment. The two results will be complementary to each other and be used for future modeling purpose. Implications: Both aims are independent research on their own, and at the same time, they will provide input for ongoing ABM research. In the future, we will develop and extend the ABM to examine the effect of the flavor ban at city, state, and federal levels, among young adults, youth, and the general population.
Accomplishments
May 2022: For the first aim, we conducted surveys in several states including New York, New Jersey, and Massachusetts to access the influence of various flavor ban policies. We found that despite the ban, most respondents continued to use e-cigarettes with banned flavors post-ban. Compliance of local retailers with the ban was not high, and many respondents obtained banned-flavor e-cigarettes through legal channels. For the second aim, we conducted discrete choice experiments in 2020 among adult e-cigarette users. We found that e-cigarette users prefer other flavors than tobacco and menthol, prefer open-systems e-cigarettes than closed-systems e-cigarettes, and prefer regular than low nicotine content. The preference varies by demographics, by the primarily used device and flavor of their e-cigarettes, and by their smoking status. When other flavors were banned from open-systems e-cigarettes, participants tended to switch to menthol flavor. The preference difference among products/devices is larger than the difference between flavors and between nicotine content. People tend to switch from closed-systems to open-systems rather than vice versa. Heated tobacco products (HTP), as a relatively new product, were less preferred compared with both cigarettes and e-cigarettes in general. We have several papers under review and one paper titled “Impact of flavours, device, nicotine levels and price on adult e-cigarette users' tobacco and nicotine product choices”. March 30, 2022: Dr. Yang was the lead author of an article resulting from his pilot project work. The article, published in Nicotine & Tobacco Research, is entitled “How Smokers of Menthol Cigarettes and Flavored Cigars Might Respond to FDA’s Proposed Bans”. July 22, 2021: Dr. Yang was lead author of an article resulting in part from his pilot project work. The article, published in Tobacco Control, is entitled “Impact of Flavours, Device, Nicotine Levels and Price on Adult E-cigarette Users’ Tobacco and Nicotine Product Choices”.
 
Title: “Substitutability of cigarettes for salt- and free-based ENDS devices in young adult ENDS users”
PI: Dr. Amanda Quisenberry, Assistant Professor at Roswell Park Comprehensive Cancer Center
Abstract and accomplishments +
Dr. Amanda Quisenberry
Dr. Amanda QuisenberryRoswell Park Comprehensive Cancer Center
Abstract
Introduction: The recent increase in electronic nicotine delivery systems (ENDS) use among youth and young adults and associated nicotine dependence may increase the risk for uptake of other tobacco products. We must understand both the conditions in which young users of ENDS may switch to using cigarettes, which are more toxic, and the associated regulatory efforts that may curb these transitions to protect the health of these young people. Aims: Specific Aim 1: To determine the abuse liability of salt-base and free-base ENDS in young exclusive ENDS users of each ENDS e-liquid type. Specific Aim 2: To determine the substitutability of combustible cigarettes for salt-base and free-base ENDS among users of each ENDS e-liquid type when menthol cigarettes are and are not available. Specific Aim 3: To determine which demographic and psychosocial characteristics mediate the level of abuse liability and substitutability determined in Aims 1 and 2. Methods: Participants who are salt- (n=25) and free-base (n=25) ENDS users will complete two online purchasing tasks when menthol cigarettes are and are not available among the multiple alternative tobacco products available using the Experimental Tobacco Marketplace. Anticipated Results: We predict that menthol cigarettes will be stronger substitutes compared to non-menthol cigarettes in both salt- and free-base nicotine ENDS users and that salt-base ENDS users will be less likely to switch products. Specific user characteristics, such as delay discounting rate, will be evaluated as modifiers of switching to cigarettes among salt- and free-base ENDS users. Implications: Regulatory efforts targeting the availability of menthol in cigarettes and other products will be informed regarding the propensity for young adult ENDS users to switch products when flavor availability is restricted.
Accomplishments
May 2022: This study aimed to identify: 1) the actions of ENDS salt-base nicotine users when their ENDS device increases in price and 2) if menthol cigarettes are stronger substitutes than non-menthol cigarettes. Participants (n=6) were endowed with an account balance based on their baseline intake of tobacco products for use in an online purchasing analog called the Experimental Tobacco Marketplace (ETM). The ETM included a variety of tobacco products, including menthol and non-menthol cigarettes, available for purchase at constant prices while the price of the participants’ ENDS product increased. Preliminary ETM findings with six participants show a decrease in purchasing of their ENDS product as price increased. Their average number of ENDS product purchases were 3 at ¼ market price (MP), 1.83 at ½ MP, 1.5 at MP, 1 at 2X MP, and 0.5 at 4X MP. They, however, did not choose to substitute with cigarettes, either menthol or non-menthol. Only one of the participants selected any alternative products no matter the price of their ENDS product. That participant chose to substitute with IQOS smooth menthol heat sticks at 2X and 4X the MP for their ENDS product, which could suggest that the menthol flavoring is an appealing factor given that this participant could have purchased IQOS tobacco flavor. Results should be interpreted cautiously given that only six participants have completed the study. Recruitment is still ongoing.
 
