The Green Heart Project is a community-based trial to evaluate the effects of increasing greenery on urban environment and community health. The study was initiated in 2018 in a low-to-middle-income mixed-race residential area of nearly 28,000 residents in Louisville, KY. The 4 square mile area was surveyed for land use, population characteristics, and greenness, and assigned to 8 paired clusters of demographically- and environmentally matched "target" (T) and adjacent "control" (C), clusters. Ambient levels of ultrafine particles, ozone, oxides of nitrogen, and environmental noise were measured in each cluster. Individual-level data were acquired during in-person exams of 735 participants in Wave 1 (2018-2019) and 545 participants in Wave 2 (2021) to evaluate sociodemographic and psychosocial factors. Blood, urine, nail, and hair samples were collected to evaluate standard cardiovascular risk factors, inflammation, stress, and pollutant exposure. Cardiovascular function was assessed by measuring arterial stiffness and flow-mediated dilation. After completion of Wave 2, more than 8,000 mature, mostly evergreen, trees and shrubs were planted in the T clusters in 2022. Post planting environmental and individual-level data were collected during Wave 3 (2022) from 561 participants. We plan to continue following changes in area characteristics and participant health to evaluate the long-term impact of increasing urban greenery.

Youth use of electronic cigarettes (e-cigarettes or vaping) has skyrocketed in recent years, resulting in a youth vaping epidemic. To combat this epidemic, a coalition of U.S.-based researchers created the Rapidly Advancing Discovery to Arrest the Outbreak of Youth Vaping (VapeRace) Center to stop youth e-cigarette use through integration of research across basic, clinical, behavioral, and population-based domains. Because most research on youth vaping is researcher-driven, the VapeRace Community Engagement and Research Translation (CERT) Core was created to facilitate stakeholder input and engagement with Center activities to develop partnerships between VapeRace researchers, youth, and the community. To help achieve these goals, a VapeRace Youth Advisory Council (YAC) was formed. This article describes the development and implementation of the VapeRace YAC, details its outcomes, and offers lessons learned and future recommendations for similar youth advisory groups.

Background: Despite increases in cardiovascular disease (CVD) prevalence among young and middle-aged adults in the United States (U.S.), associations between lifetime use of cannabis, non-cigarette tobacco products, and illicit drugs with CVD are not fully known. This study aimed to examine these associations among young and middle-aged U.S. adults. Methods: We analyzed a sample of 2933 adults aged 20-59 years from the National Health and Nutrition Examination Survey (2017-2018). CVD (i.e., health care provider diagnosis of coronary heart disease, stroke, or high blood pressure), and substance use (i.e., ever use of cannabis, non-cigarette tobacco, or illicit drugs) were assessed. Adjusted odds ratios were estimated using multivariable logistic regression. Results: Adults who used cannabis had higher odds of coronary heart disease (OR = 5.45, 95% CI: 1.86-15.95), and adults who used cigars had higher odds of stroke (OR = 2.31, 95% CI: 1.06-5.01). Further, increased odds of high blood pressure were associated with e-cigarette (OR = 1.41, 95% CI: 1.12-1.79) and smokeless tobacco (OR = 1.46, 95% CI: 1.01-2.12) use. Conclusions: Lifetime cannabis and non-cigarette use was associated with CVD among young and middle-aged U.S. adults, with the spectrum of disease varying based on substance type. CVD prevention should involve non-cigarette tobacco and cannabis use screening and counseling.

