Associations of risk factors of e-cigarette and cigarette use and susceptibility to use among baseline PATH study youth participants (2013–2014)

IntroductionImproved understanding of the distribution of traditional risk factors of cigarette smoking among youth who have ever used or are susceptible to e-cigarettes and cigarettes will inform future longitudinal studies examining transitions in use.MethodsMultiple logistic regression analysis was conducted using data from youth (ages 12–17 years) who had ever heard of e-cigarettes at baseline of the PATH Study (n = 12,460) to compare the distribution of risk factors for cigarette smoking among seven mutually exclusive groups based on ever cigarette/e-cigarette use and susceptibility status.ResultsCompared to committed never users, youth susceptible to e-cigarettes, cigarettes, or both had increasing odds of risk factors for cigarette smoking, with those susceptible to both products at highest risk, followed by cigarettes and e-cigarettes. Compared to e-cigarette only users, dual users had higher odds of nearly all risk factors (aOR range = 1.6–6.8) and cigarette only smokers had higher odds of other (non-e-cigarette) tobacco use (aOR range = 1.5–2.3), marijuana use (aOR = 1.9, 95%CI = 1.4–2.5), a high GAIN substance use score (aOR = 1.9, 95%CI = 1.1–3.4), low academic achievement (aOR range = 1.6–3.4), and exposure to smoking (aOR range = 1.8–2.1). No differences were observed for externalizing factors (depression, anxiety, etc.), sensation seeking, or household use of non-cigarette tobacco.ConclusionsAmong ever cigarette and e-cigarette users, dual users had higher odds of reporting traditional risk factors for smoking, followed by single product cigarette smokers and e-cigarette users. Understanding how e-cigarette and cigarette users differ may inform youth tobacco use prevention efforts and advise future studies assessing probability of progression of cigarette and e-cigarette use.     

Evaluating the predictive value of measures of susceptibility to tobacco and alternative tobacco products

BackgroundThe “cigarette susceptibility index” has been adapted for other products, yet, the validity of these adapted measures–particularly among youth who have used other tobacco products–has not been evaluated.MethodsWe used prospective data from the Southern California Children's Health Study to evaluate the association of questionnaire measures assessing susceptibility to e-cigarette, cigarette, hookah and cigar/cigarillo/little cigar use at wave 1 (W1; 11th/12th grade) with subsequent initiation between W1 and W2 (16 months later, N = 1453). We additionally examined whether each effect estimate differed by use of other tobacco products at W1.ResultsOdds ratios, attributable risk%, and risk differences for product initiation among susceptible vs. non-susceptible youth were consistently higher among never users of any tobacco product than among youth with any tobacco use history. For example, susceptible (vs. non-susceptible) youth with no prior tobacco use had 3.64 times the odds of subsequent initiation of e-cigarettes (95%CI:2.61,5.09), while among users of another product, susceptible (vs. non-susceptible) youth had 1.95 times the odds of e-cigarette initiation (95%CI:0.98,3.89; p-interaction = 0.016). 60.4% of e-cigarette initiation among never users of any product could be attributed to susceptibility, compared to 19.8% among users of another product. The e-cigarette absolute risk difference between susceptible and non-susceptible youth was 21.9%(15.2,28.6) for never users, vs. 15.4%(0.2,30.7) for users of another product.ConclusionTobacco product-specific susceptibility associations with initiation of use at W2 were markedly attenuated among prior users of other products, demonstrating reduced utility for these measures among subjects using other products.     

