Bio


Jessica Liu, PhD, MPH is a Postdoctoral Scholar at with the REACH Lab at Stanford University in the Department of Pediatrics, Division of Adolescent Health. Dr. Liu is a recent graduate of the Population Health Sciences PhD program in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, and she is an alumna of the MPH program in the Department of Social and Behavioral Sciences at Yale School of Public Health. Dr. Liu's research focuses on adolescent health and school-based prevention interventions, specifically the adolescent vaping epidemic. Dr. Liu has presented her research work at various scientific meetings as well as at state hearings to advocate for policy, such as for the Connecticut state-wide flavored tobacco sales restriction. She is also very passionate about teaching and mentoring, and hopes to pursue a career in academia as a professor. Fun fact – Dr. Liu's passion for teaching even extends to fitness, as she is a certified spin and group fitness instructor!

Honors & Awards


  • Harvard University, Certificate of Distinction in Teaching (May 2022)
  • Harvard T.H. Chan School of Public Health, Teaching Assistant Award (May 2022)
  • Eric W. Mood New Professional Award, Association of Yale Alumni in Public Health (October 2023)

Boards, Advisory Committees, Professional Organizations


  • Member, American Public Health Association (2017 - Present)
  • Member, Society for Adolescent Health and Medicine (2021 - Present)
  • Member, Society of Research on Nicotine and Tobacco (2021 - Present)
  • Section Councilor of the School, Health, and Wellness Section, American Public Health Association (2023 - Present)

Professional Education


  • Doctor of Philosophy, Harvard University (2023)
  • Master of Public Health, Yale University (2019)
  • Bachelor of Arts, University of California Berkeley (2015)

Stanford Advisors


Research Interests


  • Adolescence
  • Curriculum and Instruction

Current Research and Scholarly Interests


My research interests in public health focus on understanding young people’s health-related risk behavior and developing effective educational interventions to address these risk behaviors. During my doctoral training at Harvard T.H. Chan School of Public Health, I studied adolescent co-use of tobacco and cannabis, resulting in twenty first-author publications. Utilizing both qualitative and quantitative methods, my doctoral dissertation focused on two related aspects: 1) patterns and reasons for adolescents’ co-use of vaping nicotine and cannabis, and 2) assessment of school-based interventions to prevent and reduce co-use. Currently, as a postdoctoral scholar studying adolescent and young adult health at Stanford University, I continue to build upon my foundation of knowledge and research skills to design mixed-methods research studies to better understand the specific patterns and predictors of adolescent co-use, which in turn will inform the development and evaluation of evidence-based interventions to prevent and reduce co-use. During my postdoctoral fellowship, my goal is to advance and then apply my knowledge of community-based participatory research (CBPR) to research and program development, including how best involve stakeholders throughout the entire process of developing research projects and interventions. I greatly appreciate the need for evidence-based and community-informed interventions, and I want to contribute to strengthening and developing health prevention education programs through research as an independent investigator. In addition to my research interests, teaching and mentoring students, especially those less represented in science, has been a priority during my education and training as a public health academic. Throughout graduate school, I served as a teaching assistant for multiple undergraduate, master’s, and doctoral-level courses, receiving multiple teaching awards for my work. As a daughter of Taiwanese immigrants, I am the first in my family to graduate from college, so I am excited to advance my lifelong career in academia, research, and mentoring.

All Publications


  • Perceptions of Harm and Addictiveness for Nicotine Products, THC e-Cigarettes, and e-Cigarettes with Other Ingredients Among Adolescents, Young Adults, and Adults. Substance use & misuse Liu, J., McCauley, D., Gaiha, S. M., Halpern-Felsher, B. 2024: 1-11

    Abstract

    Perceptions of health harms and addictiveness related to nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients are an important predictor of use. This study examined differences in perceived harm and addiction across such products among adolescents, young adults, and adults.We conducted a cross-sectional survey (N = 6,131, ages 13-40 years old) in which participants reported perceived harm and addictiveness for 11 products (cigarettes, disposable nicotine e-cigarettes, pod-based nicotine e-cigarettes, other nicotine e-cigarettes, THC e-cigarettes, e-cigarettes with other ingredients, nicotine pouches, nicotine lozenges, nicotine gums, nicotine tablets, nicotine toothpicks). We applied adjusted regression models and conducted pairwise comparisons between age groups (13-17, 18-20, 21-25, and 26-40) and product use status (never, ever, and past-30-day use), adjusting for gender, race/ethnicity, sexual orientation, and financial comfort.Overall, participants in younger age groups perceived products to be more harmful and addictive than those in older age groups, with the exception of e-cigarettes with other ingredients. For all products, participants who never used perceived each product to be more harmful than those who ever used. For all products, participants who used the products in the past 30-days had lower perceived harm and addictiveness compared to never and ever use. Certain sociodemographic groups, such as people who identify as LGBTQ+, Non-Hispanic Black, or Hispanic, had lower perceived harm and addictiveness for most products.Efforts should be made to educate all age groups and minoritized groups on harms and addictiveness of all nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients.

    View details for DOI 10.1080/10826084.2024.2403105

    View details for PubMedID 39289177

  • Products and patterns through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis. Addictive behaviors McCauley, D. M., Liu, J., Gaiha, S. M., Halpern-Felsher, B. 2024; 158: 108105

    Abstract

    BACKGROUND: Co-use of tobacco and cannabis is common. However, few studies have examined the temporal sequencing through which individuals initiate co-use, and how these patterns vary across age. This study addresses this gap by examining the specific products and temporal sequencing through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis. Among adolescents, young adults, and adults who co-used tobacco and cannabis in the past 30days, we examined (a) whether tobacco or cannabis was used first in their lifetime and (b) which specific tobacco or cannabis product (e.g., nicotine e-cigarettes, cannabis edibles) was the first used.METHODS: Data were from a cross-sectional national survey (N=6,131, 13-40years old) in which participants reported ever use, past-30-day-use, and order of use for 17 different tobacco and cannabis products. Results were analyzed overall and by age group (13-20; 21-24; 25-40).RESULTS: 38.4% of participants reported use of both tobacco and cannabis in the past 30days. Among these participants, 70.9% used tobacco first in their lifetime (66.6%<21; 71.7% 21-24; 76.6%>24). Approximately 60% of participants who initiated co-use with tobacco reported nicotine e-cigarettes as their first tobacco product (63.3%<21; 66.7% 21-24; 49.6%>24).CONCLUSIONS: The majority of participants who used both tobacco and cannabis used tobacco first in their lifetime, and nicotine e-cigarettes were the most common form of tobacco initiation, particularly among adolescents and young adults. Findings emphasize the need for co-use prevention programs to target common products of initiation.

