BACKGROUND: Epidemiological studies have described an acculturation paradox. Increased acculturation to the United States is associated with increased consumption of dietary fat and decreased consumption of fruits/vegetables. OBJECTIVE: To expand understanding of the dietary acculturation paradox, this study examined how bicultural Mexican-American women construct ethnic identity and how these identities and identity-making processes relate to perceptions of health and nutrition. DESIGN: We utilized embedded mixed methods (in-depth interviews; survey). PARTICIPANTS/SETTING: We analyzed a purposive sample of English-speaking Mexican-American women aged 18 to 29 years (n=24) in rural California to assess ethnic identity and diet beliefs. RESULTS: Participants described food as central to expressing cultural identity, usually in terms of family interactions. Mexican food traditions were characterized as unhealthy; many preferred American foods, which were seen as healthier. Specifically, Mexican-American women perceived Mexican patterns of food preparation and consumption as unhealthy. In addition, traditional Mexican foods described as unhealthy were once considered special-occasion foods. Among the participants who expressed a desire to eat healthfully, to do so meant to reject Mexican ways of eating. CONCLUSIONS: This study raises questions about the nature of the dietary acculturation paradox. While food-the eating of Mexican foods-is central to the maintenance of ethnic identity throughout acculturation, negative perceptions about the healthfulness of Mexican foods introduce tension into Mexican-American womens self-identification. This study suggests a subtle contradiction that may help to explain the dietary acculturation paradox: While previous research has suggested that as Mexicans acculturate to the United States they adopt unhealthy diets, this study finds evidence that they do so at least in part due to perceptions that American diets are healthier than Mexican diets. Implications for interventions to improve Latinos diets include an emphasis on the family and use of Spanish linguistic cues. Finally, messages that simply advocate for traditional diets should be reconsidered because that message is discordant with perceptions of the healthfulness of such foods.

Introduction

Financial strain and discrimination are consistent predictors of negative health outcomes and maladaptive coping behaviors, including tobacco use. Although there is considerable information exploring stress and smoking, limited research has examined the relationship between patterns of stress domains and specific tobacco/nicotine product use. Even fewer studies have assessed ethnic variations in these relationships.

Methods

This study investigated the relationship between discrimination and financial strain and current tobacco/nicotine product use and explored the ethnic variation in these relationships among diverse sample of US adults (N = 1068). Separate logistic regression models assessed associations between stress domains and tobacco/nicotine product use, adjusting for covariates (e.g., age, gender, race/ethnicity, and household income). Due to statistically significant differences, the final set of models was stratified by race/ethnicity.

Results

Higher levels of discrimination were associated with higher odds of all three tobacco/nicotine product categories. Financial strain was positively associated with combustible tobacco and combined tobacco/nicotine product use. Financial strain was especially risky for Non-Hispanic Whites (AOR:1.191, 95%CI:1.083-1.309) and Blacks/African Americans (AOR:1.542, 95%CI:1.106-2.148), as compared to other groups, whereas discrimination was most detrimental for Asians/Pacific Islanders (AOR:3.827, 95%CI:1.832-7.997) and Hispanics/Latinas/Latinos (AOR:2.517, 95%CI:1.603-3.952).

Conclusions

Findings suggest discrimination and financial stressors are risk factors for use of multiple tobacco/nicotine products, highlighting the importance of prevention research that accounts for these stressors. Because ethnic groups may respond differently to stress/strain, prevention research needs to identify cultural values, beliefs, and coping strategies that can buffer the negative consequences of discrimination and financial stressors.

