Engaging and retaining adolescents in research studies is challenging. Social media offers utility for expanding the sphere of research recruitment. This study examined and compared traditional and Facebook-based recruitment strategies on reach, enrollment, cost, and retention. Substance users aged 13-17 years were recruited through several methods, including social media, a study website, fliers, talks in schools, bus ads, and referrals. Study involvement included a one-time visit and semiannual follow-up surveys. 1265 individuals contacted study personnel; 629 were ineligible; 129 declined; and 200 participants enrolled. Facebook drew the greatest volume but had a high rate of ineligibles. Referrals were the most successful and cost-effective ($7 per enrolled participant); school talks were the least. Recruitment source was unrelated to retention success. Facebook may expand recruitment reach, but had greater financial costs and more ineligible contacts, resulting in fewer enrollees relative to traditional interpersonal recruitment methods. Referrals, though useful for study engagement, did not provide a differential benefit in terms of long-term retention.

Introduction

With the changing landscape of tobacco products, the divide between cigarettes and cigars is obscured, so understanding adolescent reporting of cigar use is needed to improve best practices for surveillance, screening, and prevention/intervention. This study examined adolescents' reported cigar use and correlates of use.

Methods

Participants (N=186) were 13-17year old tobacco users participating in a prospective study of adolescent smoking behaviors. Measurement occurred at baseline and 24-months, and included demographics, nicotine dependence, tobacco use, and quit attempts. Cigar use was assessed as, "have you smoked a cigar in the last 30days" and by brand specific use in the past 30days.

Findings

Cigar use was reported by 51 adolescents (27%), and increased to 76 (41%) when identifying by brand name. African Americans (32%) were more likely to smoke cigars than whites (10%, p<.01), Asian/Pacific Islanders (3%, p=.04), and multiracial participants (24%, p=.05). Cigarette-only users smoked more per day (p=.04) and had higher cotinine levels (p=.05) than cigar users. Number of prior quit attempts (p=.84) did not differ by group. Group differences in addiction were found between cigar users and cigarette only users (p<.01). At 24months, more baseline cigar users were tobacco abstinent than cigarette only users (16% versus 7%, p<0.01, respectively).

Conclusions

Assessment of brand-specific cigars nearly doubled the reporting among adolescent users. Cigar users differed from cigarette-only users in consumption and likelihood of abstinence at 24-months. For more accurate surveillance and to inform treatment considerations, surveys of adolescent tobacco use should include cigars, including brand names, in the assessment strategy.

Introduction

Intermittent smoking is common among adolescent smokers, but little is known about adolescent intermittent smokers (ITS). This study describes a cohort of adolescent ITS and compares them to adolescent daily smokers (DS) for the purpose of providing a more detailed characterization of adolescent ITS, specifically patterns of smoking, level of self-reported addiction, and experience with cessation

Methods

Participants were 124 ITS and 55 DS. ITS were defined as smoking at least monthly but <30 days per month; and DS as smoking daily. Participants completed demographic, smoking and addiction surveys including the HONC and mFTQ.

Results

ITS started smoking at an older age, smoked fewer cigarettes per day and scored significantly lower on addiction scales, but had similar difficulty to DS in quitting smoking with similar numbers of reported quit attempts. These differences remained after adjusting for years of smoking. ITS were more likely to smoke in social situations, while DS were more likely to smoke when angry. Both groups were equally likely to report smoking when drinking alcohol.

Conclusions

We documented significant differences in smoking related behaviors between adolescent ITS and DS. Importantly, we also found that, despite low level infrequent smoking, ITS reported difficulty in quitting smoking. Given the risks from light and intermittent smoking, it is essential that we develop a greater understanding of adolescent ITS, including their difficulty in quitting and the contextual factors influencing their smoking, so that we may develop new targeted interventions.