    View details for DOI 10.1016/j.addbeh.2024.108105

    View details for PubMedID 39047653

  • Education, organizational changes, and enforcement challenges of the 2019 flavored tobacco sales restriction in Massachusetts. Drug and alcohol dependence Liu, J., Roberts, J., Winickoff, J. P., Hanby, E. P., Reynolds, M. J., Gundersen, D. A., Emmons, K. M., Tan, A. S. 2024; 262: 111394

    Abstract

    OBJECTIVES: In November 2019, the Massachusetts legislature passed An Act Modernizing Tobacco Control and became the first state to restrict retail sales of all flavored (including menthol) cigarettes, e-cigarettes, and other tobacco products (the Act). Additional tobacco control policies and health insurance coverage for tobacco treatment were included as part of the Act. Implementation of these policies occurred between November 2019 and June 2020. This study explored challenges and facilitators during the implementation of the Act experienced by public health officials, school personnel, and healthcare providers.METHODS: We conducted in-depth interviews with a purposive sample of 9 public health officials and advocates, 9 school personnel, and 8 healthcare providers from March to December 2021. We conducted thematic analysis of interview transcripts using inductive codes of key themes emerging from the interviews.RESULTS: Interviewees highlighted three key themes that impacted the implementation of the Act: 1) Education of those impacted by the Act, 2) Organizational-level changes to incorporate the Act, and 3) Enforcement challenges. Examples of challenges to the implementation of the Act included COVID-19 pandemic restrictions, navigating tobacco industry tactics around naming flavors, and confusion regarding health insurance coverage for tobacco use cessation programs. Examples of facilitators were enforcement leading to retailer compliance, committed advocacy efforts of leadership/champions, and strong coordination within and between organizations.CONCLUSIONS: These findings of Massachusetts's experience in policy implementation can inform the preparation to implement similar tobacco control policies in other states.

    View details for DOI 10.1016/j.drugalcdep.2024.111394

    View details for PubMedID 39024798

  • Popularity of Zyn and other nicotine pouch brands among U.S. adolescents, young adults, and adults in 2021. Preventive medicine Liu, J., Halpern-Felsher, B. 2024: 108068

    Abstract

    OBJECTIVE: This study identifies brands of nicotine pouches used in 2021, just before the surge in popularity of Zyn use.METHODS: We conducted a national, cross-sectional online survey of a general U.S. population (November to December 2021; N = 6131; age 13-40) via Qualtrics panels. Descriptive analyses and chi-squared tests (alpha = 0.05) were performed to assess ever and past-30-day use of nicotine pouch brands across adolescents (13-20), young adults (21-24), and adults (25-40), and to assess frequency of popular brands used among peers.RESULTS: The top brands ever used were Zyn (overall: 30.9%; adolescents: 31.9%; young adults: 33.2%; adults: 28.3%) and Lyft (overall: 28.8%; adolescents: 28.4%; young adults: 32.9%; adults: 26.3%), with no differences in ever-use by age group (p's > 0.095). The top brands used in the past-30-days were Zyn (overall: 26.4%; adolescents: 24.5%; young adults: 24.3%; adults: 30.0%) and Rush (overall: 24.2%; adolescents: 21.0%; young adults: 22.7%; adults: 28.6%). Adults (vs. adolescents, young adults) were more likely to report past-30-day use of Lyft (p = 0.004). Participants indicated Zyn (18.5%) and Lyft (18.2%) to be the most popular brands among peers.CONCLUSIONS: Even in 2021, Zyn was the most popular brand of nicotine pouches. Findings will help regulate and reduce impact of marketing of Zyn.

    View details for DOI 10.1016/j.ypmed.2024.108068

    View details for PubMedID 39002807

  • Intention to quit or reduce e-cigarettes, cannabis, and their co-use among a school-based sample of adolescents. Addictive behaviors Liu, J., Knoll, S. J., Pascale, M. P., Gray, C. A., Bodolay, A., Potter, K. W., Gilman, J., Eden Evins, A., Schuster, R. M. 2024; 157: 108101

    Abstract

    Little is known about the prevalence and predictors of adolescents' intention to quit or reduce use of e-cigarettes and/or cannabis.Frequencies of intention to change (quit, reduce) e-cigarettes and/or cannabis use were examined among 23,915 surveyed middle and high school students with sole and co-use. Predictors of intention to change were identified via LASSO/multilevel logistic regression.Among those with sole e-cigarette use (n = 543), 40.9 % intended to quit and 24.1 % intended to reduce; non-daily e-cigarette use predicted intention to quit and reduce e-cigarettes (p's < 0.03). Among those with sole cannabis use (n = 546), 10.6 % intended to quit and 25.1 % intended to reduce; absence of cannabis cravings predicted intention to reduce cannabis use (p < 0.01). Among those with co-use (n = 816), 26.2 % intended to either quit or reduce (quit/reduce) both substances, 27.5 % intended to quit/reduce e-cigarettes only, and 6.9 % intended to quit/reduce cannabis only. No predictors emerged for intention to change e-cigarette use among those with co-use (p's > 0.09), but younger age, lack of poly-tobacco use, and lack of cannabis craving predicted intention to quit/reduce cannabis use (p's < 0.04).More than half of adolescents with past-month e-cigarette use, regardless of concurrent cannabis use, expressed interest in changing their use. However, only heaviness of e-cigarette use emerged as a predictor of intention to change suggesting. While fewer students expressed interest in changing their cannabis use, cannabis cravings and poly-tobacco use predicted intent to change. Overall, findings emphasize the need to tailor interventions towards adolescents engaging in more problematic substance use patterns.

    View details for DOI 10.1016/j.addbeh.2024.108101

    View details for PubMedID 38986353

  • Impacts of the Massachusetts 2019 An Act Modernizing Tobacco Control on tobacco retailer settings: A multi-methods study. Addictive behaviors Liu, J., Roberts, J., Hanby, E., Louaddi, O., Winickoff, J. P., Reynolds, M. J., Gundersen, D. A., Gottlieb, M. A., Emmons, K. M., Tan, A. S. 2024; 157: 108089

    Abstract

    In November 2019, the Massachusetts legislature passed An Act Modernizing Tobacco Control and became the first state to restrict retail sales of all flavored (including menthol) cigarettes, e-cigarettes, and other tobacco products. Our study aims to provide the retailer experience of the new law from the perspectives of multiple stakeholders, including tobacco retailers themselves, public health officials, and Massachusetts residents.We conducted in-depth interviews with seven tobacco retailers and ten public health officials from March 2021 to April 2022. Monthly repeated cross-sectional surveys were administered through the online survey panel Prodege from April 2021 to August 2022 (adult sample: N = 765; adolescent sample: N = 900). Themes from interviews were identified by drawing on deductive codes informed by the interview guide, followed by inductive coding of data. Survey data were descriptively analyzed in R.Key themes included retailer frustration over loss of sales to neighboring states, factors associated with retailer compliance, and the need for increased education regarding the law. Survey results showed that a minority of adolescents (13.3%) and adults (26.1%) who vaped in the past 30-days were traveling to border states to purchase vape products. Less than one-quarter of adolescent participants and less than half of adult participants could correctly identify which products Massachusetts did not sell.Evidence from the retailer, public health, and end-user perspectives support mutual benefits of adjacent states enacting flavored tobacco sales restrictions, improved policy education for retailers and the public, and improved retailer enforcement.

