Category: Research

  • Cannabis Research Institute Opens in Chicago

    Cannabis Research Institute Opens in Chicago

    Credit: Spiroview

    Illinois has launched the Cannabis Research Institute (CRI), a first-of-its-kind center in the American Midwest for innovative pot studies.

    The new research hub announced last week will be a joint venture between the State of Illinois, the City of Chicago, and Discovery Partners Institute (DPI), part of the University of Illinois system.

    The institute’s aim is to develop a comprehensive body of data and research to educate the public about the socio-economic and scientific impacts of pot production and usage.

    The institute plans to undertake broad research covering everything from crop management to social impacts and health and wellness, media outlets report.

    Example topics will include the efficacy of pot and cannabis extracts for treating medical ailments such as inflammation and anxiety; the impact of legalization on the community and broader society; public health ramifications of legalizing adult-use cannabis; and the improvement of pot plants through controlled environmental conditions.

    To help ensure the CRI accomplishes those goals the DPI will be forming and leading a research team comprised of different communities, research institutions, businesses and government authorities.

  • NYTS: Youth Vape Use at Lowest Level in Decade

    NYTS: Youth Vape Use at Lowest Level in Decade

    VV Archive

    Half a million fewer U.S. youth reported current use of e-cigarettes in 2024 compared to 2023, according to new data from the National Youth Tobacco Survey (NYTS) released by the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention (CDC).

    The nationally representative data featured in the Morbidity and Mortality Weekly Report (MMWR) includes findings on e-cigarette and nicotine pouch use among U.S. youth, two categories of tobacco products the FDA and CDC are monitoring closely, particularly regarding youth use and appeal.

    NYTS is an annual school-based, self-administered survey of U.S. middle (grades 6–8) and high school (grades 9–12) students conducted Jan. 22 to May 22, 2024. Findings showed there was a significant drop in the number of U.S. middle and high school students who reported current (past 30 days) e-cigarette use – a decrease from 2.13 million (7.7%) youth in 2023 to 1.63 million (5.9%) youth in 2024.

    This decline was primarily driven by reduced e-cigarette use among high schoolers (1.56 million to 1.21 million), with no statistically significant change in current e-cigarette use among middle school students within the past year. According to an FDA release, the number of youth who used e-cigarettes in 2024 is approximately one-third of what it was at its peak in 2019, when over five million youth reported current e-cigarette use.

    “The continued decline in e-cigarette use among our nation’s youth is a monumental public health win,” said Brian King, director of the FDA’s Center for Tobacco Products (CTP). “This progress is a testament to the relentless efforts by the FDA, CDC, and others, particularly over the past half-decade. But we can’t rest on our laurels, as there’s still more work to do to further reduce youth e-cigarette use.”

    Among youth who currently used e-cigarettes, 26.3% reported using e-cigarettes daily. The vast majority of youth who currently used e-cigarettes used flavored products (87.6%), with fruit (62.8%), candy (33.3%) and mint (25.1%) being the top three most commonly used flavors. Disposable e-cigarette products were the most common product type used; however, the most popular brands included both disposable and cartridge-based products.

    Among youth who currently used e-cigarettes, the most commonly reported brands were Elf Bar (36.1%), Breeze (19.9%), Mr. Fog (15.8%), Vuse (13.7%) and JUUL (12.6%).

    Over the past year, a substantive drop occurred in youth reporting use of e-cigarette products under the Elf Bar brand – from 56.7% in 2023 to 36.1% in 2024. Elf Bar is not authorized by the FDA and has been the subject of focused compliance and enforcement actions by the agency since early 2023, including more than 1,000 warning letters and 240 civil money penalties to retailers and others in the supply chain.

    The FDA has also issued import alerts that include products under the Elf Bar brand, which places them on the “red list” and allows the agency to detain products without conducting a full inspection at the time of entry.

    Youth nicotine pouch use did not show a statistically significant change from 2023 (1.5% in 2023 and 1.8% in 2024). Of the nearly half a million middle and high school students who reported current nicotine pouch use, 22.4% used them daily.

    The most commonly reported brands among that group were Zyn (68.7%), on! (14.2%), Rogue (13.6%), Velo (10.7%) and Juice Head ZTN (9.8%). Among those who currently used nicotine pouches, the vast majority used flavored products (85.6%), with mint (53.3%), fruit (22.4%) and menthol (19.3%) being the most commonly used flavors.

