Objectives. To determine whether the COVID-19 pandemic affected e-cigarette use among young people in the United States. Methods. Data came from a weekly cross-sectional online survey of youths and young adults (aged 15–24 years). Logistic regression analyses measured odds of past-30-day e-cigarette use (n = 5752) following widespread stay-at-home directives (March 14–June 29, 2020), compared with the pre‒COVID-19 period (January 1–March 13, 2020). Logistic regression among a subsample of current e-cigarette users (n = 779) examined factors associated with reduced use following stay-at-home orders. Results. Odds of current e-cigarette use were significantly lower during the COVID-19 pandemic compared with the pre‒COVID-19 period among youths aged 15 to 17 years (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.54, 0.96) and young adults aged 18 to 20 years (OR = 0.65; 95% CI = 0.52, 0.81). E-cigarette users with reduced access to retail environments had higher odds of reporting reduced e-cigarette use (OR = 1.51; 95% CI = 1.07, 2.14). Conclusions. COVID-19 stay-at-home directives present barriers to e-cigarette access and are associated with a decline in e-cigarette use among young people. Public Health Implications. Findings support the urgent implementation of interventions that reduce underage access to e-cigarettes to accelerate a downward trajectory of youth and young adult e-cigarette use. (Am J Public Health. Published online ahead of print April 15, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306210 )

Electronic cigarette (e-cigarette) use, including JUUL, has risen to epidemic levels among high school and middle school students in the United States. Schools serve as a key environment for prevention and intervention efforts to address e-cigarette use, yet little is known about the awareness of and response to e-cigarettes in schools. This national survey of middle and high school teachers and administrators ( n = 1,420) measured JUUL awareness, e-cigarette policies, and barriers to enforcement in schools. While two thirds of respondents had heard of a product called JUUL (67.6%), less than half accurately identified a photo of a JUUL as a vaping device/e-cigarette (47.3%). Awareness of JUUL (80.9%) was higher among high school teachers (83.3%) than among middle school teachers (78.3%). A large majority of respondents reported that their school had an e-cigarette policy (82.9%), but less than half of the sample worked in a school with a policy that specifically included JUUL (43.4%). Those working in a school with an e-cigarette policy in place noted that e-cigarettes’ discreet appearance (65.6%) and difficulties in identifying origin of vapor or scent (46.1%) made the policy difficult to enforce. Efforts to increase middle and high school staff awareness of the ever-evolving e-cigarette market are essential to help prevent youth use. Adoption and enforcement of policies will be critical to ensure that schools remain tobacco-free spaces.

Many mass media campaigns aimed at changing young people’s health behavior air on digital platforms rather than on broadcast media (e.g., television), given the intended audience’s preference for web-based communication. While research suggests self-reported ad recall correlates with exposure to television advertising, it remains unclear whether self-report measures are correlated with exposure to digital advertising. This study examined the association between an objective measure of digital ad exposure and self-reported recall of digital ads from the truth® tobacco prevention campaign. Digital ad tracking methodology was employed to identify members of an online panel (ages 18−34) who had been exposed to ads during their regular web browsing. Demographics of exposed participants were used to develop a matched control group of non-exposed panel members. Members of the Exposed group (n = 458) and matched Control participants (n = 506) were surveyed on recall of truth ads, media use, and demographics. Results indicated that Exposed participants had significantly higher odds of reporting ad recall compared to Control participants. With each additional ad exposure, the odds of self-reporting higher frequency of ad exposure increased by 8% (OR = 1.08, 95% CI = 1.01−1.16). Findings suggest self-reported measures of ad recall are a valid measure of campaign exposure in a digital media environment.

Background As youth e-cigarette use has surged in the last several years, teachers and school administrators have reported challenges addressing student use of emerging e-cigarette products on school property. While federal policy prohibits smoking in U.S. schools that receive federal funding, school e-cigarette bans only exist where states or localities have acted. Little is known about school staff experiences with implementing these relatively new policies; this study examines associations between school e-cigarette policies and trainings on school staff awareness and intervention on student e-cigarette use. Methods A national convenience sample of 1,526 U.S. middle- and high-school teachers and administrators was surveyed in November-December 2018. Among respondents who provided their job title and indicated that they worked in a school rather than a district (n = 1,480, response rate = 97.0%), separate logistic regressions examine associations of school policies and policy training with e-cigarette awareness and intervention on student e-cigarette use. Results Despite being the most popular e-cigarette at the time, fewer than half (47.5%) of respondents identified an image of a JUUL device as an e-cigarette. However, respondents reporting the presence of e-cigarette policies in their schools had higher odds of recognizing e-cigarettes (OR = 3.85, p<0.01), including photo recognition of JUUL (OR = 1.90, p<0.001). Respondents reporting e-cigarette policies also had higher odds of reporting intervention on student e-cigarette use (communicating with students about e-cigarette avoidance: OR = 2.32, p<0.001; reporting students had been caught using e-cigarettes at school: OR = 1.54, p<0.05). Among respondents reporting a school e-cigarette policy, those trained on the policy had higher odds of JUUL photo recognition (OR = 1.54, p<0.01). Respondents trained on e-cigarette policies also had higher odds of reporting intervention (communicating: OR = 3.89, p<0.001; students caught using e-cigarettes: OR = 2.71, p<0.001). Conclusions As new tobacco products enter the market, school policies may be important tools to raise school personnel awareness of and intervention on emerging e-cigarette product use. However, policy adoption alone is not sufficient; policy training may further aid in recognition and intervention upon student use of e-cigarettes at school.

Although measuring exposure to public health messages is key to understanding campaign effectiveness, little is known about how exposure to and avoidance of digital ad messages may influence self-reported ad recall. A sample of 15–24-year-olds (n = 297) received a varying number of forced-view and skippable test ads across multiple simulated YouTubeTM sessions. Each session was coded for whether the participant viewed the ad or skipped it. While a majority of participants recalled the test ad, the odds of ad recall did not vary by number of sessions (opportunities for exposure). Rather, ad recall was sensitive to the number of completed ad views such that odds of ad recall doubled for each additional time the ad was completely viewed. Findings suggest that public health digital message exposure and recall can be optimized with sufficient attention paid to the proportions of forced-view ads aired when aiming to reach younger audiences.