    View details for DOI 10.1016/j.addbeh.2024.108089

    View details for PubMedID 38908050

  • Key Informants' Perceptions of Health Equity and Racial Justice Impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Tan, A. S., Roberts, J., Liu, J., P Hanby, E., Gundersen, D. A., Reynolds, M. J., Winickoff, J. P., Gottlieb, M. A., Emmons, K. M. 2024; 26 (Supplement_2): S96-S102

    Abstract

    The Massachusetts legislature passed An Act Modernizing Tobacco Control in November 2019 to restrict retail sales of flavored commercially manufactured tobacco products including menthol products, increase penalties for violating the law's provisions, and provide health insurance coverage for tobacco treatment.This study explores key informants' perceptions of intended and unintended impacts of implementation of the 2019 Massachusetts statewide law through a health equity and racial justice lens. We conducted in-depth interviews with 25 key informants from three key informant groups (public health officials and advocates, clinicians, and school staff) between March 2021 and April 2022. Using deductive codes on unintended impacts of the implementation of the law's policies, we conducted a focused analysis to identify impacts that were perceived and observed by informants from different key informant groups.Perceived or observed impacts of the law were identified across multiple levels by key informants and included concerns related to three broad themes: 1) intended impacts on health equity and racial justice, 2) ongoing availability of restricted products undermining the intended impact of the law, and 3) inequitable targeting by the policies and enforcement among communities of color.Future evaluation is needed to assess the intended and unintended impacts of implementation of the Massachusetts law to maximize the potential of the policies to reduce tobacco-related health disparities. We discuss implications and recommendations for achieving a national policy and equitable enforcement of flavored tobacco sales restrictions.This qualitative study among 25 key informants including public health and tobacco control advocates, clinicians, and school staff obtained perspectives of intended and unintended health equity and racial justice impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control. Findings and recommendations from this study can inform monitoring efforts to assess the law's impacts in Massachusetts and the adoption of similar flavored tobacco sales restrictions and other tobacco control policies in other states to maximize the health equity benefits and minimize unintended impacts.

    View details for DOI 10.1093/ntr/ntad110

    View details for PubMedID 38817028

    View details for PubMedCentralID PMC11140222

  • Does source matter? Examining the effects of health experts, friends, and social media influencers on young adult perceptions of Instagram e-cigarette education messages. Drug and alcohol dependence Lee, D. N., Liu, J., Stevens, H., Oduguwa, K., Stevens, E. M. 2024; 258: 111270

    Abstract

    Young adults' e-cigarette use is a leading public health concern. Using messages from credible sources can help improve message acceptance, yet little research has examined the role of source credibility on young adults' responses to e-cigarette education messages.We examined the impact of source on young adults' perceptions of e-cigarette education messages and e-cigarettes. In July 2022, we conducted an experimental study using an online sample of young adults (N=459, Mage=24.6) who were randomized to one of three source conditions: expert, friend, or influencer, and viewed e-cigarette education messages. We used one-way ANOVA to estimate the association between the conditions and outcomes (perceived source credibility, message trust, curiosity, use interests, perceived message effectiveness, beliefs, harm perceptions, and intentions to refrain).The expert condition was associated with significantly higher perceived source credibility (vs. friend, influencer; p<0.001), message trust (vs. friend, influencer; p<0.001), and curiosity (vs. influencer; p's<0.05).Public health campaigns may leverage health experts to deliver e-cigarette education messages targeting young adults to improve effectiveness of the messages.

    View details for DOI 10.1016/j.drugalcdep.2024.111270

    View details for PubMedID 38522212

  • Dual-Vaping of Nicotine and Cannabis among Adults who Currently Use Tobacco Products in Five New England States. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Liu, J., Hanby, E., Kingsley, M., Winickoff, J. P., Gundersen, D. A., Tan, A. S. 2024

    Abstract

    INTRODUCTION: Current measures of vaping behaviors do not distinguish what substances participants are vaping and to what extent they are dual-vaping nicotine and cannabis. This study describes the use of new survey questions that more specifically ask whether participants who vape are vaping nicotine, cannabis, CBD, or another substance.METHODS: Adults, who reported any past-30-day tobacco use, from five New England states participated in an online survey from April 2021 to July 2022. Participants who vaped were asked, "Have you used any of the following vape substances in the past 30 days?" with the possible responses of nicotine, cannabis, CBD, other, and "don't know." Dual-use of both nicotine and cannabis was defined as the vaping of both nicotine and cannabis and/or CBD in the past-30-days, operationalized as a dichotomous outcome. Data were collected in monthly, repeated cross-sectional waves. Multinomial logistic regression was used to examine correlates of dual-vaping.RESULTS: The analytic sample included 1547 adults who reported past-30-day tobacco use (mean age 42.9 years, 62.8% female, 85.4% White, 48.5% income of less than $50,000). Over one-quarter (26.1%) reported dual-vaping in the past-30-days. Identifying as male (p=0.002) and self-rated anxiety (p=0.043) were associated with a higher odds of dual-vaping.CONCLUSIONS: Our findings show that a sizable proportion of a sample of New England adults who have used tobacco in the past-30-days are dual-vaping nicotine and cannabis. Adequate survey measures for assessing the vaping of multiple substances can help in better screening and characterization of health behaviors around dual-use.IMPLICATIONS: This study addresses a key gap in adequate survey measures for assessing vaping of multiple substances. We found that among adults with past 30-day tobacco use, dual-vaping was prevalent and associated with different correlates, such as self-reported anxiety and education level, compared to sole-vaping of nicotine or cannabis. Our findings may help in characterizing and targeting future population-level surveillance and intervention efforts for multiple substance use behaviors.

    View details for DOI 10.1093/ntr/ntae062

    View details for PubMedID 38502116

  • HOW DOES AGE OF E-CIGARETTE INITIATION PREDICT PATTERNS OF PAST 30-DAY USE? McCauley, D., Gaiha, S., Liu, J., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2024: S9-S10
  • WHICH NICOTINE AND NON-NICOTINE PRODUCTS DO ADOLESCENTS AND YOUNG ADULTS WHO IDENTIFY AS LGBTQ plus PERCEIVE AS MOST HARMFUL AND ADDICTIVE? Liu, J., McCauley, D., Gaiha, S. M., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2024: S91
  • Association Between Social Media Use and Substance Use Among Middle and High School-Aged Youth. Substance use & misuse Liu, J., Charmaraman, L., Bickham, D. 2024: 1-8

    Abstract

    Purpose: The purpose of our study was to identify whether different aspects of social media use were associated with substance use among middle- and high school-aged youth. Methods: Participants were recruited from four Northeast U.S. middle schools and invited to complete an online survey in Fall 2019 and Fall 2020. We conducted separate adjusted logistic mixed effects models the substance use outcomes: ever use of alcohol, cannabis, e-cigarettes, tobacco cigarettes, prescription drugs, and multiple substances. Our sample included N = 586 participants (52.7% female, 58% White). Results: Seeing a social media post about drugs/alcohol in the past-12-months was significantly associated with higher odds of ever using alcohol, cannabis, e-cigarettes, and multiple substance use. Total number of social media sites ever used was significantly associated with higher odds of ever using cannabis, cigarettes, e-cigarettes, and multiple substances. Checking social media every hour or more was significantly associated with higher odds of ever using alcohol. Higher problematic internet use score was significantly associated with higher odds of ever using cannabis, e-cigarettes, and multiple substances. Online social support seeking score was not associated substance use. Conclusions: Our findings support the need for substance use prevention and social media literacy education and screening to begin early, ideally in elementary school before youth are using social media and substances.