Identifying behavioural characteristics of tobacco product and e-cigarette use clusters: A repeat cross-sectional analysis

BackgroundYouth may use a variety of tobacco products and e-cigarettes. However, there is a lack of evidence for the combinations of tobacco products and e-cigarettes commonly used by youth in Canada and whether youth from different usage classes share similar characteristics.MethodsA cohort of 9th grade students from Ontario, Canada was identified at baseline (2013–14) of the COMPASS study (n = 4651). Classes of youth that currently use similar combinations of tobacco products and e-cigarettes were identified at baseline, one (FY1) and two years later (FY2) using latent class analysis. Multinomial logistic regression models identified demographic and behavioural characteristics (e.g., environmental influences, substance use behaviours, etc.) of youth in current tobacco and e-cigarette use classes relative to youth in non-current use classes.ResultsAt baseline, a three-class model was identified as best, while a four-class model was identified at FY1 and FY2. A non-current use group and an all-product use group were identified every year. Students that reported having friends that smoked cigarettes, binge drinking, and using marijuana were more likely to be classified into a current use class.ConclusionsTobacco cigarettes were more likely to be used with other products than on their own. An all-product use group was identified across all three survey waves and the prevalence of this group increased over time. Given that many youth in this study used more than one tobacco product or e-cigarette and commonly reported binge drinking and using marijuana, prevention and cessation activities should address the use of multiple products.     

Electronic cigarettes and narghile users in Brazil: Do they differ from cigarettes smokers?

BackgroundCigarette smoking prevalence is declining, however, other tobacco products have emerged recently, such as electronic cigarettes (e-cigarettes) and narghile (hookah/shisha/waterpipe). Narghile sales are not prohibited in Brazil, but e-cigarettes are. Accurate estimates of such products are key for proper monitoring and control.ObjectiveTo describe the prevalence of e-cigarettes and narghile use and to investigate whether sociodemographic characteristics of individuals who are using these products differ from those who are using manufactured cigarettes.MethodsUsing a nationally representative sample survey of Brazilians aged 12–65 years in 2015, we estimated the prevalence rates of each tobacco products within the last 12-months, stratified by macro-region, municipality size, sex-at-birth, sexual orientation, color/race, age-group, and monthly income. Multivariable logistic models were fitted to understand determinants of each tobacco product use, considering the complex sample design.ResultsE-cigarette, narghile, and cigarette prevalence rates were estimated at 0.43%, 1.65% and 15.35%, respectively, corresponding to around 0.6million e-cigarette users, 2.5 million narghile users and 23.5 million cigarette users. Non-heterosexual individuals were a most-at-risk group for both e-cigarette/narghile and cigarette use. Despite similarities, e-cigarette/narghile users were younger and had higher socioeconomic status than cigarette users. Additional analyses showed that recent cigarette use seems to be more associated with e-cigarette/narghile use among youth than among adults.ConclusionsOur findings may provide valuable information about e-cigarette/narghile use in Brazil. Prevention strategies targeted to youth to both narghile and e-cigarettes use should be implemented together, which might be one strategy to prevent the emergency of a new generation of smokers in Brazil.     

A videogame intervention for tobacco product use prevention in adolescents

PurposeThis pilot study evaluated the short-term effects of an interactive videogame on changing adolescent knowledge, beliefs and risk perceptions, and intentions to use e-cigarettes, cigarettes, and other tobacco products. A secondary aim was to evaluate players' game experience.MethodsParticipants (N = 80 11–14 year olds) were recruited from 7 community-based afterschool programs in New Haven, Connecticut and Los Angeles, California. The design was a single group pre-post design with replication. A pre-test survey was administered that included demographic variables and knowledge, risk perceptions, beliefs, and intentions to use e-cigarettes, cigarettes, and other tobacco products. An interactive videogame focusing on risky tobacco use situations was subsequently played in four 60-min sessions over a four-week period, followed by a post-test survey. Analyses included paired t-tests of pre-post videogame change, regression analyses, and path analyses testing mediational effects of beliefs and risk perceptions on the relationship between knowledge and intentions.ResultsThe videogame changed knowledge of e-cigarettes and other tobacco products (p's < 0.001), risk perceptions of cigarettes and e-cigarettes (p < .01 and p < .001, respectively), and beliefs about e-cigarettes and other tobacco products (p's < 0.05), but not intentions. Older adolescents reported greater e-cigarette knowledge and risk perceptions (p's < 0.05), and females reported greater risk perception of cigarettes (p < .05). Beliefs mediated the relationship between knowledge and intentions to use e-cigarettes (indirect effect p < .05).ConclusionResults suggest that brief exposure (4 h over 4 weeks) to a videogame focused on changing knowledge and attitudes towards tobacco products may have a promising effect on preventing risk for early adolescent tobacco product use, particularly for e-cigarettes.     

