$20 million grant from the National Cancer Institute enables research into youth e-cigarette and oral nicotine use at USC

USC faculty members Adam Leventhal, PhD and Caryn Lerman, PhD have received a $20 million grant for research to inform government regulations overseeing tobacco and its marketing, with a focus on protecting young people. The USC Tobacco Center of Regulatory Science (TCORS), an interdisciplinary initiative led by the USC Institute for Addiction Science (IAS), USC Norris Comprehensive Cancer Center and the Department of Population and Public Health Sciences at the Keck School of Medicine of USC, is one of seven programs nationwide to receive funding provided jointly by the Food and Drug Administration (FDA) and the National Cancer Institute, part of the National Institutes of Health (NIH). USC TCORS was launched in 2013 with FDA and NIH support and was renewed in 2018. This new grant continues the center through 2028.

With the new federal funding, USC TCORS expands its portfolio to focus on the ways a range of tobacco products other than conventional cigarettes are used by and marketed to young people. These products include e-cigarettes and commercially marketed flavored nicotine pouches, gums, lozenges and gummies. The center’s role is to provide rigorous evidence that guides FDA action in response to a fast-changing landscape of tobacco product offerings — and trends among adolescents and young adults.

“Multi-study center grants like this are critical to pushing the field forward,” said USC TCORS co-director Adam Leventhal, PhD, professor of population and public health sciences at the Keck School of Medicine and director of the USC IAS. “A center like TCORS is more than the sum of its parts. By connecting different types of research, we can uncover a body of evidence that fits together to surpass the high threshold that the FDA requires to change federal policy.”

Gathering the evidence to prevent harm to youth

Exposure to nicotine and other chemicals in e-cigarettes may interfere with the development of brain pathways that control attention, concentration and mood. Sound policy that minimizes use of e-cigarettes and other tobacco products among young people can have long-lasting health benefits on a large scale.

“Reducing exposure to novel nicotine products through evidence-based regulation is vital to improve health,” said USC TCORS co-director Caryn Lerman, director of USC Norris Comprehensive Cancer Center and associate dean for Cancer Programs. “USC TCORS researchers have a unique opportunity to influence policy that supports the well-being of generations yet to come.”

E-cigarettes and oral products can contain high levels of nicotine, promoting addiction, and are marketed in youth-attracting fruity flavors. Messages and marketing that glamorize these products often reach young people through social media platforms.

“Adolescents see their peers, social media ‘friends’ and attractive strangers using tobacco products,” said Jennifer Unger, PhD, lead for one of the TCORS projects and professor and vice chair for faculty development in the Keck School’s Department of Population and Public Health Sciences. “In these posts, tobacco products are often paired with themes such as being popular, being attractive and having fun. This makes adolescents think that many of their peers use and approve of tobacco products, and that using tobacco will help them socially.” 

Policymakers charged with developing regulations that protect youth from social media marketing by the tobacco industry rely on research on social media influences, like the studies that Unger and her team will embark upon in USC TCORS.

Multifaceted regulatory research and forward-looking training

Grant-supported research in collaboration with partner institutions in USC TCORS will explore how e-cigarettes and oral nicotine products affect young people. The center will also examine how that impact is amplified by flavors and other characteristics of these products, as well as the marketing approaches that make them attractive to youth. Studies will consider factors such as race, ethnicity, sexual orientation, gender identity and socioeconomic status.

“A new policy may bring down tobacco use rates, but sometimes certain communities don’t see the same degree of reduction, which can perpetuate unfortunate health disparities,” said Chanita Hughes Halbert, PhD, holder of the Dr. Arthur and Priscilla Ulene Chair in Women’s Cancer, associate director for cancer equity at the USC Norris Comprehensive Cancer Center, and professor and vice chair of population and public health sciences at the Keck School of Medicine. “We’re studying the impact of factors such as product types and marketing strategies across these diverse communities so we know upfront that any resulting policies won’t have uneven benefits for different groups.”

Investigations include four major projects:

• A national survey as part of the University of Michigan’s Monitoring the Future Study will include questions assessing trends in the use of noncombustible tobacco products by adolescents and young adults.
• A longitudinal study following a cohort of young people will look at how cigarette, e-cigarette and oral nicotine product use changes over time.
• A program delving into the addictiveness of new oral nicotine products among young adults who use e-cigarettes will use telehealth to examine the impact of the type of oral nicotine product, flavor and nicotine concentration.
• A study of social media posts will aim to determine which marketing strategies for flavored nicotine products increase the likelihood of young people starting nicotine use.

The educational component of the award supports career development activities for graduate students, postdoctoral trainees and researchers who are refocusing on the field of tobacco regulatory science. USC TCORS will conduct outreach with the goal of engaging diverse trainees, and provide classroom instruction, research mentorship and coaching.

“We’re 100% targeted at informing FDA policy,” said Heather Wipfli, PhD, who co-leads the USC TCORS Career Enhancement Core and is professor of clinical population and public health sciences and of international relations. “That’s quite different from pure scientific discovery. With early-career researchers learning by working on these major, large-scale studies, it’s great for the training and it’s great for the science.”

A history of evidence that leads to action

USC TCORS has built up a track record of providing evidence that serves as the foundation for new FDA policies and nimbly incorporating new areas of study as the tobacco marketplace evolves. To date, the center’s research has been cited in FDA policy documents 31 times.

“In the last 10 years, we’ve seen that the tobacco industry moves very fast and we can’t predict what will be on the market even a couple of years from now,” said USC TCORS project lead Jessica Barrington-Trimis, PhD, MS, MA, associate professor of population and public health sciences and director of the USC Epidemiology of Substance Use Research Group. “So embedded into USC TCORS is the flexibility to pivot and adapt, in the case that there’s a new product that seems to be spreading among young people and the FDA needs early data on it.”

The TCORS leadership team also includes Raina Pang, PhD, associate professor of research population and public health sciences at the Keck School of Medicine, John Monterosso, PhD, associate professor of psychology at the USC Dornsife College of Letters, Arts and Sciences, and Ming Li PhD, director of the Data Science Shared Resource at the USC Norris Comprehensive Cancer Center.  Grant-funded projects will reach across disciplines involving an extended team of scholars at USC, such as neuroscientists from USC Dornsife and health communication specialists from the USC Annenberg School for Communication and Journalism.

“Few places have the breadth of expertise you see at the University of Southern California, and we’re capitalizing on it for this research,” Leventhal said. “It’s exciting to have experts in these different areas contributing to the field of tobacco regulatory science.”