    View details for DOI 10.1080/10826084.2024.2320372

    View details for PubMedID 38419151

  • How Age and E-cigarette Use Status Interact to Influence E-cigarette Ad Perceptions. Substance use & misuse Liu, J., Keller-Hamilton, B., Patterson, J. G., Lee, D. N., Wedel, A. V., Vázquez-Otero, C., Stevens, E. M. 2023; 58 (2): 257-265

    Abstract

    Background: The prevalence of e-cigarette use among young people remains high. Young people are susceptible to e-cigarette advertising, although potential heterogeneity in perceptions of e-cigarette ads with respect to age and e-cigarette use history remains unexplored. We aimed to assess differences in perceptions of e-cigarette ads and product use intention, by age and e-cigarette use status. Methods: Participants from an online convenience sample (N = 497, Mage=31.9) viewed two randomly selected e-cigarette ads and reported their perceptions of the ads and product use intention. We used mixed effects linear regression models to estimate associations between age group (18-20 years, 21-25 years, 26+ years), e-cigarette use status (never, former, and current use), and their interaction effects, on outcomes related to perceptions of ads and use intention. Models controlled for demographics and other tobacco use. Results: Current e-cigarette users (vs. never users) and participants who were 26+ years old (vs. 18-20 years old) had greater liking of the ads, perceived ad relevance, and perceived ad effectiveness. Among current e-cigarette users, participants who were 26+ years old (vs. 18-20 years old) had lower use intention. Conclusion: The effect of e-cigarette ad exposures on perceptions of the ad and use intention is heterogeneous with respect to age group and e-cigarette use history. While ads appealed more to adults who were 26+ years old across e-cigarette use groups, current e-cigarette users who were 18-20 years old demonstrated high use intention following ad exposure, suggesting a need for marketing interventions to mitigate continued e-cigarette use among young people.

    View details for DOI 10.1080/10826084.2022.2155479

    View details for PubMedID 36510786

    View details for PubMedCentralID PMC9877189

  • Prevalence and correlates of past 30-day dual-vaping of nicotine and cannabis among adolescents in five New England states. Drug and alcohol dependence Liu, J., Winickoff, J. P., Hanby, E., Rees, V., Emmons, K. M., Tan, A. S. 2023; 254: 111055

    Abstract

    Adolescent vaping behavior includes vaping of multiple substances, including both nicotine and cannabis (dual-vaping). This study describes the prevalence and the sociodemographic correlates of past 30-day dual-vaping.We recruited adolescents ages 13-17 from five New England states (Massachusetts, Connecticut, Rhode Island, Vermont, New Hampshire) through the Prodege online survey panel from April 2021 to August 2022. Dual-vaping was defined as vaping both nicotine and cannabis (THC and/or CBD) in the past 30-days. We analyzed the prevalence of sole-nicotine, sole-cannabis, and dual-vaping of nicotine and cannabis and used multinomial logistic regression to examine associations between sociodemographic factors and sole- and dual-vaping of nicotine and cannabis.The analytic sample included 2013 observations from 1858 participants (mean age 15.1 years, 46.2% female, 74.1% White, 82.2% heterosexual). Among these observations, 5.6% reported past 30-day sole-nicotine vaping, 5.5% reported sole-cannabis vaping, and 7.3% had dual-vaped. Correlates for higher odds of past 30-day dual-vaping included total social media sites used and household tobacco use, in contrast with sole-cannabis vaping, which included older age and self-reported depression (all p's <0.05).Adolescent past 30-day dual-vaping of nicotine and cannabis was more prevalent than past 30-day sole-vaping of either nicotine or cannabis alone. Future studies should continue to collect detailed data on the type of substances, besides nicotine, that adolescents are vaping.

    View details for DOI 10.1016/j.drugalcdep.2023.111055

    View details for PubMedID 38071894

  • Sexual orientation and gender identity differences in perceptions and product appeal in response to e-cigarette advertising. Tobacco induced diseases Liu, J., Patterson, J. G., Keller-Hamilton, B., Lee, D. N., Chrzan, K. R., Stevens, E. M. 2023; 21: 111

    Abstract

    E-cigarette use is disparately high among sexual minoritized populations. As e-cigarette advertising may influence product appeal, this study tested sexual orientation- and gender-based differences in response to e-cigarette advertisement exposure on advertisement perceptions and product appeal.We recruited 497 adults (mean age=31.9 years, 45.1% women, 54.3% heterosexual, 71.2% Non-Hispanic White) living in the United States via the crowdsourcing platform Prolific. Participants viewed two randomly selected e-cigarette advertisements (from n=173 advertisements). Post-exposure, participants rated the perceived advertisement effectiveness, relevance, and product use intention. Associations between sexual orientation and outcomes were estimated using multivariable linear mixed-effects models. We tested interaction effects between sexual orientation, gender, and advertisement feature (e.g. presence of humans, flavors, and product packaging), and ran Tukey post hoc tests for pairwise comparisons.Post-exposure, heterosexual women, sexual minoritized men, and sexual minoritized women (reference group: heterosexual men) rated perceived advertisement effectiveness and relevance lower after viewing advertisements featuring flavors (vs no flavors; all p<0.001). Sexual minoritized men and sexual minoritized women rated perceived advertisement relevance lower after viewing advertisements featuring humans (all p<0.001) or fruit (all p<0.001). Heterosexual women, sexual minoritized men, and sexual minoritized women reported lower product use intention after viewing advertisements featuring an e-liquid bottle (vs no e-liquid bottle; all p<0.05).Sexual minoritized women and men reported lower e-cigarette advertisement appeal and product use intentions than heterosexual men. More evidence is needed to understand advertisement perceptions and product appeal in this group to inform e-cigarette advertising regulations and anti-tobacco messaging campaigns that aim to reduce tobacco-related health inequities.