    “While it’s encouraging to see these numbers currently remaining relatively low, the bottom line is that we are concerned about any youth appealing tobacco product,” King said. “Our guard is up. We are aware of the reported growing sales trends for nicotine pouches and are closely monitoring the evolving tobacco product landscape for threats to public health, particularly when it comes to kids.”

  • Research Grant to Study Biopesticides for Hemp

    Research Grant to Study Biopesticides for Hemp

    Credit: Mex Chriss

    The economic importance of hemp is increasing globally and in the United States. However, because federal laws restricted hemp growth and research until recently, commercial hemp production lacks best practices for cultivation, including effective and safe pest and disease management.

    The Foundation for Food & Agriculture Research’s (FFAR) Hemp Research Consortium is providing Cornell University with a $210,000 grant to identify biologically derived crop protection products—biopesticides—to control hemp’s major pest and disease threats.

    BioWorks and the University of Kentucky (UK) are participating in the research, and BioWorks is providing matching funds for a total investment of $420,000.

    “Research on hemp production is still in its infancy, and pests and disease can be an overwhelming challenge for many growers,” said Kathy Munkvold, FFAR scientific program director. “This project is providing actionable knowledge that will help the hemp production industry thrive.”

    Companies developing crop protection products currently focus on fruit, vegetable, and commodity crops such as corn and soy, rather than newer crops like hemp. This project seeks to fill that gap through a partnership between academic institutions and industry, according to a press release.

    Researchers at Cornell, BioWorks and UK, led by Christine Smart, director of Cornell AgriTech, are determining the effectiveness of biopesticides against several hemp diseases and investigating the tolerance of hemp crops to these products.

    They are also studying the compatibility of biopesticides with other crop protection products used in hemp production. In addition, the team is examining how long the microbes in bioproducts remain on the plant, which is important for product application timing and post-harvest hemp microbial testing required for some hemp products.

    The research will broaden the understanding of how to effectively manage the pests and diseases that undermine hemp production and inform recommendations for controlling those threats. Ultimately, growers will save money through the proper use of inputs and higher crop yield, and consumers will gain more comprehensive access to safe, high-quality hemp products, according to a press release.

    “Hemp growers are looking for information on pest and disease control, and I am enthusiastic that this project will enable improved management strategies,” said Smart.

    To learn more about this grant, visit the Evaluating Biopesticides for the Treatment of Hemp page on FFAR’s website.

  • Study: Troubled Teens Likely to Start Vaping

    Study: Troubled Teens Likely to Start Vaping

    A new study has found that Australian high school students with symptoms of severe depression or poor well-being are twice as likely to have tried vaping.

    The study also found one-fifth of students in 7th and 8th grade had moderate to severe depression symptoms and demonstrated the need for early intervention targeting both mental health and vaping, experts said.

    In 2023, more than 5,000 students aged 12 to 14 were surveyed for the study as part of the OurFutures vaping prevention program led by the University of Sydney’s Matilda Centre, according to media reports.

    The results, published in the Australian and New Zealand Journal of Psychiatry, showed one-third of the cohort reported poor well-being, another third had high stress, and one-fifth had high anxiety.

    Students who reported moderate or high stress levels were 74% or 64% more likely to have tried vaping, respectively, than those who reported low levels of stress, though anxiety levels seemed to have little relationship with vape use.

    According to Michelle Jongenelis, an associate professor at the University of Melbourne, the results demonstrated the importance of early effective mental health support for young teenagers.

    The study added to previous research suggesting a connection between nicotine use and mental health issues but could not offer an explanation as data was drawn from a single point in time.

  • Finnish Youth Drop Smoking, E-Cigarette Use Rising

    Finnish Youth Drop Smoking, E-Cigarette Use Rising

    Image: sezerozger

    Finnish teens are drinking and smoking less but using more e-cigarettes and nicotine pouches, reports the Helsinki Times, citing findings from a European survey

    The European School Survey Project on Alcohol and Other Drugs (ESPAD) has been monitoring substance use among European students since 1995.

    Conducted every four years, the survey includes 16-year-olds across 23 to 39 European countries.

    The proportion of ninth graders who have never consumed alcohol has increased dramatically from 10 percent in 1995 to 35 percent in 2024.