E-cigarette use,dual use of e-cigarettes and tobacco cigarettes,and frequency of cannabis use among high school students

BackgroundThe proliferation of electronic vaping products raises many concerns, including whether these products will lead to risky behaviors among adolescents. Evidence suggests that e-cigarettes may be used to vaporize cannabis (marijuana). The current study examined associations between e-cigarette use, dual use of e-cigarettes and tobacco cigarettes, and frequency of cannabis use.MethodsData on high school students (grades 9–12) were from the 2014–2015 Canadian Student Tobacco, Alcohol and Drugs Survey (n = 23,429 respondents). Multinomial logistic regression analyses were used to examine frequency of cannabis use among those who reported using only e-cigarettes, only tobacco cigarettes, both products, and nonusers.ResultsApproximately 15% of respondents reported using cannabis at least once in the past month. Likelihood of using cannabis was significantly higher for e-cigarette only and cigarette- only users. Users of both products had increased odds for a higher frequency of cannabis use. These results indicated a sequential risk gradient in the use of cannabis for dual use, cigarette only, e-cigarette only, and non-use groups, respectively.ConclusionsYouth who reported use of e-cigarettes, tobacco cigarettes, and both products showed a heightened risk of using cannabis more frequently.     

Youth perception of harm and addictiveness of tobacco products: Findings from the Population Assessment of Tobacco and Health Study (Wave 1)

PurposeWe provide a US national assessment of youth perceptions of the harm and addictiveness of six separate tobacco products, identifying a continuum of perceived harm associated with a range of products in relation to patterns of current use, former use, and susceptibility to use tobacco products.MethodsWe evaluated youth respondents (N = 13,651) ages 12–17 from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study. Analyses (2015–2016) focused on refining measures of perceived harm for each product and delineating youth characteristics (demographic, tobacco use status) associated with beliefs about the harmfulness and addictiveness of tobacco products.ResultsCigars, hookah and e-cigarettes were each perceived as having significantly lower harm (p's < 0.05) than smokeless products, with the lowest ratings of harmfulness and addictiveness observed for hookah and e-cigarettes (p's < 0.001). Incrementally lower levels of harm and addictiveness perceptions were observed among youth at increasing risk for tobacco use (p's < 0.05).ConclusionsAmong U.S. youth, lower perceptions of harm and addictiveness of tobacco products were associated with susceptibility to use tobacco and patterns of tobacco product use. Future longitudinal assessments from the PATH Study can provide key information on youth development of perceptions of harm and addictiveness and influences on patterns of tobacco use.     

The role of flavors in vaping initiation and satisfaction among U.S. adults

BackgroundThe prevalence of electronic cigarette use has grown over the past decade, with some users reportedly initiating e-cigarette use primarily due to flavors. This study examined the role of flavors in initiation among adult e-cigarette users, as well as the association of flavors with satisfaction and perceived addiction to vaping.MethodsThe analysis sample consisted of 1492 current e-cigarette users aged 18 or older, drawn from an online quantitative survey conducted in 2016. Multivariable logistic regression and general linear models were used.ResultsMost current e-cigarette users (62.9%) typically used flavors other than tobacco (including fruit, mint/menthol, sweet, candy, coffee and other), 24.2% typically used tobacco flavors, and 12.9% typically used non-flavored e-cigarettes. Flavor was a common reason for vaping initiation, selected by 29.5% of the sample. Flavor, particularly fruit flavor, was more likely to motivate young adults 18–24 to initiate vaping compared adults 35–44. Those who used flavors, particularly mint/menthol and flavors other than tobacco flavor, had higher odds of reporting high satisfaction with vaping and had higher odds of perceived addiction to vaping than respondents who did not use flavored e-cigarettes.ConclusionsUsers of flavored e-cigarettes reported greater satisfaction and self-perceived addiction than users of non-flavored e-cigarettes. The appeal of flavors, particularly among young adults, has implications for regulatory policy regarding the marketing and promotion of flavored products. These findings may provide direction for the Food and Drug Administration's plans to restrict flavors other than menthol, mint, and tobacco.     