    View details for DOI 10.18332/tid/169739

    View details for PubMedID 37664443

    View details for PubMedCentralID PMC10472342

  • An Urgent Need for School-Based Diversion Programs for Adolescent Substance Use: A Statewide Survey of School Personnel JOURNAL OF ADOLESCENT HEALTH Liu, J., Butler, R., Turncliff, A., Gray, C., Lynch, S., Whittaker, J., Iroegbulem, V., Howell, D., Schuster, R. M. 2023; 73 (3): 428-436

    Abstract

    There has been growing interest in reserving punishment as a last resort to address substance use in schools. However, there is significant variability in adoption of alternative approaches. This study reported school personnel's perceptions of diversion programs, identified characteristics of schools/districts that currently have diversion programs, and defined barriers of implementation of diversion programs.One hundred fifty six school stakeholders from Massachusetts' K-12 schools, including district administrators, principals and vice principals, school resource officers, guidance counselors, and nurses, completed a web-based survey in May-June 2020. Participants were recruited through e-mail distributed via professional listservs, direct school outreach, and community coalitions. The web survey queried beliefs, attitudes, and actions that schools take regarding substance use infractions as well as perceived barriers to implementing diversion programs.Participants endorsed strong beliefs that punishment was an appropriate school response for student substance use, particularly for nontobacco-related infractions. Despite these personal beliefs, diversion programs were rated as more effective but less commonly used than punitive approaches (37% of respondents reported having diversion programs in their schools/districts vs. 85% used punitive approaches) (p < .03). Punishment was more likely to be used to respond to cannabis, alcohol, and other substances compared to tobacco (p < .02). Primary barriers of implementing diversion programs included funding, staff training, and parental support.Based on school personnel perceptions, these findings lend further support for a transition away from punishment and toward more restorative alternatives. However, barriers to sustainability and equity were identified that warrant consideration when implementing diversion programs.

    View details for DOI 10.1016/j.jadohealth.2023.04.006

    View details for Web of Science ID 001065648800001

    View details for PubMedID 37318411

    View details for PubMedCentralID PMC10524742

  • Barriers and facilitators to address vaping in Massachusetts schools: a mixed-methods study of school-based stakeholders. Translational behavioral medicine Liu, J., Roberts, J., Reynolds, M. J., Hanby, E., Gundersen, D. A., Winickoff, J. P., Rees, V. W., Emmons, K. M., Tan, A. S. 2023; 13 (8): 589-600

    Abstract

    We assessed vaping behaviors, environments, COVID-19 influences, and barriers and facilitators of existing approaches that address adolescent vaping in Massachusetts middle and high schools. Findings from this study will provide considerations for individual schools or districts as they advance adolescent vaping prevention and treatment efforts. We analyzed 310 open-ended comments from Massachusetts school administrators who completed a survey between November 2020 and January 2021. Further, we analyzed nine semi-structured interviews with administrators (e.g., principals, vice principals, school nurses) from Massachusetts school systems (n = 6) and school-based anti-tobacco advocates (n = 3); interviews took place between May and December 2021. Informed by Green's PRECEDE model, we conducted a framework analysis using deductive codes based on the model constructs (enabling, reinforcing, and predisposing factors) and inductive codes of key themes emerging from the interviews. Challenges to addressing adolescent vaping included staff capacity, funding, and lack of mental health and counseling supports. The COVID-19 pandemic was a major barrier to conducting usual in-person vaping programs, but also reduced student vaping at school due to new social distancing practices and bathroom use policies. Facilitators of vaping interventions included peer-led initiatives and parental involvement. Participants discussed the importance of educating adolescents on the harms of vaping and the move toward alternatives-to-suspension programs rather than disciplinary action. School-based anti-vaping program implementers-such as school districts, state departments of education, or local health departments-will need to leverage facilitators such as peer-led initiatives, alternatives-to-suspension approaches, and parental involvement, to increase the potential impact of these programs.

    View details for DOI 10.1093/tbm/ibad012

    View details for PubMedID 37084410

    View details for PubMedCentralID PMC10415734

  • Community and Opinion Leadership Effects on Vaping Discourse: A Network Analysis of Online Reddit Threads. Journal of health communication Rohde, J. A., Liu, J., Rees, V. W. 2023; 28 (8): 487-497

    Abstract

    Reddit is a popular hub for discussing vaping. A deeper understanding of the factors that influence this online discourse could inform public health messaging efforts targeting this platform. Using a network analysis framework, we sought to investigate the role of opinion leaders and online communities in facilitating vaping discussions on Reddit. We collected Reddit submissions about vaping posted in May 2021 and used these submissions to generate subreddit-level (N=261) and thread-level (N=8,377) data sets. We coded subreddits into four community categories: 1) Vaping, 2) Substance use, 3) Cessation, and 4) Non-specific. We used sociometric in-degree centrality statistics to identify subreddit opinion leaders. We computed non-parametric ANOVAs and negative binomial regressions to test associations between opinion leadership and subreddit community category variables on subreddit network composition (comprised of subreddit-level network nodes and edges) and the number of commenters on Reddit threads about vaping (thread-level). Subreddit network composition was largely dependent on opinion leaders in Non-specific communities, and less so in Vaping and Substance use communities. At the thread-level, the rate of commenters was higher among threads initiated by opinion leaders than non-opinion leaders (adjusted rate ratio [aRR]=4.84). Furthermore, threads posted in Vaping (aRR=1.64), Substance use (aRR=1.92), and Cessation (aRR=1.21) communities had higher commenter rates than those posted in Non-specific communities. Communities and opinion leaders play a key role in the composition and reach of vaping discussions on Reddit. These findings provide a foundation for public health campaigns and interventions targeting Reddit and perhaps other social media platforms.

    View details for DOI 10.1080/10810730.2023.2225447

    View details for PubMedID 37341521

  • Vaping of Cannabis, Cannabidiol, and Synthetic Cannabis Among US Sexual Minority Youths. JAMA network open Liu, J., Tan, A. S., Lee, J. 2023; 6 (8): e2329041

    Abstract

    This cross-sectional study investigates rates of vaping of cannabis, cannabidiol, and synthetic cannabis among US sexual minority youths.

    View details for DOI 10.1001/jamanetworkopen.2023.29041

    View details for PubMedID 37581889

  • Correlates of adolescent sole-, dual- and poly-use of cannabis, vaped nicotine, and combusted tobacco. Addictive behaviors Liu, J., Tan, A. S., Winickoff, J. P., Rees, V. W. 2023; 146: 107804

    Abstract

    BACKGROUND: Compared to single substance use, adolescents' use of multiple substances is associated with more severe dependence, cessation outcomes, and health risks. This study examined correlates of use and co-use of e-cigarettes, combusted tobacco, and cannabis among high school-aged (9th-12th grade, approximately aged 14-18) adolescents.METHODS: We analyzed the 2019 Massachusetts Youth Health Survey (MYHS) data to calculate the weighted means of any past 30-day sole-use of e-cigarettes, sole-use of combusted tobacco, sole-use of cannabis, dual-use of two of the above substances, and poly-use of all three substances. We then used weighted multinomial logistic regression to examine the associations between demographic, social and behavioral factors and sole-, dual-, and poly-use (vs. no use) of these substances.RESULTS: Among N=1614 respondents, any past 30-day dual-use of e-cigarettes and cannabis was the most prevalent (17.2%, SE: 1.3%). Sole-use of combusted tobacco was less than 1%, whereas 4.5% (SE: 0.7%) of respondents reported poly-use of e-cigarettes, cannabis, and combusted tobacco. Lower academic grades and self-reported depression (1 item on persistent feelings of sadness or hopelessness) were associated with increased odds of dual-use of e-cigarettes and cannabis and poly-use (vs. sole-use of any substance). Adolescents who self-reported having "any long-term emotional problems or learning disabilities" had greater odds of poly-use.CONCLUSION: Different sets of correlates were associated with sole-, dual-, and poly-use, suggesting that certain adolescents may be more vulnerable than others to multiple substance use. Future research should examine potentially modifiable upstream influences, such as the home environment and socioeconomic factors that may affect the relationship between adolescent mental health, school performance, and multiple addictive substance use.