    Only 6 percent of boys and 4 percent of girls smoked daily in 2024, down from around 20 percent at the beginning of the decade. However, vaping has been rising, with 40 percent of teens having tried e-cigarettes, up from 34 percent in 2019. Daily use is reported by 9 percent of boys and 13 percent of girls.

    The use of snus, a form of smokeless tobacco, has also dropped. In 2024, 26 percent of boys and 13 percent of girls had tried snus, with daily use at 7 percent for boys and 3 percent for girls.

    Teen use of nicotine pouches increased after Finland permitted the sale of modern oral products in 2023. By 2024, 31 percent of boys and 17 percent of girls had tried nicotine pouches, with 11 percent of boys and 3 percent of girls using them daily.

    Cannabis experimentation decreased slightly during the period studied, particularly among boys, with 11 percent of boys and 9 percent of girls having tried it in 2024.

    The full ESPAD report will be published in 2025.

  • Playing with Numbers

    Playing with Numbers

    Photo: Hafiez Razali

    How research methods distort nicotine effects and risks

    By Cheryl K. Olson

    “The paper seems like a joke.” That’s what Harvard researcher Miguel Hernan said recently to the journal Science about a report linking e-cigarettes and strokes.

    The article was concocted by a dubious research group, founded to help young international medical school graduates get coveted authorship credits. Its analysis of U.S. government survey data claimed that respondents who vaped had a higher risk of stroke, at younger ages, than those who smoked. Its glaring flaws included inflating the number of survey takers by tens of thousands and failing to correct for the relative youth of vapers.

    Despite this, the 2022 paper’s findings found their way into media headlines and anti-vaping advertising. The Science article credits Gal Cohen and Floe Foxon with sounding the alarm on this appalling study.

    Subtler issues that affect research quality, and how research is perceived by the public, are harder to spot. Research methods may seem a dull or arcane topic. But a peek at how the research sausage is made reveals some simple yet surprising ways that the process can go wrong.

    Sometimes old habits or unquestioned assumptions are to blame. Just as typewriters affect how we text on our mobiles, legacy cigarette research methods and mindsets influence how we study noncombustible nicotine products.

    Hours of Vaping?

    Everyone understands cigarettes. When it comes to totting up use, cigarettes are easy. They come in standard units. You light, puff and extinguish. Not so for products such as vapes. How, then, do researchers compare smoking with these new nicotine-delivery systems?

    “There’s a lot of research showing that people who use e-cigarettes graze throughout the day,” says Arielle Selya, who conducts nicotine product research at Pinney Associates. “Unlike cigarettes, there’s no defined stopping and starting. They don’t have to finish a discrete unit; they just puff on and off.” Measuring this kind of variable, intermittent activity is a challenge.

    This problem is not unique to vaping. Studying nicotine pouch use, I found unexpectedly wide variations in what people did and what they thought was normal. Some tossed a pouch in the trash after 10 minutes or 15 minutes. Others kept one in their mouth for a couple of hours. A few sometimes reused a pouch they’d started earlier or cheeked pouches of two different flavors at once.

    As an example of what can go wrong, Selya pointed to a recent study of vaping and respiratory symptoms. To the authors’ credit, they tried to measure heaviness of e-cigarette use. The problem was the poor fit between their question and the behavior. They asked, “How many hours did you use electronic cigarettes per day?”

    “I’m not a vaper, but that seems like such a strange question,” says Selya. “Like asking how many hours do you spend drinking water?”

    Better approaches to measuring nicotine product use include writing down what you’re doing whenever a device pings you (ecological momentary assessment) or in a daily diary.

    Twisted Terminology

    Another holdover from cigarettes is the way tobacco is seen as the default flavor for all nicotine-containing products. “With e-cigarettes, you have to add a tobacco flavor,” notes Selya. “But researchers often say ‘flavored’ when they mean ‘non-tobacco flavored’–in some communications even the NYTS team does this–but tobacco itself is a flavor! This generates misunderstandings.”

    Nicotine research terminology can defy common sense. Consider the concept of “abuse liability.” In everyday English, abuse implies harm. When the U.S. Food and Drug Administration assesses new drugs, stricter regulation may be required if there’s abuse potential, defined as “intentional, nontherapeutic use” to “achieve a desired psychological or physical effect.” An effect like euphoria, hallucinations or distorted thoughts or perceptions. 