BACKGROUND:Volatile organic compounds (VOCs) are ubiquitous gaseous chemicals emitted from multiple sources and present in both indoor and outdoor air. VOC exposures have been linked to detrimental cardiometabolic effects; nevertheless, the underlying mechanisms remain unclear. In this study, we evaluated the relationship between VOC exposure and sympathetic activation. METHODS:Participants (n=696, age 25-70 years) were recruited between 2018 and 2021 in Louisville, KY. Clean catch, spot urine samples were obtained. Urinary metabolites of VOCs and monoamines were quantified using UPLC-MS/MS. The associations of creatinine-adjusted, log-transformed urinary constituents were examined using adjusted multivariable linear regression models for individual metabolites and quantile-based g-computation for overall mixture models. Final models were adjusted for demographics, stress, smoking status, medication use, and urine collection time. RESULTS:Higher urinary levels of several VOC metabolites were associated with higher urinary levels of monoamines and their metabolites. A quartile increase in the overall VOC metabolite mixture was associated with 27% [18%, 37%] (serotonin) to 54% [36%, 73%] (epinephrine) higher urinary parent monoamine concentrations. For phase I monoamine metabolites, concentrations were 25% [16%, 35%] (vanillylmandelic acid) to 37% [29%, 46%] (3-methoxytyramine) higher per quartile increase in VOC metabolite mixture. CONCLUSIONS:Our results suggest that exposure to VOCs is associated with elevated sympathetic activation. Individual and mixture analyses identified robust associations with metabolites of N,N-dimethylformamide, 1,3-butadiene, ethylbenzene/styrene, propylene oxide, and crotonaldehyde. Elevated sympathetic tone may be a significant contributor to the negative cardiometabolic outcomes associated with VOC exposure.

INTRODUCTION:For over a decade, electronic cigarettes (e-cigarettes) have been the most used tobacco product among US youth. Although past research has stressed the importance of tailoring health communication messaging and interventions, much more work remains to be done in this area. To learn about youth views on vaping from their firsthand experience, we employed Photovoice to examine how youth experience vaping in their everyday lives. METHODS:Through Photovoice methodology and the SHOWED approach to discussion in 2022, we engaged US youth in conversation about vaping exposure and outcomes, focusing on how they experience vaping in their everyday lives. Employing the constant comparative method, discussion transcripts and notes were analyzed, revealing two overarching themes. RESULTS:Pervasiveness and Promotion, the first theme, illustrated the ever-present nature of vaping in the experiences of study participants. Health and Environmental Impacts, the second theme, described participants' apprehensions regarding vaping's negative effects. CONCLUSIONS:Overall, the examples, perspectives, and conclusions that the youth participants shared throughout these discussions illuminated frequent exposure to e-cigarette use and marketing as well as many concerns about the risks associated with use. Health communication messaging in these areas may be useful in refining existing and crafting new prevention and cessation campaigns.

OBJECTIVE:Despite a decline in cigarette use, the dual use of cigarettes and electronic vaping products (EVPs) is a concerning pattern of nicotine consumption in the United States. Anxiety, a risk factor for tobacco use, may contribute to dual-use patterns; however, the association between daily anxiety symptoms and dual use of cigarettes and EVPs is not known. This study investigated associations between daily anxiety symptoms and dual cigarette and EVP use overall and by sex, race, and ethnicity. METHOD:Data are from the 2020-2022 National Health Interview Survey (n = 83,544). Multinomial logistic regression models, adjusted for sociodemographic factors, tobacco use, mental health services, and medication characteristics, examined the relationship between daily anxiety and current exclusive/dual cigarette and EVP use. Stratified analyses explored effect modification by sex, race, and ethnicity. RESULTS:Among the sample, 13.0% reported daily anxiety symptoms, and 1.3% reported dual cigarette and EVP use. Daily anxiety was associated with increased odds of exclusive cigarette (odds ratio [OR] = 1.54, 95% CI [1.42, 1.68]), exclusive EVP (OR = 1.44, 95% CI [1.23, 1.68]), and dual use (OR = 2.16, 95% CI [1.77, 2.63]). Stratified analyses showed significant associations between dual use and daily anxiety among Hispanic, non-Hispanic White, non-Hispanic Black, and non-Hispanic Asian adults. Of note, Hispanic males and females, non-Hispanic White males and females, Black females, non-Hispanic Asian males, and females of another race/ethnicity had higher odds of dual use, whereas Asian females had lower odds. CONCLUSIONS:This study highlights heterogeneous relationships between daily anxiety and dual cigarette and EVP use at the intersection of sex, race, and ethnicity. Tailored interventions addressing persistent mental health symptoms are crucial for reducing tobacco use and associated disparities.