    View details for DOI 10.1016/j.addbeh.2023.107804

    View details for PubMedID 37478525

  • Absolute and relative e-cigarette harm perceptions among young adult lesbian and bisexual women and nonbinary people assigned female at birth. Addictive behaviors Patterson, J. G., Keller-Hamilton, B., Wedel, A., Vazquez-Otero, C., Liu, J., Lee, D., Stevens, E. M., Wagener, T. L. 2023; 146: 107788

    Abstract

    PURPOSE: Young adult lesbian and bisexual women report considerable e-cigarette disparities, which may be attributed to low harm perceptions. No studies have assessed differences in e-cigarette harm perceptions in this group, nor which factors might be intervention targets to influence harm perceptions.MATERIALS AND METHODS: We investigated differences in and modifiable correlates of e-cigarette harm perceptions among young adult lesbian and bisexual women and non-binary people assigned female at birth. Young adult women and non-binary people assigned female at birth, aged 18-30years old, and who self-identified as lesbian or bisexual (N=471) reported absolute and relative harm perceptions of e-cigarettes to health in an online survey. We modeled associations between harm perceptions and individual, interpersonal, and contextual factors.RESULTS: Bisexual (vs. lesbian) participants perceived higher absolute harm of e-cigarettes (Mean (M)=7.61 vs M=7.09, p=.03). Participants rated e-cigarettes as slightly less harmful than cigarettes, and there was no statistically significant difference by sexual orientation (Bisexual: M=4.84 vs Lesbian: M=4.36). In multivariable models, bisexual (vs. lesbian) participants and Hispanic/Latinx and Other race (vs. non-Hispanic White) participants reported higher absolute and relative e-cigarette harm perceptions. Greater sexual identify affirmation and greater perceived stress were associated with higher absolute and relative e-cigarette harm perceptions.CONCLUSIONS: E-cigarette harm perceptions vary vis-a-vis individual-level factors. Self-identification as bisexual or minoritized race/ethnicity, greater sexual identity affirmation, and greater perceived stress was associated with increased harm perceptions. Understanding variations may inform targeted health communications to reduce e-cigarette use disparities.

    View details for DOI 10.1016/j.addbeh.2023.107788

    View details for PubMedID 37429104

  • Association of Vaping Identity and e-Cigarette Perceptions among Young Adults Who Vape. Substance use & misuse Lee, D. N., Liu, J., Oduguwa, K., Stevens, E. M. 2023; 58 (11): 1418-1424

    Abstract

    Background: In the U.S., 9.3% of young adults currently vape. However, little is known about how vaping identity (i.e., internalizing vaping as an important part of oneself) can influence young adults' e-cigarette perceptions. The purpose of this study was to examine the association between vaping identity and e-cigarette perceptions among young adults. Methods: Young adults who vape (N = 252, Mage = 24.7) were recruited to participate in an online survey assessing a trusted source of health information, e-cigarette harm perceptions, and intentions to abstain from vaping. We estimated associations between vaping identity on outcomes and the interaction of vaping identity and combustible cigarette use on outcomes. Results: Participants with higher vaping identity reported lower trust in government health agencies and a doctor, and higher trust in the tobacco industry and e-cigarette industry (ps < 0.05). Those with higher vaping identity also reported lower e-cigarette harm perceptions and intentions to abstain from vaping (ps < 0.05). Conclusions: Findings show that higher vaping identity is associated with greater trust in the tobacco industry, lower trust in health experts, lower e-cigarette harm perceptions, and lower intentions to abstain from using e-cigarettes. This suggests that efforts to reduce vaping among young adults may need to leverage messages that reduce the credibility of the tobacco industry and prevent nonsmoking young adults from developing a vaping identity.

    View details for DOI 10.1080/10826084.2023.2223286

    View details for PubMedID 37331989

  • Characteristics Associated with Young Adults' Intentions to Engage with Anti-Vaping Instagram Posts. International journal of environmental research and public health Liu, J., Lee, D. N., Stevens, E. M. 2023; 20 (11)

    Abstract

    The purpose of this study was to identify behavioral and sociodemographic factors associated with intentions to engage with anti-vaping Instagram posts among a young adult population. This study proposes the following research questions: (1) Does e-cigarette use status influence intentions to engage with anti-vaping Instagram posts?, and (2) How are e-cigarette use and social media use associated? We recruited a convenience sample of young adults (N = 459; aged 18-30 years) in July of 2022 into an online experimental study from Prolific. Participants saw five image-based Instagram posts about the health harms of using e-cigarettes. Participants were then asked about their intentions to engage ("Comment on", "Reshare", "DM/Send this to a friend", "Like", and/or "Take a screenshot of") with the posts. We used logistic regression to run adjusted models for each engagement outcome, which included fixed effects for sociodemographics, tobacco use, and social media/internet use. For the sum of the engagement outcome, we used Poisson regression. Total number of social media sites used was associated with intentions to "Like" the posts (p = 0.025) and the overall engagement score (p = 0.019), respectively. Daily internet use was associated with intentions to "Comment on" (p = 0.016) and "Like" (p = 0.019) the posts. Young adults who reported past 30-day e-cigarette use had higher odds of using Twitter (p = 0.013) and TikTok (p < 0.001), and a higher total number of social media sites used (p = 0.046), compared to young adults who reported never use e-cigarettes. The initial evidence from our exploratory research using a convenience sample suggests that social media campaigns about the harms of e-cigarette use may be an effective way to engage younger audiences, a generation that frequents social media. Efforts to disseminate social media campaigns should consider launching on multiple platforms, such as Twitter and TikTok, and consider e-cigarette use status when posting.