Background

Marijuana and tobacco are the substances used most commonly by adolescents and co-occurring use is common. Use of one substance may potentiate the addictive properties of the other. The current study examined the severity of nicotine addiction among teen smokers as a function of co-occurring marijuana use.

Methods

Participants were 165 adolescents (13-17 years old) who reported smoking at least 1 cigarette per day (CPD) in the past 30 days. General linear models examined the association of marijuana use with multiple measures of nicotine addiction including the Modified Fagerström Tolerance Questionnaire (mFTQ), Hooked on Nicotine Checklist (HONC), ICD-10, and the Nicotine Dependence Syndrome Scale (NDSS).

Results

The adolescent sample (mean age=16.1 years, SD=0.95) averaged 3.0 CPD (SD=3.0) for 1.98 years (SD=1.5). Most (79.5%) also smoked marijuana in the past 30 days. In models controlling for age, daily smoking status, and years of tobacco smoking, frequency of marijuana use accounted for 25-44% of the variance for all four measures of adolescent nicotine dependence.

Conclusions

Marijuana use was associated with greater reported nicotine addiction among adolescent smokers. The findings suggest a role of marijuana in potentiating nicotine addiction and underscore the need for treatments that address both smoked substances.

Introduction

Differences in the rate of nicotine metabolism between genders and different races have been hypothesized to contribute to disparities in smoking rate, susceptibility to addiction, and ability to quit smoking. The purpose of this study was to determine the effect of race and gender on the rate of nicotine metabolism as indicated by the nicotine metabolite ratio (NMR) in adolescent smokers.

Methods

One hundred and fifty-nine adolescent smokers aged 13-17 were given 2mg of deuterium-labeled cotinine (cotinine-d4). The NMR was calculated as the ratio of concentrations of deuterium-labeled 3'-hydroxycotinine (ng/ml) to cotinine-d4 (ng/ml) in saliva and is a validated biomarker of the rate of nicotine metabolism.

Results

The sample was 67.3% female and racially mixed. On average, Whites had the fastest rates of metabolism compared with both Blacks/African Americans (p < .01) and Asians (p = .01). The NMR was similar between males and females (p = .70). Among the 19 girls who reported using estrogen-containing contraceptives, there was no significant difference in NMR compared with the 83 girls who did not use contraceptives (p = .24) or the 10 who used progestin-only contraceptives (p = .45).

Conclusions

Among adolescent smokers, racial variations in rates of nicotine metabolism were similar to those that have been reported in adult smokers. In contrast to findings in adult smokers, the NMR did not vary significantly by gender or self-reported hormone use.

Background

Understanding predictors of e-cigarette use among adolescents in the context of wide availability and extreme popularity of these products is important for prevention and treatment. This study identifies correlates of e-cigarette use frequency and dependence among adolescent users.

Methods

Adolescent e-cigarette users (N = 173) were recruited from the San Francisco Bay Area. Participants reported demographic and psychosocial characteristics, e-cigarette use behaviors, and cigarette use. Bivariate relationships between potential correlates were examined, and correlates significant at p < .10 were included in full models predicting frequency and dependence.

Results

In the full models, frequent use was associated with receiving one's first e-cigarette from a family member rather than a friend (r = -0.23, p < .001) or a store ( = -0.13, p = .037), using nicotine in all e-cigarettes versus some e-cigarettes (r = -0.17, p = .007) or unknown nicotine use (r = -0.15, p = .014), using a customizable device versus a Juul (r = -0.22, p < .001), vape pen (r = -0.20, p = .002), or other/unknown device (r = -0.16, p = .009), and friends' e-cigarette use (r = 0.20, p = .002). Dependence was associated with younger age of first use (r = -0.18, p = .012), friends' use (r = 0.18, p = .01), and recent cigarette use (r = 0.17, p = .019).

Conclusions

When assessing problematic e-cigarette use among adolescents, it is important to consider social factors (e.g., friends' and family members' e-cigarette use), device type, and dual use with cigarettes.