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INTRODUCTION: The potential of e-cigarettes to elicit symptoms of nicotine dependence has not been adequately studied, particularly in adolescent populations. The present study examined the prevalence of e-cigarette-specific symptoms of nicotine dependence (“symptoms of e-cigarette dependence”) and the associations between these symptoms, e-cigarette usage group, and e-cigarette cessation-related items among Texas adolescents. METHODS: This study involved a cross-sectional analysis of adolescents from Wave 4 of the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) (n=2,891/N=461,069). Chi-Square analyses examined differences in the prevalence of symptoms of dependence by e-cigarette usage group (exclusive versus dual users of e-cigarettes and combustible tobacco products) and demographic characteristics. Weighted multivariable logistic regression analyses examined the associations between symptoms of e-cigarette dependence, e-cigarette usage group, and e-cigarette cessation items. RESULTS: Exclusive e-cigarette users experienced symptoms of e-cigarette dependence, although the prevalence of most of the symptoms was higher for dual users. Adolescents who reported more symptoms of dependence were less likely to report both wanting to quit e-cigarettes and a past-year quit attempt for e-cigarettes (adjusted odds ratio “AOR”=0.61 (95% CI=0.41, 0.92) and AOR=0.52 (95% CI=0.30, 0.92), respectively). CONCLUSIONS: This study is the first to demonstrate that adolescent e-cigarette users are experiencing symptoms of dependence specific to e-cigarettes. In addition, symptoms of dependence may be barriers to e-cigarette cessation. Future research is needed to determine if characteristics of e-cigarette use (e.g. frequency and intensity) are associated with dependence. Keywords: E-cigarettes; adolescents; dependence

Objectives In 2016, the US Surgeon General issued a Call to Action to address adolescent e-cigarette use and school-based prevention interventions are an effective component of comprehensive tobacco control. This study describes the development and dissemination of CATCH My Breath, an e-cigarette prevention program for middle and high school students. Methods Starting in 2014, a university and nonprofit collaboration designed, formatively evaluated, pilot tested, and disseminated the CATCH My Breath Program (CMB). The team used Social Cognitive Theory to develop the program and Diffusion of Innovations Theory to disseminate the program. Dissemination strategies were applied beginning in 2016. This paper describes the application of both theories and the resulting reach of CMB. Results Since dissemination began, CMB has been rapidly adopted, following the typical diffusion normal curve. As of June 2020, approximately 4,000 schools in the United States have adopted the program, 70,000 teachers have taught the program, and 1,400,000 students have been exposed to program materials. Conclusion The application of Social Cognitive Theory and Diffusion of Innovation Theory resulted in effective prevention results and rapid, widespread adoption of the CMB. This level of adoption and implementation represents 25% of the school marketplace. CMB should be considered as the school component of the recommended combustible and e-cigarette prevention and control toolkit, alongside mass media, marketing restrictions, retail access, taxation, flavor ban, and FDA premarket approval. Other public health interventions seeking rapid adoption should consider applying principles of Diffusion of Innovation as a guide for development and dissemination.

Introduction: Cross-sectional studies have repeatedly observed that African American adolescents are less likely to smoke when compared to White and Hispanic adolescents. Although much is known among high school samples, few scientifically based studies have reported these race and ethnic differences in cigarette smoking among younger samples. Methods: This study employed a secondary analysis of data from a 3-year middle school violence prevention project. The study design was a 3-year serial cross-sectional survey, out of which a cohort of students from sixth to eighth grade was formed. Smoking measurers were taken yearly. Results: 8865 students responded in 1994, 9115 in 1995, and 9364 in 1996; 1589 students are in the 3-year cohort. Smoking prevalence rates from both measurement periods confirm the disparity between African Americans, Whites, and Hispanic youth. Although weak in sixth grade, by eighth grade, White and Hispanic students are smoking at two to four times the rate of their African American classmates. Conclusions: Clearly, more etiological research needs to be conducted to understand the social, cultural, and intrapersonal forces that operate to inhibit the onset of smoking in African American youth and promote the onset of smoking in White and Hispanic youth.

We examined the concurrent and predictive validity of stages of change and susceptibility to smoking with respect to smoking onset among adolescents. We also sought to determine whether concurrent use of the two constructs, in the form of an integrated stage/susceptibility index, would predict adolescent smoking acquisition better than either construct alone. Data were examined from two study populations: a prospective study of 1124 elementary-school through senior-high-school students and a cross-sectional study of 5624 high-school students. Both constructs demonstrated good concurrent and predictive validity. A measure integrating the stages of smoking acquisition and susceptibility to smoking constructs was created by dividing the precontemplation group as a function of susceptibility. This new classification system yielded better concurrent and predictive validity than did either stage of smoking acquisition or susceptibility to smoking alone.

We examined the concurrent and predictive validity of stages of change and susceptibility to smoking with respect to smoking onset among adolescents. We also sought to determine whether concurrent use of the two constructs, in the form of an integrated stage/susceptibility index, would predict adolescent smoking acquisition better than eithe r construct alone. Data were examinedfrom two study populations: a prospective study of 1,124 elementary-school through senior-high-school students and a cross-sectional study of 5,624 high-school students. Both constructs demonstrated good concurrent and predictive validity. A measure integrating the stages of smoking acquisition and susceptibility to smoking constructs was created by dividing the precontemplation group as a function of susceptibility. This new classification system yielded better concurrent and predictive validity than did either stage of smoking acquisition or susceptibility to smoking alone.