    View details for DOI 10.3390/ijerph20116054

    View details for PubMedID 37297658

    View details for PubMedCentralID PMC10252522

  • Key Informants’ Perceptions of Health Equity and Racial Justice Impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control Nicotine & Tobacco Research Tan, A. S., et al 2023
  • Effects of brief exposure to misinformation about e-cigarette harms on Twitter on knowledge and perceptions of e-cigarettes. Digital health Liu, J., Wright, C., Elizarova, O., Dahne, J., Bian, J., Williams, P., Zulkiewicz, B., Tan, A. S. 2022; 8: 20552076221116780

    Abstract

    This study examined whether exposure to misinformation found on Twitter about e-cigarette harms leads to inaccurate knowledge and misperceptions of harms of e-cigarette use among cigarette smokers.We conducted an online randomized controlled experiment in November 2019 among an online sample of 2400 adult US and UK cigarette smokers who did not currently use e-cigarettes. Participants viewed four tweets in one of four conditions: 1) e-cigarettes are as or more harmful than smoking, 2) e-cigarettes are completely harmless, 3) e-cigarette harms are uncertain and 4) control (physical activity). Outcomes were knowledge about e-cigarettes and harm perceptions of e-cigarette use for five diseases. We conducted multiple logistic and linear regressions to analyze the effect of experimental conditions on outcomes, controlling for baseline knowledge and perceived harms.Participants in the 'as or more harmful' condition (vs. control group) had higher odds of accurate knowledge about e-cigarettes containing toxic chemicals (p < 0.001), not containing only water vapor (p < 0.001) and containing formaldehyde (p < 0.001). However, these participants had lower odds of accurate knowledge that e-cigarettes did not contain tar (p < 0.001) and contained fewer toxins than cigarettes (p < 0.001). Exposure to 'as or more harmful' tweets also increased harm perceptions for five diseases (all p < 0.001), with the greatest effect observed for lung cancer (β = 0.313, p < 0.001). This effect was greater among UK participants for all diseases.Brief exposure to misinformation on Twitter reduced accurate knowledge of the presence of tar and the level of toxins compared with smoking and increased harm perceptions of e-cigarette use.

    View details for DOI 10.1177/20552076221116780

    View details for PubMedID 35935711

    View details for PubMedCentralID PMC9350525

  • Associations between perceived source credibility, e-cigarettes, and e-cigarette ad perceptions. Preventive medicine reports Lee, D. N., Liu, J., Keller-Hamilton, B., Patterson, J. G., Wedel, A. V., Vázquez-Otero, C., Stevens, E. M. 2022; 28: 101862

    Abstract

    The use of e-cigarettes among U.S. adults remains high, and aggressive industry advertising is a contributor. Consumer opinions of the e-cigarette industry's credibility can influence e-cigarette product and ad perceptions. The purpose of this study was to examine the association of perceived source credibility of e-cigarette ads and consumer attitudes toward e-cigarette ads and product use. In October 2021, we conducted a survey using an online convenience sample (N = 497, Mage = 31.9). Participants viewed two randomly selected e-cigarette ads and were asked questions regarding source credibility, perceptions of the ads, and e-cigarette use. Linear mixed effects models with random intercepts were used to estimate associations between perceived source credibility with perceived ad relevance, effectiveness, liking, product use interest, and e-cigarette harms perceptions. We also tested whether associations between perceived source credibility and ad and e-cigarette perceptions were moderated by e-cigarette use. Models controlled for cigarette smoking status, age, sex, race, ethnicity, sexual orientation, and income. Perceived source credibility was positively associated with increased perceived ad relevance, effectiveness, liking, and product use interest (ps < 0.001). E-cigarette use moderated associations of perceived source credibility and perceived ad relevance, perceived ad effectiveness, and interest in using e-cigarettes, with associations being strongest among never users. Findings suggest that tobacco control messaging aiming to reduce the credibility of the e-cigarette industry might be most effective among adults who have never used e-cigarettes.

    View details for DOI 10.1016/j.pmedr.2022.101862

    View details for PubMedID 35733610

    View details for PubMedCentralID PMC9207267

  • Contextual challenges in police-assisted substance use referral programs: Impact of COVID-19 and Black Lives Matter movement. Substance abuse Liu, J., Heckel, E., Coroiu, A., Rees, V. W. 2022; 43 (1): 486-494

    Abstract

    Background: Police assisted referral (PAR) programs provide people with substance use disorders (SUD) with a non-arrest treatment pathway, yet systemic barriers, including stigma and access to treatment services, may limit engagement. We sought to understand how the dual contextual challenges of COVID-19 and the Black Lives Matter movement have impacted PAR programs. Methods: Participants completed semi-structured interviews between July and September 2020. Transcribed interviews were analyzed qualitatively to extract emergent codes and themes. Results: Key themes included: adoption and reach of adapted remote services, and barriers to access; and questions on the role of police as health service providers, including police embeddedness in the community. COVID-related social distancing demands undermined police engagement with people with SUD. Treatment providers and advocates reported moderate success in utilizing remote interventions as workarounds. While participants acknowledged the Black Lives Matter movement's criticism of police, many saw continued value in police involvement in substance use interventions, due to their accessibility in communities and capacity for rapid response. Conclusions: PAR programs quickly adapted to a largely remote format, increasing longer-term accessibility. While Black Lives Matter had little direct impact on PAR programs, concerns about police-community relations were acknowledged. Recommendations include further police training to enhance trust and reduce stigma, and wider integration of digitally-based substance use referral options.

    View details for DOI 10.1080/08897077.2021.1949662

    View details for PubMedID 34236296

  • School-based programs to prevent adolescent e-cigarette use: A report card. Current problems in pediatric and adolescent health care Liu, J., Gaiha, S. M., Halpern-Felsher, B. 2022: 101204

    Abstract

    Given high rates and known health consequences of adolescent e-cigarette use as well as adolescents' susceptibility to nicotine addiction, school-based efforts to prevent and reduce adolescent e-cigarette use should continue to be developed, implemented, disseminated, and evaluated. This paper elaborates on best practices for developing and implementing prevention programs, including the importance of grounding programs in theories and frameworks that empower adolescents, including normative and interactive education, and having programs that are easily accessible and free of cost. Programs should also address key factors driving adolescent e-cigarette use, including discussing misperceptions, flavors, nicotine content, addiction, and the role that marketing plays in appealing to adolescents. The paper also discusses the gap areas of currently available prevention programs and highlights the need for evidence-based approaches and the importance of rigorous evaluation of programs.

    View details for DOI 10.1016/j.cppeds.2022.101204

    View details for PubMedID 35534403

  • History of Adolescent Tobacco Prevention and Cessation Programs and Recommendations for Moving Forward Encyclopedia of Child and Adolescent Health Liu, J., Mathur Gaiha, S., Halpern-Felsher, B. 2022
  • The First State Tobacco Flavor Ban: Perceptions of Adolescent Vaping and High School Tobacco Control Needs in a Changing Landscape. Journal of School Health Liu, J., et al 2022
  • Youth Tobacco Use before and after Flavored Tobacco Sales Restrictions in Oakland, California and San Francisco, California Tobacco Control Liu, J., Hartman, L., Tan, A. S., Winickoff, J. P. 2022
  • Reasons for E-cigarette Use, Vaping Patterns and Cessation Behaviors among U.S. Adolescents Nicotine and Tobacco Research Lindpere, V. 2022
  • Does Tobacco Screening in Youth Primary Care Identify Youth Vaping? The Journal of adolescent health : official publication of the Society for Adolescent Medicine Liu, J., Halpern-Felsher, B., Harris, S. K. 2021

    Abstract

    PURPOSE: The purpose of this study was to evaluate the sensitivity of a tobacco use screening question, modified to include the word "e-cigarette," in detecting past 12-month nicotine vaping and past 12-month tobacco product use inclusive of nicotine vaping, among adolescent primary care patients.METHODS: We conducted secondary analysis of data from a pilot trial of adolescent substance usescreening and brief intervention in pediatric primary care. Participants were patients aged 12-18years (N= 278) presenting for annual well-visits at five practices in Massachusetts in 2015-2017. Study measures consisted of a clinical brief screener item and tobacco/electronic cigarette items on a confidential, self-administered research questionnaire (criterion measure).RESULTS: The clinical brief screener item identified 24 of 30 adolescents with past 12-month tobacco use (sensitivity 80%); 15 of 30 with past 12-month electronic cigarette use (sensitivity 50.0%), and 25 of 42 with tobacco and/or electronic cigarette use (sensitivity 59.5%).CONCLUSIONS: These findings support the need to develop and test a screening measure that is sensitive for capturing electronic cigarette use.