    When it comes to reduced-harm nicotine products, abuse potential becomes, weirdly, a plus. A backhanded compliment. If you want to attract someone away from cigarettes, features like rapid nicotine absorption, relaxation and relief of withdrawal encourage that transition.

    Abuse liability also illustrates another nicotine methodology vexation: there is no agreed-on way to measure it. One article looked at comments made by the FDA on manufacturers’ submissions for multiple types of nicotine products. Regulators considered a whole range of measures related to abuse liability, from product chemistry and pharmacokinetics to subjective factors. Of the latter, “liking” the product turned out to be the most reliable and sensitive abuse liability measure!

    Misleading Measures

    Again, cigarettes are simple and familiar. Novel nicotine products, by contrast, come in ever-evolving variations. U.S. government surveys, such as the Population Assessment of Tobacco and Health (PATH) and National Youth Tobacco Survey (NYTS), measure trends in who is using what products. The results are widely used and reported. However, for survey results to make sense, people must understand the questions.

    Discrepancies in results suggest that research participants often misunderstand nicotine products and/or the terms being used to describe them. For example, answers about vaping brands and device types often don’t match. In the NYTS, just two-thirds of teens who said they “usually” used a pod/cartridge brand of e-cigarette (such as Juul, Logic or Vuse) also said they “most often” used a pod/cartridge device. Almost one in five adults in the PATH study had these kinds of mismatched answers about their vaping behavior. 

    Some questions have even larger errors. “The NYTS asks whether your e-cigarette product contains nicotine salts,” says Selya. “And overall, about 50 percent said they don’t know.”

    This is also true for so-called “concept” flavors, she notes. “Not strawberry-banana, but something like cosmic fusion. When youth are asked about concept or ice flavors, they don’t know the characteristics of their product, or maybe don’t understand those words.”

    NYTS first asked youth about tobacco-free nicotine pouches in 2021. That year, just 1.9 percent of teens reported ever using one. Checking the details, I found a flaw: The questionnaire defined nicotine pouches as “flavored.” However, over a third of teen ever-users said the pouch product they used was unflavored. (Perhaps they confused pouches and snus?) 

    A further example: the 2023 NYTS found that 1 percent of youth—an estimated 370,000—had ever used a heated-tobacco product. At the time, that product category was not sold in the United States.

    As Ray Niaura of New York University told me, “That can’t be right. Literally, it’s impossible. So that means it’s measurement error.”

    This suggests young survey takers were befuddled. “Kids aren’t going to know,” says Niaura. “‘Heated tobacco: Yeah. I smoked a cigarette. It’s heated. I light it on fire.’”

    Yet the Centers for Disease Control and Prevention reported the result without comment or explanation.

    If a product is only used by a small percentage of people, these sorts of errors could create unreal changes in year-to-year trends. The reporting of those potentially misleading trends affect the perceptions of academics, regulators and the public. “With that amount of uncertainty and some of the low numbers, it’s hard to figure out what’s the signal versus the noise,” notes Selya.

    Questionable Choices

    Another seemingly simple but complicated issue: Who counts as a current product user? Youth surveys typically ask “have you used e-cigarettes at all, even a puff, in the last 30 days?” Surveys aimed at adults commonly ask, “Do you currently use e-cigarettes some days, every day or not at all?”

    If you assume capturing any youth e-cigarette use is important, then “even a puff” makes sense. But it also makes it difficult to separate teens who are briefly experimenting from teens at risk for problematic ongoing use.

    In studies that look at how using nicotine products affect some aspect of health, researchers choose what outcomes to measure. Their choices can suggest biases or suspicious holes in what’s reported.

    A recent study using PATH data tried to compare e-cigarette use and the age at which people developed asthma. “Why age of asthma onset rather than whether they developed asthma at all?” says Selya. “Often, I read a study and think, did you look at these other related outcomes? If so, why weren’t they published?” This issue of results that may exist but aren’t reported are known as the “file drawer problem.” Preregistering study plans would avoid this issue.

    Researchers, Meet Users

    Before I dove deeply into tobacco harm reduction, my research focused on the effects of violent video games on youth. Finding discrepancies between research reports and what teens told me, I realized that many of the field’s most-cited “experts” had never actually played or even observed the games they studied.

