Article Summary

Cullen, K. A., Liu, S. T., Bernat, J. K., Slavit, W. I., Tynan, M. A., King, B. A., & Neff, L. J.
(2019). Flavored tobacco product use among middle and high school students – United
States, 2014-2018. Morbidity and Mortality Weekly Report, 68(39), 839–844. https://doi-
org.ezp.waldenulibrary.org/10.15585/mmwr.mm6839a2
This report uses data from the National Youth Tobacco Survey (NYTS) to estimate the
use of flavored tobacco products among middle- and high-school students in the US between
2014 and 2018. NYTS is a school-based, annual, and self-administered survey for middle
schoolers (grades 6-8) and high schoolers (grades 9-12) in the US. The survey examines tobacco-
related exposure, beliefs, attitudes, behaviors, and influences. Usually, it is conducted through a
cross-sectional questionnaire administered nationally. This specific report by Cullen et al. (2019)
draws data from five National Youth Tobacco Surveys (2014, 2015, 2016, 2017, and 2018),
including samples sizes of 22,007 (73.3%), 17,711 (63.4%), 20,675 (71.6%), 17,872 (68.1%),
and 20,189(68.2%), respectively.
Study participants were asked multiple questions, including current (within the last 30
days) use of bidis, dissolvable tobacco products, snus, smokeless tobacco, pipe tobacco, cigars,
hookahs, e-cigarettes, and cigarettes. Also, participants were asked whether they have taken,
within the last 30 days, tobacco-based products flavored or laced to taste like chocolate, fruit,
candy, alcohol (cognac, wine), mint (menthol), or any other flavor.
Using a weighted model and a 95% confidence interval, the data was adjusted for
inconsistencies, and the cleaned data were analyzed using SAS software. The data indicated that
7.2% of middle school students confessed to using a tobacco product within the specified period.
The number among high school students is higher at 27.1%, bringing about 4.92 million

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students. The majority stated that they had used a flavored tobacco product, with e-cigarettes
taking the lead at 65.2%. However, the data results note that between 2014 and 2018, there has
been a non-linear decrease in the usage of flavored tobacco products among middle-aged and
high school students between 72 to 67.4%. The factors contributing to the decrease are linked to
the decrease in the number of flavored products. However, the factors that favor high usage
among the students. First, most noncigarette products are flavored and shaped like a regular pen
drive, favoring discrete usage. The paper notes the need for collective local efforts to curb the
usage, such as restricting their sale.
Stern, M. C., Barnoya, J., Elder, J. P., & Gallegos-Carrillo, K. (2019). Diet, physical activity,
obesity, and related cancer risk: Strategies to reduce cancer burden in the Americas.
Salud Publica de Mexico, 61(4), 448–455. https://doi-
org.ezp.waldenulibrary.org/10.21149/9753
The paper analyzes the contribution of a healthy diet in preventing and controlling
cancer. The paper denotes that proper diet discipline, optimum body mass index, and good
physical activity can prevent about 15% of cancers in low-income countries and 20% in first-
world countries. The strategy involves building the habit among children as a futuristic approach
to protect them when they mature. The shift in the risk distribution and protective measures is
associated with the increase in adopting foreign diets and neglecting traditional ones. The study
notes that proper physical exercise curbs colorectal cancer and significantly reduces breast
cancer.
The study established that the health of the immigrants deteriorates with every generation
that lives in a foreign land. Taking the case of Latinos, the study notes that the immigrants
portray robust health and low mortality and morbidity. However, their children adopt the diet

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patterns of the locals, thus leading a more unhealthy life and altering their morbidity. The use of
high-energy diets increases the intake of sugar, saturated fats, and red meat while reducing the
intake of fresh fruits and vegetables. This factor is amplified by the manufacturers who invest
heavily in marketing and advertising, increasing unhealthy eating practices.
The paper also presents strategies for managing and reducing obesity among Latinos in
the United States. The first strategy proposes the involvement of all the members of the
macroenvironment in enforcing healthy eating by serving the recommended amounts of each
food type. These include saving children-sized proportions in hotels and restaurants. The
subsequent strategy promotes water uptake among children by providing safe and readily
available water. The paper concludes that colorectal cancer, primarily associated with lifestyle, is
already reducing amongst the Latinos living in the United States.

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References

Cullen, K. A., Liu, S. T., Bernat, J. K., Slavit, W. I., Tynan, M. A., King, B. A., & Neff, L. J.
(2019). Flavored tobacco product use among middle and high school students – United
States, 2014-2018. Morbidity and Mortality Weekly Report, 68(39), 839–844. https://doi-
org.ezp.waldenulibrary.org/10.15585/mmwr.mm6839a2
Stern, M. C., Barnoya, J., Elder, J. P., & Gallegos-Carrillo, K. (2019). Diet, physical activity,
obesity, and related cancer risk: Strategies to reduce cancer burden in the Americas.
Salud Publica de Mexico, 61(4), 448–455. https://doi-
org.ezp.waldenulibrary.org/10.21149/9753