In California, the overall prevalence of youth cigarette smoking continues to decline, even with the emergence of ANDS.We conducted in-depth qualitative interviews with 49 Californian youth between the ages of 15-25, who reported ever vaping nicotine, to consider whether and how the meanings and role of vaping varies by youth’s pathways of initiation of vaping and smoking. By understanding how youth, with various NT use pathways, make sense of their vaping practices, we can more fully understand youth’s motivations for vaping and identify innovative and responsive prevention, treatment, and policy efforts that may be better tailored to youth’s unique needs and experiences. This study is based on narrative data from in-depth interviews with 49 youth. Volunteers were recruited using street-level outreach methods ,through Facebook advertising, and by referral to participate in a 2-hour openended interview designed to collect descriptive data on the participant’s background and everyday life; their NT use pathways and current use practices, the socio-cultural meanings of e-cigarettes and cigarettes in youths’ lives; and perceptions of NT control policies. In person or by phone, participants were screened for eligibility which included being between 15-25 years old, reporting ever vaping nicotine, and living in the San Francisco Bay area. Preceding the interview, a questionnaire was administered that included basic demographics and questions about NT use, including age of initiation and past 30-day use. We obtained parental consent from eligible volunteers under the age of 18. All participants provided consent or assent to participate and received a $50 honorarium. Study procedures were approved by our Institutional Review Board. Interviews were digitally recorded,cannabis growing equipment professionally transcribed, and integrated with ATLAS.ti, a qualitative data management software program. The first stage of analysis included coding all transcripts to isolate narratives by topic into manageable analytical segments.
The codelist was developed by the authors, informed by existing literature and preliminary analysis of interviews. Codes were extensive and included perceptions of smoking and vaping, initiation stories, social motivations of use, pathways of use, cessation motivation, and future intentions of use. Using questionnaire data on age of initiation of both vaping and smoking, the lead author categorized each participant according to 3 pathways: vaping-to-smoking, smoking-to-vaping, and vaping only, and then grouped interview transcripts by pathways to structure analysis of the coded data and to *Please do not circulate without permission from the corresponding author. compare whether participants’ perceived role of vaping varied by pathway of use. The lead and second author then conducted a second phase of thematic analysis to identify emergent themes from the narrative data.We also examined divergent and conflicting discourses within interviews to reduce threats to validity by challenging our a priori assumptions, including the use of ANDS for cessation.Quotations from participants introduced below are identified by participant-selected pseudonyms to maintain anonymity. The most common pathway reported among participants was smoking-to-vaping, with 36 of 49 participants characterized into this pathway. Eight participants began vaping prior to smoking and five participants reported only vaping but never smoking . Though youth held different attitudes about vaping—many were indifferent, others regarded them as “lame”, and a few considered vaping “cool”—nevertheless, participants’ narratives about their initiation pathways revealed important insights into the role that vaping played in their lives. Overall, analysis illustrated that regardless of pathway, youth considered vaping to be a valuable alternative to smoking, often chosen in consideration of relative risk. The ways in which participants across pathways described vaping as an alternative varied, yet their discussions collectively highlighted widespread acknowledgement of the risks associated with smoking and how they attempted to minimize those risks by vaping.
This qualitative study sought to understand the perceived role of vaping among youth who initiated vaping according to different pathways of nicotine use. Overall, youth, regardless of initiation pathway, were fully aware of the health consequences of smoking, and their decisions to vape reflected considerations of relative risk where vaping was seen as a suitable alternative to smoking. Some studies suggest that vaping as an alternative to smoking does not suggest a rational process of risk reduction but instead illustrates the ways in which nicotine consumption can be maintained in settings where smoking is prohibited.However, narratives from our participants reflected the ways in which youth considered risk reduction whereby vaping was strategically used to replace or reduce smoking to minimize short and long-term health risks, as a less harmful form of nicotine for coping with stress, or to temporarily engage in the positive social aspects of youthful experimentation while reducing the personal risks smoking presented. The fact that youth consider relative risks and integrate ANDS as a transitional behavior towards smoking cessation highlights the need to acknowledge harm reduction in constructing public health messaging and policies. To date, studies have not sufficiently considered the practice of harm reduction among young people despite some qualitative research suggesting that they may very well be seeking out relatively less harmful nicotine products, like ANDS, either in lieu of or to reduce/quit smoking cigarettes.For example, in a qualitative study of 50 young e-cigarette users in Scotland and Northern England, McKeganey and colleagues found that decisions to continue vaping were often related to youth’s perceptions that e-cigarettes were less harmful than smoking.Likewise, Robertson and colleagues, found that though vaping was originally intended for smoking cessation among some of their participants, vaping “failed to meet their expectations” and therefore goals to eliminate smoking shifted into goals to reduce smoking.Participants in our study were generally more positive about vaping as a suitable replacement for smoking. But, like Robertson’s participants, they similarly perceived the reduction in smoking that vaping facilitated to be valuable on the pathway towards eventual smoking cessation.