    Similarly, many nicotine researchers seem to have never held or used the noncombusted products they study. This leads to findings that don’t reflect real-world situations. One example is an article by Sebastien Soulet and Roberto Sussman on metal contents of e-cigarette aerosols. They found that researchers were overheating tank vaping devices, generating aerosols that would be “likely repellent to human users.”

    “I think there’s a big disconnect and abysmally low involvement of actual consumers, the people affected by policies,” says Selya. Partnering with people who actually know and use novel nicotine products would be a giant step toward improved research quality.  

    References

    Foxon F. (2023). Discordant device/brand reporting among adolescents who used e-cigarettes in the National Youth Tobacco Survey. Nicotine and Tobacco Research. https://doi.org/10.1093/ntr/ntad228

    Joelving F. (2024). Prescription for controversy. Science. https://www.science.org/content/article/questionable-firms-tempt-young-doctors-with-easy-publications

    Selya A, Ruggieri M, Polosa R. (2024). Measures of youth e-cigarette use: strengths, weaknesses and recommendations. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2024.1412406

    Soulet S, Sussman RA. (2022). A critical review of recent literature on metal contents in e-cigarette aerosol. Toxics. https://www.mdpi.com/2305-6304/10/9/510

    Vansickel A et al. (2022). Human abuse liability assessment of tobacco and nicotine products: approaches for meeting current regulatory recommendations. Nicotine and Tobacco Research. https://doi.org/10.1093/ntr/ntab183

    Cheryl K. Olson is a California-based public health researcher who specializes in behavioral health issues and consults on tobacco product behaviors via McKinney Regulatory Science Advisors. She spent 15 years on the faculty of Harvard Medical School.
  • Vape Products Tied to Reduced Smoking Prevalence

    Vape Products Tied to Reduced Smoking Prevalence

    Photo: Rain

    A new analysis conducted on the latest available U.S. National Health Interview Survey (NHIS) data through 2022 showed that population-level data suggest that smoking prevalence has declined at an accelerated rate in the last decade in ways correlated with increased uptake of e-cigarette use.

    Since their market introduction, the question of whether combustion-free products could be a useful tool in the fight against cigarette smoking or simply a substitute has divided the scientific community. Over the years, technological innovation and the development of various products on the market have modified the health risk parameters related to the use of these tools, creating the basis for a redefinition of public health policies.

    To date, vaping is at the center of scientific debate: both for adult smokers who cannot quit and see these products as a way to reduce exposure to toxic substances released by cigarette smoke, and for the concern over use by at-risk groups, such as younger individuals. Many experts believe that vaping represents a gateway to smoking.

    According to the Center of Excellence for the acceleration of Harm Reduction, evidence for the gateway effect has not been detected in population-level studies on the prevalence of e-cigarette use and smoking among young people; indeed, smoking prevalence remains at an all-time low among U.S. adolescents and young adults, despite increases in e-cigarette use.

    The new analysis “Increased e-cigarette use prevalence is associated with decreased smoking prevalence among U.S. adults” published in the Harm Reduction Journal  is an update on a previous analysis modeling population-level prevalence that assessed whether and how much the introduction of e-cigarettes in the U.S. may be correlated with declining smoking prevalence among populations of U.S. adults using the NHIS .

    Results showed that population-level data continue to suggest that smoking prevalence has declined at an accelerated rate in the last decade in ways correlated with increased uptake of e-cigarette use.

    “We found that as ecig use increases at the population level, smoking prevalence tends to decrease, which is what you’d expect to observe if e-cigarettes were used as an alternative to cigarette smoking in the real world” said Floe Foxon, Pinney Associates researcher and author of the analysis, in a statement

    “We also found that this possible substitution between e-cigarette use and smoking was most pronounced in groups that used e-cigarettes the most, which again would be expected if e-cigarettes were being used instead of cigarettes. While it is important to note that the study does not infer causality and that these methods have limitations noted in the paper, they do appear to support a growing body of literature including other simulation studies, econometric research, and randomized controlled controls which suggest that e-cigarettes substitute for cigarettes among adults.”

