Background: Given increasing use of e-cigarettes among adolescents in the United States and its potential for nicotine addiction, encouraging adolescents to quit using these products has become a public health priority. This study examined factors at various socio-ecological levels associated with e-cigarette quit intention (pre-contemplation, contemplation, or preparation) using the Stages of Change of the Trans-theoretical Model among the U.S. adolescents. Methods: We used cross-sectional data from the past 30-day adolescent exclusive e-cigarette users participating in Wave 4 of the Population Assessment of Tobacco and Health study (n = 349). Weighted adjusted multinomial logistic regression models were used to analyze the data. Results: Compared to pre-contemplators and contemplators, preparators were more likely to believe that nicotine in e-cigarettes was “very/extremely harmful” (vs. “not at all harmful”) to health (p < 0.001) and people cause a “lot of harm” (vs. “no harm”) to themselves when they use e-cigarettes (p < 0.001). In comparison to pre-contemplators, contemplators and preparators were more likely to report that their parents/guardians talked with them about not using e-cigarettes than those whose parents/guardians did not talk with them (p < 0.001). Additionally, contemplators and preparators were also more likely to report that they “often/very often” (vs. never) noticed health warnings on e-cigarette packages (p < 0.001). Conclusion: Our findings suggest that harm perception, influence of family, and e-cigarette health warnings are some of the important factors associated with the stages of change for intention to quit among adolescent e-cigarette users. This study will help public health practitioners and researchers design multi-level e-cigarette cessation interventions for adolescents.

Patient-centered communication (PCC) plays a pivotal role in improving healthcare quality and health outcomes. A plethora of cancer prevention-related information is publicly available, potentially leading to cancer information overload (CIO). However, little is known about whether experience with PCC can help prevent or reduce CIO among adults without a history of cancer. Pooled data from the Health Information National Trends Survey (HINTS 5, Cycles 1-4, 2017 through 2020) were utilized for 10,636 non-institutionalized U.S. adults (≥18 years) without a history of cancer. The CIO was constructed based on respondents' experiences of difficulties following myriad cancer prevention recommendations. Experience of PCC was measured on a composite score scale of 0 to 100 based on elements of the PCC model for patient-healthcare provider encounters. A multivariable logistic regression model was fitted to investigate associations between PCC and CIO. Approximately 75.0% of the study respondents with a lower mean PCC expressed experiencing CIO (79.1 vs. no-CIO = 82.1, p < .001). With each one-unit score increase on the PCC scale, the odds of experiencing CIO decreased by approximately 1% (adjusted OR = 0.993; 95% CI: 0.988, 0.997; p < .01). The findings highlight that higher levels of PCC are associated with reduced odds of experiencing CIO. Increased PCC could help individuals better navigate cancer prevention-related information, thus reducing stress and improving informed decision-making. Healthcare providers and policy initiatives should promote tailored cancer prevention communication practices that prioritize patient-centeredness.

Background: Waterpipe (WP) smoking has become a global public health problem in recent decades and growing evidence indicates that it can cause nicotine dependence. Most evidence on WP dependence to date has been derived from survey- or laboratory-based studies. This study employed qualitative methods to explore WP users’ perceptions of dependence in Aleppo, Syria. Methods: A total of 15 focus groups were conducted with 64 adult WP smokers (51 males and 13 females) using a semi-structured interview. All focus group discussions were audiotaped, transcribed, and coded using directed content analysis. Findings: Several WP dependence features were consistent with those commonly reported by cigarette smokers. These included positively reinforced features, such as smoking’s association with social gatherings and cultural connectedness, and negatively reinforced features including relief of withdrawal symptoms, stress, and boredom. Although interest in quitting was low, many users perceived quitting WP to be difficult and an indicator of loss of control over smoking, a common marker of dependence. Several observed dependence features were specific to WP, including transitioning from social smoking to smoking alone, and adapting one’s behavior to the considerable effort normally required to engage in WP smoking despite inconvenience or cost, and often at the expense of other reinforcers such as social interaction. Conclusion: The general and specific features of WP dependence need to be considered in developing instruments to measure WP dependence, in clinical assessment of WP dependence, and in developing cessation programs.