Use of non-cigarette alternative tobacco products is becoming increasingly prevalent in the United States, particularly among young adults who have the highest rates of use of these products. Limited evidence indicates that 18% of young adults have tried at least one of the following alternatives: snus, hookah, dissolvable tobacco, or an electronic nicotine delivery device (i.e., e-cigarette). Increasing use among young adults is alarming because tobacco addiction is solidified during this developmental period and because tobacco industry marketers have refocused their efforts on this population, their youngest legal targets (>18 years old). Yet, there is limited information on the diversity oftobacco products used by young adults, the changes and patterns of use across time, and the impact oftobacco marketing on young adults'use of noncigarette alternatives. The proposed research will establish a rapid response surveillance system to monitor, and respond to, changes in tobacco marketing and trends in young adults'use of non-cigarette alternatives, including flavored products. Data will be collected semi-annually over a three year period from two subgroups of Texas young adults: students enrolled in 4-year colleges and those enrolled in 2-year vocational programs. Vocational students tend to occupy lower socio-economic status (SES) categories than students enrolled in 4- year colleges, are more likely to be racial/ethnic minorities, and to have higher rates oftobacco use. Disparities in rates oftobacco use between the two groups may be due to differential tobacco marketing, which targets minority and lower SES individuals more heavily than other groups. However, there is no information on how the marketing environments differ across vocational and 4-year students. Our surveillance system will conduct repeated and direct observation of tobacco marketing over three years to characterize the tobacco marketing to which the two groups are exposed and in turn, examine the impact of marketing on changes in tobacco use over time.
The Specific Aims of the research are to: 1) Describe the trajectories and transitions of tobacco use over time and determine the cognitive and affective factors associated with them;2) Document and describe the tobacco marketing to which young adults are exposed;and 3) Determine the impact of marketing on young adults'tobacco use. The proposed research will inform the FDA authority over manufacturing and marketing of tobacco products. For example, this study can provide evidence about the developmental pathways characterizing use of flavored products by subgroups of young adults. As such, this study can inform FDA decisions about allowable constituents and additives during manufacture. Moreover, our comprehensive surveillance oftobacco marketing can inform changes in, or elimination of, marketing in certain channels (e.g., direct mail) and components of advertising content (e.g., images of models). Findings will also strengthen the evidence to enact regulation for tobacco products that are currently unregulated, such as cigars and hookah.

Public Health Relevance

Non-cigarette alternatives have been heavily marketed to young adults, who have the highest rates of use of these products. Documenting trends in the diversity oftobacco products used by young adults and the impact of tobacco marketing on these trends will build the evidence base for the FDA to revise and develop regulations over manufacturing and marketing oftobacco products. Ultimately, these FDA actions will have a major impact on decreasing tobacco-related morbidity and mortality.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center (P50)
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Special Emphasis Panel (ZRG1-BDCN-A)
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University of Texas Health Science Center Houston
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