The discrepancies between e-cigarette sales data and the prevalence of e-cigarette use from surveys highlight the challenges in tracking and understanding the use of new and emerging tobacco products. In a rapidly changing media environment, where successful and influential marketing campaigns can be conducted on social media at little cost, marketing expenditures alone may not fully capture the influence, reach and engagement of tobacco marketing.

Background Awareness and use of electronic cigarettes has rapidly grown in the U.S. recently, in step with increased product marketing. Using responses to a population survey of U.S. adults, we analyzed demographic patterns of exposure to, searching for, and sharing of e-cigarette related information across media platforms. Methods An online survey of 17,522 U.S. adults was conducted in 2013. The nationally representative sample was drawn from GfK Group's KnowledgePanel® plus off-panel recruitment. Fixed effects logit models were applied to analyze relationships between exposure to, searching for, and sharing of e-cigarette related information and demographic characteristics, e-cigarette and tobacco use, and media behaviors. Results High levels of awareness about e-cigarettes were indicated (86% aware; 47% heard through media channels). Exposure to e-cigarette related information was associated with tobacco use, age, gender, more education, social media use, and time spent online. Although relatively small proportions of the sample had searched for (~5%) or shared (~2%) e-cigarette information, our analyses indicated demographic patterns to those behaviors. Gender, high income, and using social media were associated with searching for e-cigarette information; LGB and less education were associated with sharing. Current tobacco use, age, being Hispanic and time spent online were associated with both searching and sharing. Conclusions U.S. adults are widely exposed to e-cigarette marketing through the media; such marketing may differentially target specific demographic groups. Further research should longitudinally examine how exposure to, searching for, and sharing of e-cigarette information relate to subsequent use of e-cigarettes and/or combustible tobacco.

Purpose To improve smoking prevention efforts, better methods for identifying at-risk youth are needed. The widely used measure of susceptibility to smoking identifies at-risk adolescents; however, it correctly identifies only about one third of future smokers. Adding curiosity about smoking to this susceptibility index may allow us to identify a greater proportion of future smokers while they are still pre-teens. Methods We use longitudinal data from a recent national study on parenting to prevent problem behaviors. Only oldest children between 10-13 years of age were eligible. Participants were identified by RDD survey and followed for 6 years. All baseline never smokers with at least one follow-up assessment were included (n=878). The association of curiosity about smoking with future smoking behavior was assessed. Then, curiosity was added to form an enhanced susceptibility index and sensitivity, specificity and positive predictive value were calculated. Results Among committed never smokers at baseline, those who were ‘definitely not curious’ were less likely to progress towards smoking than both those who were ‘probably not curious’ (ORadj =1.89; 95% CI=1.03-3.47) or ‘probably/definitely curious’ (ORadj=2.88; 95% CI=1.11-7.45). Incorporating curiosity into the susceptibility index increased the proportion identified as at-risk to smoke from 25.1% to 46.9%., The sensitivity (true positives) for this enhanced susceptibility index for both experimentation and established smoking increased from 37-40% to over 50%., although the positive predictive value did not improve. Conclusion The addition of curiosity significantly improves the identification and classification of which adolescents will experiment with smoking or become established smokers.

Introduction Tobacco use among transgender adults continues to be an area of research with few reported findings. The limited literature indicates higher cigarette use among transgender adults, compared with the general population. This national study is the first to report on cigarettes, cigars, and e-cigarettes by examining differences in transgender tobacco use independent of sexual orientation. Methods Data were collected in 2013 using a nationally cross-sectional online survey of U.S. adults (cisgender, n=17,164; transgender, n=168) and analyzed in 2015. Past 30–day tobacco use point estimates and adjusted logistic regression while controlling for false discovery rate were reported for transgender and cisgender respondents. Results Transgender adults reported higher past 30–day use of any cigarette/cigar/e-cigarette product (39.7% vs 25.1%) and current use of cigarettes (35.5% vs 20.7%), cigars (26.8% vs 9.3%), and e-cigarettes (21.3% vs 5.0%) compared with cisgender adults (all p-values ≤0.003). Transgender respondents had significantly higher odds of past 30–day tobacco product use for any cigarette/cigar/e-cigarette product (OR=1.97, 95% CI=1.25, 3.1), e-cigarettes (OR=5.15, 95% CI=3.36, 7.88), cigars (OR=3.56, 95% CI=2.27, 5.59), and cigarettes (OR=2.10, 95% CI=1.35, 3.28) versus cisgender respondents (all p-values ≤0.0035). Conclusions Transgender adults are at higher risk for tobacco use than cisgender adults and risk of specific product use varies by gender. This is the first U.S. national study to assess differences in use of various tobacco products using questions that specifically ask for gender identity separately from sexual orientation. This study provides data that can inform targeted interventions to promote transgender health.