The relationship between socioeconomic and demographic characteristics and health effects of green spaces has been studied, suggesting that certain groups may reap more health benefits from exposure to nature. However, the link between the perceived benefits of nature and socioeconomic and demographic characteristics remains a gap in the literature. We used a subsample (n = 711, 2018–2019) from an environmental cardiovascular risk cohort to investigate the perceived benefits of nature. Participants completed an 11-item survey about their perceptions of the benefits of nature at in-person visits. Socioeconomic and demographic characteristics including income, education, race, biological sex at birth, and age, were self-reported. Generalized linear models were used to evaluate associations between the perceived benefits of nature and demographic and socioeconomic factors; odds ratios and 95% confidence intervals (CIs) are reported. Both unadjusted and fully adjusted models for race, age, sex, and education are reported. Our results suggest that participants who identified as male, a member of a minoritized population, and/or completing less education perceived nature as less beneficial. Although additional research is needed to better understand contributors to these perceptions, access to convenient, safe, and multi-use green spaces may be important in encouraging time in nature and shifting perceptions of the benefits of greenness.

BackgroundYouth and young adult nicotine and cannabis users most commonly use multiple delivery methods (e.g. vaping plus combustible cigarette smoking). Vaping and combustible cigarette use are also associated with increased internalizing symptoms (i.e. anxiety, depression, suicidal ideation); however, it is unclear whether there are differential patterns of associations based on product use patterns. Therefore, the purpose of the current study was to examine user group differences in internalizing symptoms, how internalizing symptoms may impact use, and the perceived impact of vaping on internalizing symptoms.MethodParticipants were 1742 U.S. youth and young adults aged 13-24 (Mage = 18.04, SD = 3.46; 49.3% female; 74.9% White) who completed self-report measures online.ResultsCurrent users, regardless of the number of products used, were more likely to report clinically elevated anxiety and depression symptoms as well as suicidal ideation. Poly-product users also were more likely to endorse indicators of dependence. There were few group differences in terms of affect-related motivations to vape.ConclusionsThese findings suggest that youth and young adults reporting any use of nicotine or THC should be screened for internalizing symptoms and that cessation interventions for this age group target internalizing symptoms as well as dependence symptoms.

Volatile organic compounds (VOCs) are ubiquitous gaseous chemicals present in indoor and outdoor air. These compounds are emitted from several sources such as automobiles, paints, and household items. Human exposures are frequent and expected to increase with climate change. VOC exposures have been linked to negative cardiometabolic effects; however, the underlying mechanisms by which they impact cardiovascular function remain unknown. Exposure to VOCs may stimulate sympathetic nervous system activity. Thus, we aim to investigate the association of urinary VOC metabolites with levels of catecholamines as a biomarker of sympathetic activation. Participants (n=806, age 25-70) were recruited between 2018-2021 from low- to middle-income neighborhoods in Louisville, KY. Clean catch, spot urine samples were obtained during an in-person study visit. Urinary samples were used to quantify metabolites of VOCs and catecholamines using UPLC-MS/MS. The associations of log-transformed, creatinine standardized urinary constituents were examined using adjusted multivariable linear regression models for individual metabolites and quantile-based g computation for overall mixture models. Final models were adjusted for relevant demographic factors, stress, smoking status, medication use, and urine collection time. Detectable levels of acrylamide, acrolein, 1,3-butadiene, crotonaldehyde, N, N-dimethylformamide, propylene oxide, styrene, toluene, and xylene metabolites were present in >80% of urinary samples. In adjusted models, higher concentrations of most VOC metabolites, other than BMA (a metabolite of toluene), were associated with higher levels of urinary catecholamines (p<0.001). Specifically, a 10% increase in 11 individual VOC metabolites was associated with 1.2% to 2.4% higher epinephrine, 0.7% to 1.4% higher norepinephrine, and 0.7% to 1.5% higher dopamine levels. A quartile increase in the overall VOC metabolite mixture was associated with 57% higher epinephrine (95%CI = 41, 76%; p<0.001), 37% higher norepinephrine (95%CI=28, 48%; p<0.001), and 40% dopamine levels (95%CI=31, 48%; p<0.001). Our results suggest that exposure to these ubiquitous volatile compounds is associated with an increase in sympathetic stimulation. Mixture analysis further demonstrated potential additive effects of VOC exposures on autonomic modulation. Hence, an elevated sympathetic tone may in part be responsible for the negative cardiometabolic outcomes related to increased VOC exposure.