Title: “Identifying Causal Pathways in Longitudinal Tobacco Product Transition Studies”
PI: Dr. Shu Xu, Clinical Assistant Professor at New York University
Abstract and accomplishments +
Dr. Shu Xu
Dr. Shu XuNew York University
Abstract
Introduction: The accelerating rate of e-cigarette use among U.S. youth and young adults during the past few years has sparked public health concerns, including the possibility that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults. Therefore, on both counts, it is important to identify risk and protective factors that mediate the transition between e-cigarette and cigarette use and vice-versa. Aims: The overarching aim of this application is to apply and disseminate causal mediation methods to tobacco research. Specifically, we will apply causal mediation methods to tobacco use data to evaluate the mediational role of harm perceptions that may explain the transition from e-cigarette to combustible cigarette use, and from cigarettes to e-cigarettes. Methods: We will use Waves 1 - 4 data from the Population Assessment of Tobacco and Health (PATH) project, jointly sponsored by the National Institution on Drug Abuse and several other federal research agencies, to track e-cigarette and cigarette use transitions among youth and adults. We will apply both causal mediation analysis methods (i.e., marginal structural equation models, g-estimation, natural effect models, and nonparametric structural equation models) in addition to the conventional mediation method to assess whether among baseline tobacco naïve participants (Wave 1), ever e-cigarette use (Wave 2) were associated with smoking initiation (Waves 3 - 4) and whether this association can be partially or fully explained by harm perception of tobacco use (Wave 3). Likewise, we will also study the transition from cigarette use to e-cigarette use. Anticipated Results: We will assess the mediated effect of harm perceptions on the transition from e-cigarette use to cigarette use and vice versa, and assess the mediated effect when an interaction between e-cigarette use, cigarette use and harm perceptions exists. We will compare the findings of each method in terms of model assumptions, definition of causal effects, estimates, and precision of estimation. Implications: The proposed study fills the gap between advances in causal inferential statistics and applied tobacco research. The findings of the proposed study will inform youth prevention and adult cessation efforts by providing insight into trajectories of e-cigarette and cigarette use.
Accomplishments
May 2022: The data for the study were from the Population Assessment of Tobacco Research (PATH) study Waves 1 - 4. We conducted mediation analyses using data from the 7511 youth who initiated e-cigarette use or remained tobacco naive at Wave 2, reported harm perceptions of e-cigarette use at Wave 3, and reported current tobacco use at Wave 4. All potential confounders (e.g., demographics, drug use history, perception of harm) were reported at Wave 1. Among the 7.3% (n = 546) of youth who initiated e-cigarette use at Wave 2, 47.4% (n = 259) perceived e-cigarette use as less harmful than cigarette use at Wave 3, and 33.7% (n = 184) became current tobacco users at Wave 4. Among the 92.7% (n = 6965) of youth who did not initiate e-cigarette use at Wave 2, 27.5% (n = 1912) perceived e-cigarette use as less harmful than cigarette use at Wave 3, and 9.4% (n = 654) became current tobacco users at Wave 4 (reported past-30-day use of any tobacco products including e-cigarettes, traditional cigarettes, cigar, chewing tobacco/snuff/dip, hookah, roll-your-own cigarette, pipe, snus, dissolvable, bidi, or heated tobacco). We used three estimation methods, the traditional mediation analysis, and two causal mediation analyses using resampling and weighting methods, to adjust for confounding in the causal pathways. The results of the three methods consistently indicated that e-cigarette initiation is causally associated perception of e-cigarette as less harmful relative to cigarette use, which leads to subsequent current tobacco product use.October 31, 2021: Dr. Xu was the lead author of an article resulting from her pilot project work. The article, published in Prevention Science, is entitled “Relationships Between E-cigarette Use and Subsequent Cigarette Initiation Among Adolescents in the PATH Study: an Entropy Balancing Propensity Score Analysis” and is available here.
 