Cognitive risk factors of electronic and combustible cigarette use in adolescents

IntroductionCognitive susceptibility to cigarette smoking has been demonstrated to predict future cigarette initiation in adolescents. Examining this construct prior to tobacco product initiation may provide useful information on the differential risk of individuals initiating cigarette vs. e-cigarette products. Additionally, examining how susceptibility and tobacco product use relate to perceived harm cognitions will increase understanding of risk predisposition among adolescents.MethodData were taken from a longitudinal study of middle school students (n = 1023; age = 12.1, 52.2% female, 72.1% white) in the Northeastern U.S. Likelihood of e-cigarette and cigarette ever-use in high school was examined as a function of a validated index of cigarette smoking susceptibility among tobacco naïve students in middle school. Prospective associations between cognitive susceptibility to smoking and subsequent perceived harm of e-cigarettes (assessed in high school), and cross-sectional associations between concurrent tobacco product ever-use status and perceived harm of e–cigarettes were examined.ResultsAdolescents classified as susceptible to cigarette smoking in middle school were more likely to initiate use of cigarettes (OR = 2.53) and e-cigarettes (OR = 1.95) as compared to adolescents classified as non-susceptible; cigarette smoking susceptibility did not differentially predict use of one product over the other. Adolescents endorsing e-cigarette use, reported significantly less perceived harm associated with e-cigarettes vs. cigarettes, while those who endorsed cigarette only or dual use did not.ConclusionOur data indicate that cognitive susceptibility to cigarette smoking may index a broad risk factor for using either cigarettes or e-cigarettes in the future, and is prospectively associated with perceived harm of e-cigarette use. Overall, those who used any tobacco product perceived e-cigarettes as less harmful when compared to abstainers. Individual facets of perceived harm (addiction potential and harm vs. cigarettes) differ between cigarette only users and e-cigarette users and may help to explain the choice to use one product vs. the other.ImplicationsThis is the first study to examine prospective associations between cognitive susceptibility to cigarette smoking, predating tobacco use, and subsequent likelihood of cigarette vs. e-cigarette initiation. This study demonstrates that initiation of either product is elevated among youth who are susceptible to smoking; thus susceptibility to smoking may serve as a useful marker of vulnerability to tobacco product use. Furthermore, this study provides novel information on the relationship between tobacco product onset and specific harm perceptions associated with e-cigarettes versus cigarettes among adolescents.     

Perceptions about e-cigarette flavors: a qualitative investigation of young adult cigarette smokers who use e-cigarettes

Background: Although in recent years, an increased number of young adult smokers have used flavored e-cigarettes, little research has been conducted to explore young adult smokers’ perceptions about e-cigarette flavors.

Methods: This study used qualitative methods to examine young adult smokers’ perceptions towards e-cigarette flavors, their intentions of using e-cigarettes given a flavor ban, and their perceived role of e-cigarette flavors in their smoking behaviors. We conducted in-depth, semi-structured interviews to explore these themes among a purposive sample of 25 young adult smokers in the U.S. (aged 18–34) who had used e-cigarettes to reduce cigarette smoking. Thematic content analysis was employed to assess the qualitative data.

Results: Most participants reported enjoying e-cigarettes with fruit, candy, dessert or menthol/mint flavors and valued having a wide selection of flavors. Most participants reported that they would likely quit or significantly reduce e-cigarette use if e-cigarette flavors were banned. Participants had little knowledge of the nicotine concentration in their e-cigarettes or the harm associated with the use of e-cigarette flavorings. Additionally, participants perceived e-cigarette flavorings as helpful in cutting down smoking by allowing for increased e-cigarette use frequency and duration.

Conclusion: Participants indicated positive perceptions towards e-cigarette flavors and considered the role of e-cigarette flavors to be important in cutting down on cigarettes. Banning or restricting flavored e-cigarettes may discourage participants from using e-cigarettes for smoking cessation. The lack of knowledge about flavored e-cigarettes’ harm and risks, together with the escalated consumption of flavored e-cigarettes, are causes for concern and warrant further attention.     