Despite declines in adolescent nicotine vaping during the COVID-19 pandemic, vaping continues to be a public health issue for many adolescents. Most studies on teen reasons for vaping and on barriers and facilitators of vaping were conducted prior to the pandemic. Because teen culture changes so rapidly, and because the pandemic had wide-reaching effects on teens and mental health, it is critical to have a current understanding what helps adolescents to quit vaping (facilitators), as well as what prevents them from quitting (barriers) in order to design effective and engaging interventions. The objective of this qualitative study was to examine reasons for vaping, and barriers and facilitators to quitting vaping among high school age (14-18 years old) students. Students (n = 28; 60.7 % female; 50 % White, 10.7 % Black or African American, 25 % Asian or Asian American, 3.6 % other non-Hispanic; 7.2 % Hispanic; 21.4 % former vapers, 78.6 % current vapers) were recruited online from four regions in the US and participated in one of five online focus groups. We conducted a content analysis of the focus groups using a team-based coding approach. The most frequently cited reasons for vaping were mood, peer influence, and boredom. Results also showed that the stigma of seeking treatment acted as a barrier to quitting vaping, while self-reflection acted as a facilitator. In addition, two factors, peer influence and health effects, served as both barriers and facilitators, depending on the context. Program developers can use this information to design engaging vaping cessation programs intended for adolescents.

Introduction: Cannabis vaping has become increasingly popular among adolescents in recent years. However, research examining mental health determinants of cannabis vaping is scant. This study investigated the relationship between psychological distress and cannabis vaping among a nationally representative sample of U.S. adolescents. Methods: Data are from the cross-sectional 2022 National Youth Tobacco Survey, restricted to adolescents ages 11-18 (n=22,202). Psychological distress was categorized as normal, mild, moderate, and severe according to the Patient Health Questionnaire for Depression and Anxiety-4. Cannabis vaping was defined as any use in the past 30 days. To estimate the association between psychological distress and cannabis vaping, logistic regression was performed adjusted for age, biological sex, race/ethnicity, sexual orientation, school grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use. Analyses were conducted in 2023. Results: Nearly 8% of adolescents vaped cannabis in the past 30 days, and 25.6% reported moderate or severe psychological distress. Mild, moderate, and severe psychological distress were associated with cannabis vaping in the unadjusted model. In the adjusted model, the odds of cannabis vaping were higher among adolescents who had severe psychological distress (OR: 1.46, 95% CI: 1.09-1.96), compared to adolescents with no distress. Older age, poor grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use were also associated with cannabis vaping. Conclusions: Severe psychological distress was associated with past 30-day cannabis vaping among U.S. adolescents. Adolescents experiencing psychological distress need to be screened for cannabis vaping to help prevent and reduce use and promote mental health. Am J Prev Med 2024;66(3):534-539. (c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Background: College students who identify as a sexual minority (i.e., lesbian, gay, bisexual, or other sexual orientation) are at higher risk for e-cigarette use than their heterosexual or "straight" peers. However, little is known about factors, such as e-cigarette outcome expectancies, that might influence these differences in prevalence rates. Therefore, the current study examined differences between heterosexual and sexual minority college student e-cigarette users in terms of days of past-month e-cigarette use, e-cigarette dependence, and e-cigarette outcome expectancies. A secondary aim of the study was to examine whether outcome expectancies served as an explanatory mechanism in the association between sexual minority status and e-cigarette use frequency and dependence. Methods: Participants were heterosexual (n = 90; Mage = 19.65, SD = 2.70; 76.7% female; 77.8% White) and sexual minority (n = 44; Mage = 20.02, SD = 2.18; 68.2% female; 90.9% White) college student e-cigarette users who completed self-report measures. Results: Students who identified as a sexual minority reported greater e-cigarette dependence, more frequent past 30-day use, and greater negative consequences and positive reinforcement e-cigarette outcome expectancies. Follow-up mediation analyses indicated a significant indirect effect of sexual minority status on both days of past-month e-cigarette use and e-cigarette dependence through expectancies for negative consequences and positive reinforcement. Conclusions: These findings suggest that positive reinforcement and negative consequences outcome expectancies may be contributing to the disparities in e-cigarette use among college students who identify as a sexual minority and could be useful targets for cessation interventions for this population.