Tobacco harm reduction approaches emphasize the substitution of less harmful forms of nicotine for more harmful combustible tobacco products for smokers, who are unable or unwilling to quit.Though some approaches to tobacco control may be considered harm reduction strategies ,most often abstinence is an explicitly-stated goal and discussions of reducing harm remain controversial, particularly when it comes to nicotine use by young people.This is largely due to concerns about the developmental risks associated with any nicotine consumption and the threat of long-term addiction,combined with beliefs that young people behave irrationally and are in need of protection. This study suggests, instead, that youth are applying a logic of risk reduction to negotiate their nicotine use. Though tobacco harm reduction is arguably viewed as a “source of one of the most divisive…debates in tobacco control history,”our study highlights that tobacco harm reduction may be gaining momentum not as an explicit tobacco control strategy but rather as a “consumer-led health initiative” due to youth’s use of vaping to reduce smoking-related harms.Our findings should be interpreted in light of the following limitations. First the sample is not a representative sample of young vapers in the San Francisco bay area nor can it suggest which pathway of NT use is most common. Qualitative research is well-suited for identifying under explored or unanticipated phenomena to inform hypotheses for future studies. Second, this study did not set out to compare perceptions across initiation pathways and, thus, did not have equal numbers of participants in each pathway. However, it is intriguing that the majority of ever vapers recruited into the study were classified in the smoking-to-vaping pathway, particularly in light of the invisibility of young people characterized by this pathway in the existing literature.Notably, since this was a study of youth who reported ever vaping, none were characterized into a smoking-only pathway. Future research should consider meanings of vaping among never vaping youth, both who smoke and those who do not. Also, this study cannot predict to what extent vaping for harm reduction ultimately leads to smoking cessation. This issue should be examined in future studies with longitudinal designs. Finally, we included a broad range of youth, 15-25 years old. Because qualitative research concerned with identifying variation of experience, we focused broadly on youth, as a socially-constructed category defined less by chronology and more by its progression of stages.Individuals experiencing homeless in the United States have high lifetime rates of incarceration, cannabis plant growing with estimates ranging from 20 to 70%.Homelessness and incarceration share many risk factors, both health-related and economic.Individuals experiencing homelessness have an increased risk of police citations related to survival behaviors , heightened visibility to law enforcement, and decreased ability to adhere to conditions of parole or pay citations, increasing the risk of arrest.
After incarceration, people have an increased rate of homelessness,and incarceration leads to increased housing vulnerability due to loss of housing during incarceration, decreased eligibility for employment and public housing, and disrupted community ties.The average age of single adults experiencing homelessness in the US has increased; the proportion age 50 or older is growing.The US criminal justice population is also aging.Adults 55 or older in prison increased by 366% between 1999 and 2016,and in jails, by 278% between 1996 and 2008.The prevalence of, and risk factors for, incarceration among older adults experiencing homelessness remains unexamined. Most studies examining incarceration and housing instability are retrospective or cross-sectional analyses including all ages.In the general population, incarceration decreases with age, though rates remain high among older homeless adults. Understanding older adults’ unique risk factors for incarceration is critical to target interventions to prevent criminal justice involvement. This is increasingly important as the COVID-19 pandemic has had a disproportionate impact on people living in congregate settings.Understanding movement between homelessness and the criminal justice system can inform interventions to prevent SARS COV-2 transmission, particularly among older adults who are at increased risk of severe disease and death. Therefore, in a prospective cohort of older adults who were homeless at study entry, we examined factors associated with subsequent incarceration over the multi-year study period including sociodemographic, social, housing, and health factors. We hypothesized that continued homelessness, substance use, mental illness, and cognitive impairment would be associated with incident incarceration.We completed a descriptive analysis using all variables from baseline. Variables included only in the descriptive analysis were income, illicit income sources, duration of homelessness, hospitalizations, and history of incarceration. To identify risk factors for incarceration, we selected independent variables based on our hypotheses. We assessed bivariable associations between a priori independent variables and incarceration using an extended Cox hazard model to incorporate multiple, independent events and time-varying covariates. We used 6-month intervals as the period of measure for time-to-event outcomes. In the hazard models, we included demographics , life history , and cognitive impairment as time-constant variables assessed at baseline. We included all other variables as time varying. We estimated our multi-variable model by including variables with bivariable type III p-values < 0.20. If a categorical variable had more than two levels, we included all levels in our multi-variable model if any type III pvalue was < 0.20. We reduced the model using backward elimination by retaining variables with type III p-values < 0.05 in our final model. We conducted our analysis in SAS using complete case analysis and robust confidence intervals. In a sensitivity analysis, we estimated models without the probation and parole variables. We estimated models separately for homelessness based on HEARTH and nights unsheltered to assess the role of unsheltered homelessness and rehousing on incarceration. First, we estimated models including HEARTH and covariates. Then, we replaced HEARTH with any nights unsheltered.In this prospective study of older adults experiencing homelessness, almost one-quarter experienced at least one incarceration event during follow-up. We found several risk factors for incarceration that are associated in the general adult population, including substance use, and being on parole or probation. Building on prior data about the association between homelessness and incarceration, we found that individuals who continued to experience homelessness at follow-up had an elevated risk of incarceration compared to those who exited homelessness. We found that having a larger social network is associated with incarceration, which has not been reported previously. Though the median age of the cohort at baseline was 58, participants had a burden of disease and disability commensurate with adults aged 15–20 years older.Individuals experiencing homelessness, like those in prisons, experience an early onset of geriatric conditions and are considered “older” by age 50.Despite this population’s relative frailty, study participants continued to experience incarceration.