E-cigarettes were initially introduced as a less harmful alternative to combustible cigarettes, but marketing efforts may now be exceeding these claims by associating e-cigarettes with words related to healthy foods. These associations could mislead people to assume vaping is a healthy practice. Tweets from January to March 2017 were obtained from the Twitter Streaming Application Programming Interface (API) to assess content about vaping linked to healthy food words. Tweets were classified into one of nine categories along with their source (marketer vs. non-marketer). We content analyzed original English language public postings on Twitter that included vaping-related keywords and at least one of eight co-occurring healthy food-related labels (e.g., 'natural,' 'vitamin,' 'vegan,' and 'organic') (N = 1205). Chi-square analyses compared themes by message source. Findings suggest vaping is being marketed in ways that could paradoxically lead consumers to believe that e-cigarettes are health-enhancing. We found more tweets representing vaping as health-enhancing (9%) than referring to it as a smoking-cessation device (1%). The largest category of tweets referred to vaping as harmless (28%) and therefore compatible with a healthy lifestyle. Tweets presenting vaping as harmless or with a sensation theme were more likely to be authored by marketers than by non-marketers. Food and drug regulation needs to be more vigilant to prevent misleading advertising from e-cigarette marketers.

Vape shops are popular brick-and-mortar stores that sell e-cigarette products but are not understood well. Previous analysis of Yelp reviews of vape shops located in various ethnic neighborhoods in Los Angeles, California in 2014 identified characteristics of vape shop as delineated by consumers. In this study, we assessed the associations between these characteristics and vape shops going out of business in 2015. Content analysis of Yelp reviews of 72 vape shops in 2014 identified 1) general characteristics of the reviews/reviewers, 2) vape shop, staff, and marketing attributes, 3) physical environment, and 4) health claims. In 2015, in-person visits confirmed that 22% of these vape shops closed permanently. We analyzed whether characteristics/attributes identified in 2014 associated with stores remaining open (n = 56) or permanently closing (n = 16) in 2015. Univariate findings showed that open vape shops relative to closed shops had greater 1) number of reviews, 2) rebuilds/fixings, 3) ratings of staff attributes as "helpful/patient/respectful," and 4) report of the physical environment as "bar type." Bar type vape shops and those with rebuilding/fixing capabilities were associated with staying open, suggesting the popularity of these attributes. Yelp consumer reviews is a useful research tool to identify consumer-determined important sustaining attributes of vape shops and may be used to identify aspects of enduring shops that need regulations.

Introduction

Given increasing efforts to regulate e-cigarettes, it is important to understand factors associated with support for tobacco regulatory policies. We investigate such factors found in social media and hypothesize that greater online engagement with tobacco content would be associated with less support for e-cigarette regulatory policies.

Methods

We constructed social networks of Twitter users who tweet about tobacco and categorized them using a combination of social network and Twitter metrics. Twitter users were identified as representing leaders, followers or general users in online discussions of tobacco products, and invited to complete an online survey. Participants responded to questions about their engagement with tobacco-related content online, degree of support for e-cigarette regulations, exposure to tobacco marketing, e-cigarette use and other demographic information. We examined links between their reported engagement with tobacco-related content and support for e-cigarette regulatory policies using structural equation modelling.

Results

The analytic sample consisted of 470 participants. The conceptualized structural equation model had a good fit (χ² (32) = 24.85, p = 0.09, CFI = 0.99, RMSEA = 0.03). Findings support our hypothesis: engagement with online tobacco content was negatively associated with support for e-cigarette policies, while controlling for e-cigarette use, tobacco marketing exposure, social media use frequency and demographic factors.

Conclusions

Findings suggest that our hypothesis was supported. Twitter users engaging with tobacco-related content and harboring negative attitudes toward e-cigarette regulatory policies could be an important audience segment to reach with tailored e-cigarette policy education messages.