Other tobacco product and electronic cigarette use among homeless cigarette smokers

ObjectiveWe determined the prevalence and correlates of other tobacco product and electronic cigarette (e-cigarette) use in a clinic-based sample of homeless cigarette smokers.MethodsIn April–July 2014, we used time-location sampling to conduct a cross-sectional, in-person survey of 306 currently homeless adult cigarette smokers recruited from 5 clinical sites at Boston Health Care for the Homeless Program. We assessed past-month use of large cigars, little cigars, smokeless tobacco, and e-cigarettes. Among those who had used e-cigarettes, we assessed the reasons for doing so. We used logistic regression analysis to identify the participant characteristics associated with the use of each product.ResultsEighty-six percent of eligible individuals participated in the survey. In the past month, 37% of respondents used large cigars, 44% used little cigars, 8% used smokeless tobacco, 24% used an e-cigarette, and 68% used any of these products. Reasons for e-cigarette use included curiosity (85%) and to help quit conventional cigarettes (69%). In multivariable regression analyses, homeless smokers with greater subsistence difficulties were more likely to use little cigars (p = 0.01) and less likely to use e-cigarettes (p = 0.001). Non-Hispanic black (p = 0.01), Hispanic (p < 0.001), and rough-sleeping (p = 0.04) participants were more likely to use large cigars. Readiness to quit was not associated with other tobacco product use but was significantly associated with e-cigarette use to help quit smoking (p = 0.02).ConclusionsHealth care providers who serve homeless people should consider routine screening for the use of other tobacco products and e-cigarettes to help guide smoking cessation discussions and tobacco treatment planning.     

The impact of local regulation on reasons for electronic cigarette use among Southern California young adults

ObjectiveTobacco control policies have decreased tobacco use among youth and young adults. We aimed to identify whether specific local tobacco retail licensing ordinances were associated with reasons for e-cigarette use, in order to examine whether strong local policies may reduce e-cigarette initiation rates by influencing the appeal of these products.MethodsOnline questionnaires were completed by Southern California Children's Health Study participants in 2015–2016 (mean age = 18.9 years). Those who had ever used an e-cigarette (N = 614) were asked about reasons for use; additional data were collected on local jurisdiction tobacco sales policy, friends' attitudes toward e-cigarette use, e-cigarette characteristics (level of nicotine, flavorings), and history of tobacco use. Multivariate logistic regression models evaluated associations of each factor with reasons for e-cigarette use, adjusting for gender, ethnicity, highest parental education, tobacco use history and with a random effect of jurisdiction.ResultsThe top reason for e-cigarette use was “They come in flavors I like” (56.6%). Using e-cigarettes to quit smoking was uncommon (12.8%). Participants in jurisdictions with weaker tobacco retail licensing ordinances were more likely to report use of e-cigarettes because they are less harmful than cigarettes (50.1% vs. 36.2%), more acceptable to non-tobacco users (38% vs. 25%), and because they can use e-cigarettes in places where smoking is prohibited (30.7% vs. 18.3%; all p < .05).ConclusionTargeted policy to enforce a strong regulatory environment that denormalizes e-cigarette use, conveys the adverse impact of e-cigarettes, and restricts use in public places may reduce e-cigarette use among adolescents and young adults.     

Flavored tobacco use is associated with dual and poly tobacco use among adolescents

