Understanding uncontrolled vaping among vulnerable populations - PROJECT ABSTRACT Use of e-cigarettes or vapes is increasingly popular. Vulnerable populations most likely to vape include adolescents and young adults, sexual minorities, and people with poor mental health. Vaping is likely less harmful overall than smoking combustible cigarettes. Nevertheless, some users vape at frequencies that far exceed what they prefer, which we term uncontrolled vaping, augmenting health risks and producing greater addiction. In light of these concerns, some e-cigarette users may take actions intended to get their vaping under control. This vaping restraint could reduce health risks and support cessation of tobacco products including e-cigarettes. Vaping restraint strategies may present more challenges than efforts to reduce smoking because e-cigarette portions and refill sizes are unregulated, leaving users without familiar cues to encourage portion control (e.g., the end of a cigarette). However, the prevalence of uncontrolled vaping and restraint strategies is unknown, including for vulnerable populations. To fill these important gaps, the overarching goal of the proposed research is to understand uncontrolled vaping as well as vaping restraint strategies, which likely vary substantially across vulnerable populations, different device types, and dual use with combustible cigarettes. We build on the Process Model of Self-Control, hypothesizing greater impact of situational than cognitive restraint strategies. In Aim 1, we will develop measures of uncontrolled vaping and restraint strategies. We will conduct phone interviews with adolescent, young adult, and adult current e- cigarette users to identify language they employ to describe uncontrolled use and vaping restraint and then develop survey measures. In Aim 2, we will characterize the prevalence and correlates of both uncontrolled vaping and restraint strategies. We will survey a probability sample of current e-cigarette users (including adolescents, young adults and adults) and evaluate the suitability of the new measures among vulnerable populations. We will then calculate national estimates of uncontrolled use and vaping restraint strategies, and examine whether these outcomes are more common among vulnerable populations, certain device type users, and dual users. In Aim 3, we will establish the longitudinal impact of vaping restraint strategies on uncontrolled vaping. We will conduct a follow-up online survey at 12 months with the e- cigarette users from the Aim 2 sample. We will examine the association of baseline vaping restraint with uncontrolled vaping and smoking behavior 12 months later. Findings from the proposed research can inform regulatory science for e-cigarettes (e.g., by creating product standards for refill size and device features associated with uncontrolled use). The proposed research is responsive to FDA and NCI scientific interest areas of Addiction and Behavior.