  • Study: Vaping as Effective as Chantix as Quit Aid

    Study: Vaping as Effective as Chantix as Quit Aid

    Credit: Brian Jackson

    E-cigarettes were just as effective as the gold-standard pharmaceutical drug varenicline, also known as Chantix, in helping people quit smoking, according to a clinical trial published Monday in JAMA Internal Medicine.

    A total of 458 daily smokers who were willing to quit were randomly assigned to one of three groups for a 12-week trial.

    One group received a nicotine-containing e-cigarette and placebo tablets, another group received varenicline and a nicotine-free e-cigarette, and the third group received a placebo tablet and a nicotine-free e-cigarette. All three groups also received extensive tobacco cessation counseling.

    After 26 weeks, approximately the same percentage of participants using varenicline and e-cigarettes, 43.8 percent and 40.4 percent respectively, had stopped smoking.

    The difference in quit rates between the two groups was not statistically significant.

    The JAMA study is the first published randomized controlled trial to directly compare varenicline to e-cigarettes.

    Previous studies have shown that e-cigarettes can help adults quit smoking. However, most of these studies have compared e-cigarettes either to a placebo or to nicotine replacement therapy, such as patches and lozenges, which help smokers manage their withdrawal symptoms.

  • Smoking Down, Vaping Up Among Indonesian Minors

    Smoking Down, Vaping Up Among Indonesian Minors

    Photo: Taco Tuinstra

    Smoking is down but vaping is up among Indonesian minors, reports The Jakarta Globe, citing a recent health survey.

    According to the Indonesian Health Survey (SKI), the prevalence of smoking among 10-18-year-olds decreased to 7.4 percent in 2023, down from 9.1 percent recorded in the 2018 Basic Health Research.

    However, the figure is still higher than the 7.2 percent prevalence in 2013 and the 5.4 percent target set in the 2015-2019 National Medium-Term Development Plan, noted Eva Susanti, director of non-communicable disease prevention and control at the Health Ministry during a World No Tobacco Day media briefing in Jakarta on May 29.

    Minors’ use of e-cigarettes, meanwhile, increased from 0.06 percent in 2018 to 0.13 percent in 2023.

    The Health Ministry is intensifying efforts to prevent children from smoking or vaping. This includes banning the consumption of tobacco and e-cigarettes by children and pregnant women, prohibiting tobacco advertising on social media, and outlawing the sale of single cigarettes.

  • Study Links Social Media Usage With Youth Vaping

    Study Links Social Media Usage With Youth Vaping

    Credit: Feng Yu

    In a recent study published in Thorax, researchers found associations between the use of social media platforms and the risk of combustible cigarette smoking and vaping among youth.

    The study is based on a survey of almost 11,000 young British people ages 10 to 25 who were tracked from 2015 through 2021.

    Overall, 8.5 percent said they currently smoked, 2.5 percent said they vaped and about 1 percent did both, according to media reports.

    How much time they spent on TikTok, Instagram, and other social media platforms tracked well with their odds of smoking or vaping, the study found.

    Just 2 percent of people who reported no social media use engaged in cigarette smoking, but that rose to 17 percent among those who said they were on social media seven-plus hours per day.

    Similarly, less than 1 percent of those who avoided social media vaped, compared to 2.5 percent of those who used it seven or more hours daily.

    Dr. Graham Wheeler, honorary senior lecturer at the Imperial Clinical Trials Unit, Imperial College London, and statistics director for Statistical Innovation in Specialty and Primary Care at GSK, said the results of this large study are similar to the findings of other research into the association of social media use and smoking habits.

    “However, the researchers didn’t record the social media platforms used, or how the users interacted with friends on these platforms. For example, are stronger associations seen amongst users of TikTok or Instagram compared to Whatsapp?

    “Social media use is self-reported, so may not be an accurate record of actual use.

    “The researchers also assessed how the interaction of social media use and variables such as age, household income and sex were associated with cigarette and e-cigarette use. However, they did not report the interaction of social media use with parental use of cigarettes and e-cigarettes, which is one of the strongest variables associated with children’s smoking habits. We don’t know if this trend of higher odds of being a smoker increasing with social media usage changes when comparing children of parents who are smokers and children of parents who are not smokers.

    “This survey reports responses given at a single point in time, rather than following non-smokers over time to see if the likelihood of them taking up cigarette smoking or e-cigarette use is associated with increasing levels of social media use.”