Understanding the association between initial experimentation with a tobacco product and subsequent patterns of tobacco use among youth is important to informing prevention activities for youth in the US. We conducted an online survey from August to October 2017 among youth aged 13-18 years. The current analysis focused on respondents reporting initial experimentation with any tobacco product (n = 2,022). Using multinomial logistic regression, we examined the association between first tobacco product tried (cigarettes; cigars including cigarillos, little cigars, and bidis; electronic nicotine delivery systems (ENDS); smokeless and chewing tobacco; or hookah) with subsequent patterns of tobacco use while adjusting for covariates. Of the youth who experimented, 56.8% were non-current tobacco users. Of current tobacco users (n = 934), 13% were exclusive ENDS users, 5.3% exclusive combustible mono-users, 13.4% ENDS plus combustible poly-users, 3.3% combustible product only poly-users, and 8.2% other tobacco poly-users. The most common type of first tobacco product tried was ENDS (44.7%), followed by cigarettes (35.0%) and cigars (8.6%). Those who experimented with combustible tobacco products were less likely to be exclusive ENDS users [Relative Risk Ratio (RRR) = 0.46; 95% CI = 0.28, 0.73 for cigarettes; RRR = 0.32; 95% CI = 0.13, 0.81 for cigars; and RRR = 0.33; 95% CI = 0.14, 0.79 for hookah] when compared to non-current tobacco users (reference group). Tobacco product choices for initial experimentation appear to play a role in subsequent tobacco use patterns among youth. Understanding the reasons behind initial product choice may inform our understanding regarding the reasons for subsequent current tobacco product use, thus informing youth prevention efforts.

Cardiovascular disease (CVD) remains the leading cause of mortality in the U.S. accounting for 1 in 4 deaths each year. Environmental factors, such as neighborhood safety, may increase the risk of CVD. Therefore, the current study assessed perceived neighborhood safety and its association with CVD risk factors (i.e. dyslipidemia, hypertension, type II diabetes) among 663 adults (mean age: 49.97 years, 61.24% female, 78.28% White). Participants completed self-report measures as part of a larger study of environmental influences on cardiac health. Results indicated that individuals reporting low perceived neighborhood safety had greater odds of having at least one CVD risk factor (OR = 2.76, 95% CI: 1.46, 5.22) compared to those with high perceived safety. There was a significant interaction between gender and the presence of at least one CVD risk factor in relation to perceived neighborhood safety. Low perceived neighborhood safety was associated with greater odds of having at least one CVD risk factor among males (OR = 5.48, 95% C.I: 1.82, 16.52) but not females. These findings suggest that low perceived safety is associated with CVD risk factors, especially among males. Future work should seek to better understand the interaction by gender in the relationship between perceived safety and CVD risk factors.