ObjectivesThis study examines the relationships between flavored tobacco use and single, dual, and poly tobacco product use, among adolescents. Given the increased use of flavored tobacco products, it is vital to understand if flavored products are associated with dual and poly tobacco product use.MethodsData were obtained from the 2017 National Youth Tobacco Survey. Participants were 2042 adolescent past 30-day tobacco users. Multivariable multinomial logistic regression models were used to assess the relationship between flavored tobacco use and past 30-day single, dual, and poly (three or more) tobacco product use. Two analyses were conducted using different categories as referent groups to allow for a comprehensive examination of the relationship between all groups. Covariates included sex, grade level, race/ethnicity and exposure to tobacco marketing.ResultsApproximately half of all adolescent tobacco users (45.7%) reported use of more than one product. The majority of adolescent tobacco users reported using flavors (69.4%). Flavored tobacco use was significantly correlated with a greater risk of dual (RRR: 2.09) and poly (RRR: 5.54) tobacco use, relative to single product use, controlling for covariates. Similarly, flavored tobacco use was significantly correlated with a greater risk of poly (RRR: 2.66) tobacco use, relative to dual tobacco use, controlling for covariates.ConclusionsA positive relationship was observed for flavored tobacco use and multiple tobacco product use. Findings suggest the need to consider stronger regulations of flavored tobacco products. Similarly, as most adolescent tobacco users reported using flavors, findings suggest the need to emphasize flavored tobacco use in prevention and education programs.     

Environmental tobacco smoke exposure among electronic cigarette users

IntroductionExposure to environmental tobacco smoke (ETS) from combustible tobacco products causes various diseases and makes quitting smoking more difficult. However, little is known about exposure of e-cigarette users to ETS from combustible tobacco products. This study aimed to investigate e-cigarette users' exposure to ETS from tobacco smokers.MethodsThe association between ETS exposure frequency and different types of smokers including e-cigarette users was examined using ordered logistic regression analysis and nationally representative survey data on 28,765 individuals who were interviewed in the Canadian Tobacco, Alcohol and Drugs Surveys conducted during 2013 and 2015. Survey respondents were classified into one of five smoker types: smokers of tobacco only, dual users of tobacco and e-cigarettes, users of e-cigarette only, former smokers and never smokers. The analyses were conducted using the entire sample and by age group.ResultsYoung to mid-age (15–54) dual users of both regular cigarettes and e-cigarettes have higher ETS exposure than even tobacco smokers. Young to mid-age single users of e-cigarettes are less exposed to ETS than tobacco smokers, but still have higher ETS than never smokers. At older age (55+), both dual and single e-cigarette users face similar risks of ETS exposure as tobacco smokers.ConclusionsE-cigarette users are at high risk of ETS exposure. Policies that target the behaviour of e-cigarette users as well as the environments surrounding them to address their high ETS exposure risk would be beneficial.     

Exclusive versus dual use of tobacco and electronic cigarettes among adolescents in Poland, 2010–2016

Globally, electronic cigarette (e-cigarette) use among adolescents has increased, along with concerns about potential health implications from exclusive and concurrent tobacco and e-cigarette use (i.e., “dual use”). This study used data from a cross-sectional survey administered to 5708 students aged 15–19 in secondary and technical schools throughout two regions of Poland. Data from 2010–2011 (n = 1760); 2013–2014 (n = 1970) and 2015–2016 (n = 1978) were analyzed to assess changes in use of cigarettes and e-cigarettes from 2010–2016, and correlates of exclusive and dual use, daily use, and intensity of product use from 2013–2016. In this sample, e-cigarette trial and past 30-day exclusive e-cigarette use significantly increased over time (2010–2011: 2%; 2013–2014: 8%; 2015–2016: 11% (p < .05)). Dual use increased from 2010–2011 (4%) to 2013–2014 only (23%, p < .05); and remained stable from 2013–2014 to 2015–2016 (24%, p = .60). Most dual users reported using cigarettes before trying e-cigarettes (82% in 2013–2014, 76% in 2015–2016). Analyses comparing dual users to exclusive users showed significant differences in frequency and intensity of product use, similar findings were observed within dual users. Following the introduction of e-cigarettes, both total tobacco use and total cigarette use increased. Among youth in Poland, e-cigarettes do not seem to replace conventional cigarettes, but instead contribute to a more diverse array of available products from which youth can experiment.     

“Technophilia”: A new risk factor for electronic cigarette use among early adolescents?