    View details for DOI 10.1016/j.jadohealth.2021.01.017

    View details for PubMedID 33610402

  • Inside the adolescent voice: A qualitative analysis of the appeal of different tobacco products. Tobacco induced diseases Liu, J. n., Ramamurthi, D. n., Halpern-Felsher, B. n. 2021; 19: 15

    Abstract

    While cigarette use has decreased, adolescents' overall use of tobacco (e.g. e-cigarettes, cigars, and hookah) has increased. The purpose of this qualitative study is to highlight the decision-making process of adolescents to use certain products over others and why certain tobacco products appeal to them.Twenty-five participants were recruited from a larger study surveying adolescents' perceptions and tobacco use (772 high school students). The participants were involved in one-on-one semi-structured phone interviews on the appeal of different tobacco products. Interviews were recorded, transcribed verbatim, and analyzed by identifying relevant codes and themes.Participants for this study had a mean age of 16.4 (SD=1.2) years; over half (14/25) were female. Three major themes emerged from the interviews: 1) social context and circumstances to use, including using and sharing with peers, and reducing boredom; 2) importance of flavors, smell, taste, smoke tricks, and accessibility of products; and 3) misperceptions and misinformation of product risks.The findings that emerged showed why participants favored certain tobacco products, especially e-cigarettes, over others. The results support areas for future research and practice, and inform how interventions can better address the appeal of different tobacco products to ultimately prevent adolescent use.

    View details for DOI 10.18332/tid/132856

    View details for PubMedID 33654482

    View details for PubMedCentralID PMC7908110

  • Youth Appealing Features in Popular E-Cigarette Brand Advertising in the U.S. after Heightened Scrutiny in 2018 Tobacco Control Liu, J., Vazquez-Otero, C., Berman, M., Stevens, E. M. 2021
  • Smokers’ Likelihood to Engage with Misinformation of E-cigarette Relative Harms on Twitter: Results from a Randomized Controlled Experiment JMIR Public Health and Surveillance Liu, J., et al 2021
  • How Emotional Reponses and Perceived Relative Harm Mediate the Effect of Exposure to Misinformation about E-cigarettes on Twitter and Intention to Purchase E-cigarettes International Journal of Environmental Research and Public Health Liu, J., et al 2021
  • A Breath of Knowledge: Overview of Current Adolescent E-cigarette Prevention and Cessation Programs. Current addiction reports Liu, J., Gaiha, S. M., Halpern-Felsher, B. 2020: 1–13

    Abstract

    Purpose: Adolescent use of electronic cigarettes (e-cigarettes) has risen rapidly, which is concerning given the health effects of e-cigarettes and youth susceptibility to nicotine addiction. It is critical that efforts to educate, prevent, and reduce adolescent use of e-cigarettes are developed and evaluated. The purpose of this paper is to review available current prevention and cessation programs.Findings: A web-based search of currently available e-cigarette prevention and cessation/treatment programs was conducted using Google in May of 2020. Programs were then reviewed on whether they included theory- and evidence-based practices of effective adolescent prevention and cessation programs. Eight prevention programs, seven cessation programs, and one program that addressed both prevention and cessation were identified and included in this review. Most prevention programs included the importance of understanding flavored e-cigarette products, addressed industry-targeted marketing, included social learning activities to develop refusal skills, delivered free-of-cost, available online, and explicitly stated their incorporation of theory. Five prevention programs and two cessation programs had empirically evaluated their e-cigarette-related components.Conclusions: Although the programs reviewed largely incorporated theory and included key components known to be effective, there are some gaps in the programs' overall ability to prevent and stop adolescents from using e-cigarettes, such as lack of dedicated e-cigarette materials. More evidence-based tools, resources, and evaluations are needed to best inform adolescent e-cigarette cessation. Addressing the gaps that existing prevention and cessation programs present requires intervening at multiple systematic levels, conducting more rigorous program evaluations, and bolstering the availability of cessation programs.

    View details for DOI 10.1007/s40429-020-00345-5

    View details for PubMedID 33204602

  • What Does It Meme? A Qualitative Analysis of Adolescents' Perceptions of Tobacco and Marijuana Messaging. Public health reports (Washington, D.C. : 1974) Liu, J., McLaughlin, S., Lazaro, A., Halpern-Felsher, B. 2020: 33354920947399

    Abstract

    OBJECTIVES: With the increasing popularity of electronic cigarettes and legalization of recreational marijuana, messaging from websites and social media is shaping product perceptions and use. Quantitative research on the aesthetic appeal of these advertisements from the adolescent and young adult perspective is lacking. We evaluated (1) how adolescents and young adults perceived tobacco and marijuana messaging online and through social media platforms and (2) interactive behaviors related to these messages.METHODS: We interviewed 24 participants from the Tobacco Perceptions Study, a longitudinal study of adolescents' and young adults' (aged 17-21) tobacco-related perceptions and tobacco use. We collected qualitative data from October 2017 through February 2018, through individual semi-structured interviews, on participants' experiences and interactions with online tobacco and marijuana advertisements and the advertisements' appeal. Two analysts recorded, transcribed, and coded interviews.RESULTS: Themes that emerged from the interviews focused on the direct appeal of online messaging to adolescents and young adults; the value of trusting the source; the role of general attitudes and personal decision-making related to using tobacco and/or marijuana; the appeal of messaging that includes colors, interesting packaging, and appealing flavors; and the preference of messages communicated by young people and influencers rather than by industry.CONCLUSION: These findings suggest the need for increased regulation of social media messaging and marketing of tobacco and marijuana, with a particular focus on regulating social media, paid influencers, and marketing that appeals to adolescents and young adults. The findings also suggest the importance of prevention programs addressing the role of social media in influencing the use of tobacco and marijuana.

    View details for DOI 10.1177/0033354920947399

    View details for PubMedID 32791026

  • The Juul Curriculum Is Not the Jewel of Tobacco Prevention Education JOURNAL OF ADOLESCENT HEALTH Liu, J., Halpern-Feisher, B. 2018; 63 (5): 527-528