Racial discrimination has been identified as a risk factor for cardiometabolic diseases, the leading cause of morbidity and mortality among racial/ethnic minority groups; however, there is no synthesis of current knowledge on the association between discrimination and cardiometabolic diseases. The objective of this systematic review was to summarize evidence linking racial/ethnic discrimination and cardiometabolic diseases. The review was conducted based on studies identified via electronic searches of 5 databases (PubMed, Google Scholar, WorldWideScience.org, ResearchGate and Microsoft Academic) using terms related to discrimination and cardiometabolic disease. Of the 123 eligible studies included in the review, 87 were cross-sectional, 25 longitudinal, 8 quasi-experimental, 2 randomized controlled trials and 1 case–control. Cardiometabolic disease outcomes discussed were hypertension (n = 46), cardiovascular disease (n = 40), obesity (n = 12), diabetes (n = 11), metabolic syndrome (n = 9), and chronic kidney disease (n = 5). Although a variety of discrimination measures was employed across the studies, the Everyday Discrimination Scale was used most often (32.5

Background: Although lifestyle factors have been linked to chronic diseases among adults, their association with diagnosed individual and comorbid cardiometabolic (CMD) and pulmonary disease (PD) is not fully known. This study aimed to examine the associations between lifestyle factors and individual and comorbid CMD and PD among U.S. adults. Methods: We used cross-sectional data from the 2017–2020 National Health and Nutrition Examination Survey (n = 7394). Health care provider’s diagnosis of CMD and PD and lifestyle factors (i.e., past 5-day tobacco use, past 12-month alcohol use, diet, sleep troubles, and physical activity) were assessed. Adjusted odds ratios were estimated using logistic and multinomial logistic regression. Results: Trouble sleeping was associated with increased odds of CMD (OR: 2.47) and PD (OR: 2.29) individually, while physical activity was associated with lower odds (OR: 0.75, OR: 0.77). Past 5-day tobacco (OR: 2.36) and past year alcohol (OR: 1.61) use were associated with increased PD odds. Lifestyle factors were associated with increased odds of comorbid CMD and PD. Conclusions: Lifestyle factors were associated with increased odds of individual and comorbid CMD and PD among adults. CMD and PD prevention should involve promoting lifestyle modification and implementation of policies that eliminate structural barriers to healthy lifestyle adoption.

INTRODUCTION:Previous investigations have reported that individuals living in greener neighborhoods have better cardiovascular health. It is unclear whether the effects reported at large geographic scales persist when examined at an intra-neighborhood level. The effects of greenness have not been thoroughly examined using high-resolution metrics of greenness exposure, and how they vary with spatial scales of assessment or participant characteristics. METHODS:We conducted a cross-sectional assessment of associations between blood pressure and multiple high-resolution measures of residential area greenness in spatially concentrated HEAL Study cohort of the Green Heart Project. We employed generalized linear models, accounting for individual-level covariates, to examine associations between different high-resolution measures of greenness and blood pressure among 667 participants in a 4 sq. mile contiguous neighborhood area in Louisville, KY. RESULTS:In adjusted models, we observed significant inverse associations between residential greenness, measured by leaf area index (LAI), and systolic blood pressure (SBP) within 150-250 m and 500 m of homes, but not for Normalized Difference Vegetation Index (NDVI) or grass cover. Weaker associations were also found with diastolic blood pressure (DBP). Significant positive associations were observed between LAI and SBP among participants who reported being female, White, without obesity, non-exercisers, non-smokers, younger age, of lower income, and who had high nearby roadway traffic. We found few significant associations between grass cover and SBP, but an inverse association in those with obesity, but positive associations for those without obesity. CONCLUSIONS:We found that leaf surface area of trees around participants home is strongly associated with lower blood pressure, with little association with grass cover. These effects varied with participant characteristics and spatial scales. More research is needed to test causative links between greenspace types and cardiovascular health and to develop population-, typology-, and place-based evidence to inform greening interventions.