There has been a surge in the number of vape shops in the USA. Research on the marketing practices of e-cigarette manufacturers is scarce and even less known are the practices of vape shop retailers. Past research on tobacco marketing has shown differences in the amount and content of marketing material, based on a community's demographic profile. This study examined marketing strategies in vape shops and explored differences among vape shops located in communities that differ by ethnic composition. Data was gathered in 2014 from a pilot-study on vape shops (n=77) in Los Angeles, which documented the characteristics of shops through employee interviews and in-store observations. Data were collected from shops located in communities that were predominantly, African-American (n=20), Hispanic (n=17), Korean (n=18), or non-Hispanic White (n=22). Sixty-one percent of vape shops had advertisements (print ads and posters) for e-cigarettes and 84% offered discounts. Vape shops in Hispanic communities were more likely to have ethnic specific marketing material compared to shops in other communities. All the shops provided customers with free samples, however those in Korean and non-Hispanic White communities had a significantly higher prevalence of customer accessible free samples. Vape shop marketing practices differed by ethnic community. A large majority of shops provided free samples to their customers, a practice which is now banned by the FDA. It will be important to monitor how vape shops will adjust their marketing strategy because of this ban. Future research should expand on the findings presented here to provide regulators with further crucial information.

Background

This study analysed posts to Instagram related to KandyPens, an open-system pod mod e-cigarette company, marketing its products as aromatherapy devices. The objective was to determine themes, corresponding user profiles and references to types of e-liquid solutions used with KandyPens.

Methods

Data consisted of publicly available posts to Instagram with the hashtag '#kandypens' collected from 8 June to 8 August 2018 (n=1775). Identified themes included: product appearance (eg, highlighting design features including colour of device), user experience (eg, vape tricks), flavours (eg, strawberry) and promotions (eg, $10 off). The type of e-liquid solutions (nicotine, aromatherapy and cannabis) used with KandyPens were also recorded. Instagram profiles were categorised into: vaping enthusiast/advocates, influencers, KandyPens' official Instagram account, vape vendors and average Instagram users.

Results

User experience (28.90%) and product appearance (21.80%) were predominant themes followed by promotions (10.08%), and flavours (1.01%). About 32.43 % of posts referenced cannabis-related solutions, 2.98 % of the posts mentioned nicotine-related solutions and 0.11 % of the posts mentioned aromatherapy. Average Instagram users (24.89%) posted the majority of posts followed by vape vendors (20.72%), KandyPens' official account (17.96%), vaping enthusiasts/advocates (10.75%) and influencers (0.45%).

Conclusion

KandyPens markets its products as aromatherapy devices; however, Instagram posts related to these products rarely mentioned their purported purpose. Future research should consider product design, user experience and the co-use of nicotine and cannabis with KandyPens to assess implications related to product appeal and abuse liability.

Social media platforms offer opportunities for targeted health communication ads to improve tobacco and cannabis prevention efforts. This study described tobacco and cannabis-related ads targeted towards adolescents and young adults on Snapchat. Data comprised of publicly available tobacco (n = 70) and cannabis-related (n = 64) ads from Snapchat in 2019. Identified themes included: Health consequences (Health effects of tobacco or cannabis use), Financial & legal consequences (Adverse financial or legal implications of substance use), Quitting (Resources for cessation), Industry tactics (Tobacco industry misleads individuals), Policy advocacy (Cannabis law reforms or legalization). Ad performance metrics included average Ad Impressions (number of views per ad) and Ad Spend (cost per ad). Ads were also categorized by Sponsoring Organizations (Government or Advocacy organizations). Health Consequences was the predominant theme followed by Quitting among tobacco-related ads. Government organizations sponsored most tobacco-related ads. Tobacco-related ads targeting adolescents received mean = 4,122,071 impressions and cost mean = $10,385.6 per ad. Tobacco-related ads targeting young adults received mean = 2,151,217 impressions and cost mean = $5,382.1 per ad. Health Consequences was a predominant theme among cannabis-related ads followed by Policy Advocacy. Advocacy organizations sponsored most cannabis-related ads targeting young adults. Cannabis-related ads targeting adolescents received mean = 415,293.8 impressions and cost mean=$793.92 per ad. Cannabis-related ads targeting young adults received mean = 293,267.7 impressions, and cost mean = $740.58. Government and advocacy organization sponsored ads reached millions of adolescents and young adults on Snapchat. Prevention campaigns may consider these number of impressions and cost per ad by theme when designing platform specific ads in the future.