Bridging the Gap is a quarterly newsletter from the Knowledge Exchange, Provincial Addiction and Mental Health team at Alberta Health Services. It provides a brief summary of some of the latest research and publications that may be of interest to practitioners in the field of addiction and mental health. Each newsletter provides structured accounts of research on a given topic, based on a limited search of the literature for recent publications. We do not thoroughly assess the quality of the research identified so this publication acts as a signpost for further reading and assessment, rather than as a definitive account of what should be included in clinical practice.

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Tobacco smoking is a leading cause of preventable diseases, contributing to over 8 million deaths worldwide annually. Vaping, introduced as a less harmful alternative to smoking, has seen a rise in popularity, especially among younger demographics. However, both practices are associated with health risks, including respiratory and cardiovascular diseases. As well, emerging evidence is linking vaping to potential harms, such as lung injury and nicotine addiction. Despite the risks, cessation, or reduction interventions, including behavioral therapies and nicotine replacement products, offer effective strategies to address tobacco and nicotine dependence. These strategies also include educational campaigns that highlight the dangers of vaping and smoking, as well as accessible cessation resources specifically designed for younger age groups.

Graham, R., Bharthi, K., Williams, J., Sharifi, V., Pedram, P., Fahim, M., Bulloch, A., & Patten, S. B. (2024). Addictive Behaviors, 149: 107839. doi.org/10.1016/j.addbeh.2023.107839.

Focus of the Study: The cross-sectional study describes the prevalence of e-cigarette use and smoking in Canada by age and gender at three different time points: before the COVID-19 pandemic (October–December 2019) and during two different waves of the COVID-19 pandemic (December 2020–January 2021 and December 2021–January 2022). The study also explores motivations for vaping by comparing users who vape daily, and the proportion of exclusive e-cigarette users compared to dual users (those who use both e-cigarettes and traditional cigarettes).

Key Findings:

» Overall, past 30-day use of e-cigarettes remained consistent, while past 30-day use of cigarettes appeared to decline across the three-time points. There was a large decrease in cigarette use in the past 30 days among females, specifically in the 20-24 age group, indicating that the pandemic had a positive influence for females to decrease their cigarette use in comparison to males.

» The largest past 30-day use of e-cigarettes was among individuals aged 15-19 and 20-24. Although vaping among 15-19 age group remained consistent across the three time points, the largest increase in vaping from 2020 to 2021 occurred among the 20-24 age group.

» Motivations for vaping among those 25 years and older who used in the past 30 days were to quit, reduce, abstain from or substitute for smoking; while those aged 15-24 years old indicated their motivations for vaping were not related to quitting or reducing smoking. The pandemic may have influenced smoking behaviors among younger population to reduce their health risk considering COVID-19, with smoking being a risk factor for severe COVID-19 outcomes.

» Individuals aged 20-24 years increased their vaping from 2020 to 2021 as a coping strategy, in which this group developed nicotine dependency, suggesting that this group to be at a greater risk for starting or increasing e-cigarette use.

Implications for Practice: The study indicated a greater risk among the 20-24 years old in starting and increasing e-cigarette use, suggesting the need for more targeted preventive measures for 20-24 age group to address cigarette and e-cigarette use. Given the high level of interests in vaping found among teenagers in this study, health professionals should focus strategies that include education, support for cessation or reduction, and regulatory measures to mitigate the health risks associated with vaping.

Link to Article: https://pubmed.ncbi.nlm.nih.gov/37839145/.

Bteddini, D. S., LeLaurin, J. H., Chi, X., Hall, J. M., Theis, R. P., Gurka, M. J., Lee, J. H., Mobley, E. M., Khalil, G. E., Polansky, C. J., Kellner, A. M., Fahnlander, A. M., Kelder, S. H., Fiellin, L. E., Gutter, M. S., Shenkman, E. A., & Salloum, R. G. (2023). Addictive Behaviors, 141, 107637.

Focus of the Study: The study evaluated the effectiveness and feasibility of two vaping prevention programs, CATCH My Breath and smokeSCREEN, among rural youth in Florida. CATCH My Breath educates students about e-cigarettes and promoting resistance skills and healthy lifestyles, while smokeSCREEN uses interactive gaming to teach the risks of vaping and smoking. The mixed methods study involved two phases: focus groups with youth aged 11 to 17 to refine the programs based on participant feedback, and a randomized controlled trial (RCT) to measure the programs' impact on knowledge, susceptibility to vaping, risk perceptions, and perceived benefits of not vaping. Pre- and post-assessments were administered to 82 participants who were randomized into three groups: CATCH My Breath, smokeSCREEN, and a control group. 