This study examined whether biological sex moderates the relationship between experiences of workplace culture and urinary levels of catecholamines and their metabolites. We conducted a series of regression analyses (predictors: 3-methoxytyramine (3MT), 5-hydroxyindolacetic (5HIAA), and dopamine (DA); outcomes: employee engagement and workplace culture) in a sample of 218 participants. Compared to men, women rated workplace culture less positively (r = −0.210; p < 0.01) and had stronger positive associations with 3MT (r = 0.328; p < 0.001), DA (r = 0.376; p < 0.001), and 5HIAA (r = 0.168; p < 0.01). There was a significant moderation effect between 3MT and sex on employee engagement (b = −1.76 (SE = 0.84); p < 0.01), and 3MT had a positive significant association for men with engagement (p < 0.05); however, there was no significant association for women. Findings suggest that for women, less positive experiences with workplace culture could elevate 3MT, stimulating sympathetic nervous tone and potentially amplifying risks for negative health outcomes. Conversely, men who reported higher employee engagement had higher levels of 3MT, suggesting possible health risks associated with high levels of engagement, rather than lack of engagement. Overall, study findings suggested differential health risks based on biological sex, potentially impacting health risk policy development.

Purpose Health care providers (HCP) are uniquely positioned to advise against electronic cigarette (e-cigarette) use, potentially influencing youth perceptions of e-cigarette harms. However, research examining these associations is scant. We examined whether HCP e-cigarette-related advice is associated with youth e-cigarette harm perceptions. Design Cross-sectional study. Setting National Youth Tobacco Survey data (2022). Subjects 21,254 youth aged 9-18 years. Measures E-cigarette harm perceptions (i.e., relative addictiveness, occasional use harm, and secondhand e-cigarette aerosol (SHA) harm) and HCP advice to abstain from using e-cigarettes (yes/no) were assessed. Analysis Adjusted odds ratios were estimated using multinomial logistic regression models. Results Among the sample, 33.9% perceived e-cigarettes as equally addictive to cigarettes, 39.9% perceived occasional e-cigarette use to cause a lot of harm, and 23.3% perceived SHA to cause a lot of harm. Youth who received HCP advice had higher odds of perceiving e-cigarettes as more addictive than cigarettes (OR: 1.64, 95% CI: 1.35-2.00) and causing a lot of harm (OR: 1.49, 95% CI: 1.16-1.90). Youth who received HCP advice had higher odds of perceiving SHA causing little harm (OR: 1.23, 95% CI: 1.04-1.44). Conclusion HCP advice was associated with youth e-cigarette harm perceptions and perceptions that SHA causes little harm. HCP e-cigarette counseling may help inform understanding of harms, which may reduce or prevent use.

Background: E-cigarette outcome expectancies (i.e., beliefs about the expected consequences of e-cigarette use) are a key factor in motivating use. Emotion regulation difficulties have demonstrated significant associations with outcome expectancies; however, there has yet to be an examination of associations between specific emotion regulation difficulties and specific e-cigarette outcome expectancies, which could serve as targets for intervention efforts. Therefore, the current study sought to examine the unique predictive ability of specific emotion regulation difficulties in terms of e-cigarette outcome expectancies. Methods: Participants were 116 college student e-cigarette users (M-age = 19.72, SD = 1.88; 71.6% female) who completed self-report questionnaires for course credit. Results: Greater difficulties engaging in goal-directed behavior when experiencing negative emotions and fewer difficulties accessing effective emotion regulation strategies were associated with positive reinforcement outcome expectancies. Greater emotion regulation difficulties in general were also associated with negative reinforcement outcome expectancies, though there were no significant individual predictors. Conclusion: These results suggest that greater emotion regulation difficulties are associated with mood-related e-cigarette outcome expectancies, and targeting emotion regulation difficulties, particularly difficulty engaging in goal-directed behavior when upset, may be useful to incorporate into intervention efforts.