Title: “Assessing the toxicity of DIY additives in response to a flavor ban in ECIG liquids”
PI: Ahmad El-Hellani, Assistant Research Professor at American University of Beirut and Eric Soule, Assistant Professor at East Carolina
University
Abstract and accomplishments +
Eric Soule
Eric SouleEast Carolina
University 
Ahmad El-Hellani
Ahmad El-HellaniAmerican University of Beirut
Abstract
Introduction: The availability of lavors is one of the top reasons for ECIG use initiation, especially among youth and young adults. A growing body of evidence demonstrates that access to appealing ECIG liquid flavors makes it easier to transition to regular ECIG use among those who have tried ECIGs. In response to the identified role of flavors in increasing ECIG appeal, policies restricting flavors in ECIG to menthol and tobacco have been considered or implemented. Previous research has indicated some ECIG users may attempt to make their own ECIG liquids in response to a ban on ECIG liquid flavors, a behavior is known as do-it-yourself (DIY) mixing. Some ECIG users may use ingredients in their DIY ECIG liquids with unknown toxicity when inhaled from ECIG aerosol, including sweeteners, alcohols, or essential oils. Aims: Aim 1: Identify compounds that ECIG users may add to their ECIG liquids in response to a restriction on flavors. Aim 2: Assess the toxicity of DIY flavored ECIG liquids that include additives/recipes identified in Aim1. Methods: A systematic internet search will be conducted to identify additives (such as sweeteners, cannabinoid (CBD) oil, essential oils, etc.) that may be used in DIY ECIG liquids. These DIY ECIG liquid recipes will be used to generate ECIG aerosol. Reactive oxygen species (ROS) will be measured in the generated aerosol and will be compared to ROS aerosols from standard commercially available ECIG liquids. Anticipated Results: This project will provide insight into the toxicity of DIY ECIG liquids. Implications: Consumers’ addition of unregulated chemicals to their liquids represents a major public health concern as research shows that additives like commercial flavors increase the toxicity of ECIG aerosols.
Accomplishments
May 2022: This study examined the toxicity of DIY flavored ECIG liquids. DIY liquid additives were identified by reviewing ECIG users’ reported responses to a hypothetical flavor ban and a review of 15 ECIG internet forums to include essential oils, cannabidiol oil (CBD), sucralose, ethyl maltol. Concentrations of additives and PG/VG ratio were based on popular recipes identified in ECIG forums or DIY websites. A total of 27 liquids containing different levels and combinations of sucralose, CBD, essential oil, nicotine, and tobacco and menthol flavors were prepared. These liquids were used to assess reactive oxygen species (ROS) emissions in machine-generated aerosols. DIY flavor concentrates and commercially available flavored liquids were tested for comparison. Data showed that aerosols generated from DIY flavor concentrates or from menthol and tobacco flavors mixed with DIY additives yielded similar ROS levels compared to commercially available flavored liquids. Moreover, mixing menthol flavor with CBD or essential oil yielded significantly higher ROS emissions than menthol or PG/VG liquid. Only CBD yielded significantly higher ROS with tobacco flavor. Varying sucralose concentration in the liquid yielded the same levels of ROS as PG/VG base liquid. However, increasing power within the same concentration condition yielded significantly higher ROS. Interestingly, nicotine form affected ROS emissions from a liquid containing sucralose. Our data showed that DIY liquids may be as toxic as commercially available flavored ECIG liquids. Restricting flavor availability while keeping DIY concentrates and DIY additives available for ECIG users reduces the impact of the introduced policy. November 2022: Drs. El-Hellani and Soule were first and second authors of an article resulting from their pilot project work. The article, published in Tobacco Control, is entitled “Assessing toxicant emissions from e-liquids with DIY additives used in response to a potential flavour ban in e-cigarettes”.
 
Title: “The Potential Impact of Individual Decision Making and Social Network Structure on TobaccoProduct Regulation Effectiveness and Disparities in Adolescent Tobacco Use Behavior”
PI: Iris Shao, Doctoral Student at Emory University
Abstract and accomplishments +
Iris Shao
Iris ShaoEmory University
Abstract
Introduction: Several existing tobacco product regulatory actions and changes in tobacco product characteristics, such as required warning messages display on cigarette packaging provide an excellent opportunity for prevention among adolescent tobacco product users. However, evaluating the impact and sustainability of these regulatory actions on long-term adolescent tobacco use behaviors still faces tremendous obstacles, especially given mixed evidence of effectiveness in different target population and persisting disparities among the socially disadvantaged. Aims: Aim 1: To estimate the effect of social network structural characteristics on adolescent tobacco use behavior, stratified by sex, race/ethnic, and parental socioeconomic status respectively, using the National Longitudinal Study of Adolescent to Adult Health dataset. Aim 2: To evaluate potential effectiveness of tobacco product marketplace regulation (e.g. smokeless tobacco/cigarette labeling and warning statement requirement) on adolescents of heterogeneous socio-demographic characteristics, using a systems modeling approach. Anticipated Results: We hypothesize that high network clustering, density, and in-degree centrality are associated with lower levels of tobacco use; such associations differ by sex, race/ethnicity, and parental socioeconomic status. In addition, we will develop an agent-based model to explore potential long-term effectiveness of different tobacco product regulations, incorporating information theory and game theoretic analysis. Implications: Findings from this project will provide decision makers with a holistic understanding of potential impact of these regulations on population-level distributions and disparities in adolescent tobacco use behavior. In addition, this project will help motivate future research design and data collection, taking into consideration both inter-personal and intra-personal perspectives.
Accomplishments
May 2022: Using the National Longitudinal study of Adolescent to Adult Health study Wave I through Wave V data, we identified three distinct trajectory classes of past 30-day cigarette smoking: persistent non-smoker, progressing non-smoker, progressing smoker. Sex, race/ethnicity, presence of a smoker in the household, parental education and perceived belonging to school during adolescence were significant predictors of trajectory. As compared to progressing non-smoker, persistent non-smoker is associated about 80% decreased risk in electronic cigarette use during late adulthood. With respect to cigarette smoking, in-degree centrality was not associated with cigarette smoking. However, every unit decrease in local clustering coefficient was associated with a 70% decreased odds of being a smoker within the network, when adjusting for socio-demographic characteristics, friend’s smoking behavior and prior smoking behavior.
 

View other award years: 202220212019