Key Findings:

» Focus group participants shared their concerns with prevention programs, and recommended acknowledging youth autonomy, addressing stress and mental health, targeting younger age groups, using social media, and providing incentives. Adjustments were made to the programs based on this feedback before implementation. 

» Participants in the CATCH My Breath intervention group showed significant increases in general tobacco-related knowledge and risk perceptions toward other tobacco products.

» The smokeSCREEN intervention group demonstrated significant increase in general knowledge, knowledge about e-cigarettes, and risk perception towards e-cigarettes.

» The control group reported significantly increased risk perception towards cigarettes. 

» Overall, both CATCH My Breath and smokeSCREEN appear to be promising for preventing vaping and tobacco use. Participation in both interventions led to improved knowledge, and higher perception of risks associated with tobacco use.

Implications for Practice: Health professionals should consider creating flexible programs that respect young people's independence. These programs would include information about stress and mental health and use social media to reach youth. These efforts can engage young people better and help them make informed choices about their health. 

Link to Article: https://pubmed.ncbi.nlm.nih.gov/36753933/

Kowitt, S.D., Sheldon, J.M., Vereen, R.N., Kurtzman R.T., Gottfredson, N.C., Hall, M.G., Brewer, N.T., & Noar, S.M. (2023). Nicotine and Tobacco Research, 25(3), 430-437.

Focus of the Study: The research aimed to understand the effects of anti-smoking ads on vaping perceptions and behaviors among adolescents. The study included a national sample of 623 U.S. adolescents aged 13–17 years recruited in 2020 from the AmeriSpeak panel at the University of Chicago. Participants were randomized into four conditions, in which they were exposed to different ads: vaping prevention, vaping control, smoking prevention and smoking control.

Key Findings:

» In comparison to the control group, the vaping prevention ads led to grabbing participants’ attention (more attention), making participants feel scared (negative affect), and making participants think about reasons for not vaping (cognitive elaboration).

» The vaping prevention ads did not affect susceptibility to vaping or perceived likelihood of vaping-related harm or smoking-related outcomes compared to the control group.

» The smoking prevention ads did not affect smoking-related outcomes. However, the smoking prevention ads made youth less susceptible to vaping, led to more negative attitudes about vaping, and led to a higher perceived likelihood of harm from vaping, compared with the control group.

» Findings demonstrate the effectiveness of vaping prevention ads on vaping outcomes and indicate that smoking prevention ads also discourage vaping.

Implications for Practice: To prevent youth smoking and vaping, clinicians should recognize the potential influence of vaping and smoking ads on adolescents’ attitudes and behavior. Clinicians should also consider leveraging these findings in prevention and health promotion for youth.

Link to Abstract: https://pubmed.ncbi.nlm.nih.gov/36006858

Boynton, M.H., Sanzo, N., Brothers, W., Kresovich, A., Sutfin, E.L., Sheeran, & P., Noar, S.M. (2023). Tobacco Control, 32, 228-235. 

Focus of the Study: The study aimed to identify and test the perceived effectiveness of various elements of vaping prevention ads among adolescents aged 13-17 years in the U.S. A total of 1501 youth took part an online study from October 29 to December 3, 2020, in which these respondents were exposed to seven different ads and were asked to rate on perceived message effectiveness (PME) and vaping appeal. 

Key Findings:

» PME was highest for elements that were similar to more traditional tobacco prevention and control messaging such as chemical constituents, negative health effects, graphic images, and warning images.

» Elements that were indicative of industry targeting, environmental impact, flavors, food images and people’s faces were associated with lower PME. Similarly, hashtags, statistics and the use of first-person language, and the word ‘teen’ were associated with lower PME. 

» The study indicated varied PME depending on the current tobacco use status (e.g., current user, susceptible user, and non-user). Most notably, elements relating to lung impacts were associated with higher PME for users, while the word “addiction” was associated with higher PME for non-users.

» Ads with a flavour theme were associated with increased ratings on vaping appeal. 

Implications for Practice: Clinicians should consider excluding references to flavors, or the word ‘teen’ and focus on the harmful health implications of vaping when providing counseling or vaping prevention messages.

Link to Article: https://tobaccocontrol.bmj.com/content/32/e2/e228

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• Vaping:
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• AlbertaQuits Helpline
• QuitCore Group Support
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• The Substance Abuse and Mental Health Services Administration (SAMHSA) has produced the following resources:
• Reducing Vaping Among Youth and Young Adults | SAMHSA
• SAMHSA publishes a Tobacco Cessation Toolkit for Substance Use Disorder Treatment Programs | SAMHSA
• Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings | SAMHSA Publications and Digital Products
• Tobacco, E-Cigarettes, and Vaping | SAMHSA