PurposeDevelop and validate a scale that measures Technophilia (positive orientation toward new technology) and use it to address orientation toward new technologies to explain e-cigarette trial and adoption, especially in relatively low risk adolescents.MethodsSurvey data were obtained from students of the three largest cities in Mexico (n = 8123). We developed eight questions involving access, use and pleasure from different electronic media to measure technophilia. Exploratory factor analysis (EFA) was conducted. Linear GEE models were used when regressing technophilia on covariates. When regressing e-cigarette and conventional cigarette trial and use, logistic GEE models were used. Finally, we used multinomial logistic regression to evaluate the associations between technophilia and e-cigarettes as the first tobacco product.ResultsTechnophilia were correlated with theoretically-related variables. Unadjusted and adjusted models regressing e-cigarette trial and use indicated that students in the highest quartile for technophilia were more likely to have tried e-cigarettes compared with the lowest quartile (AOR_{Q4 vs Q1} = 1.36, 95% CI 1.14–1.62). Technophilia was not independently associated with current e-cigarette use in adjusted models. Students with higher technophilia were more likely to have first tried e-cigarettes in both crude and adjusted models (AOR_Q4vQ1 = 1.66, 95% CI 1.20–2.31; AOR_Q3vQ1 = 1.43, 95% CI 1.02–2.01). Technophilia did not have a statistically significant, independent association with first use of other tobacco products.ConclusionThis study suggests that technophilia is associated with trial of e-cigarettes among youth. The measure we developed appears useful for understanding why some youth are open to trying novel, technologically oriented ways to consume nicotine.     

Predictors of youth e-cigarette use susceptibility in a U.S. nationally representative sample

ObjectivesGiven that nicotine is one of the most addictive substances and that adolescents who are exposed to nicotine via e-cigarettes can progress to conventional cigarette smoking, there is a need to identify youth who are susceptible to e-cigarette use and prevent them from initiating e-cigarette use. Susceptibility to e-cigarette use, defined as the absence of a firm decision not to use e-cigarettes, is a useful concept that can be used to predict e-cigarette initiation and identify youth who have high risk of initiating e-cigarettes. This study was conducted to investigate factors that affect youth susceptibility to e-cigarette use.MethodsYouth who have never smoked conventional cigarettes and who had seen or heard of e-cigarettes but never used them (N = 9853) were drawn from the Population Assessment of Tobacco and Health (PATH) Study Wave 1 youth dataset collected from 2013 to 2014. Data were analyzed using logistic regression to investigate intrapersonal and environmental determinants of youth susceptibility to e-cigarette use.ResultsOverall, 24.2% (n = 2410) of youth who have never used e-cigarettes were susceptible to e-cigarette use. Psychological problems and rebelliousness were associated with increased susceptibility. Ever use of alcohol, marijuana, and other substances and household secondhand smoke exposure were found to be risk factors. Perceptions of e-cigarettes as addictive and harmful worked as protective factors.ConclusionsThe results revealed determinants of e-cigarette use susceptibility. Multi-level intervention approach is needed to prevent youth from being susceptible to e-cigarette initiation.     

E-cigarette use is associated with susceptibility to tobacco use among Australian young adults

BackgroundCalls have been made to relax current Australian regulations related to e-cigarettes to increase the accessibility of the devices for smoking cessation purposes. However, e-cigarettes have been found to increase risk of initiation of conventional cigarette smoking, especially among young adults. To assist in guiding the development of policy in Australia, the present study examined whether e-cigarette use among Australian young adults who have never smoked a tobacco cigarette is associated with susceptibility to future tobacco cigarette use.MethodAn online web panel provider recruited 519 never smokers aged 18–25 years (55% female; average age = 21.21 years, SD = 2.32). Respondents completed an online survey that assessed their curiosity about tobacco smoking, willingness and intentions to smoke, and a number of individual and social factors. Cross-sectional regression analyses were conducted to assess the association between e-cigarette use and susceptibility to tobacco cigarette use while controlling for multiple covariates.ResultsCuriosity about tobacco smoking, willingness to smoke, and intentions to smoke were significantly higher among users of e-cigarettes than never users. The relationship between e-cigarette use and susceptibility to future tobacco cigarette use remained significant after controlling for numerous covariates.ConclusionE-cigarette use, even just one or two puffs, has the potential to increase susceptibility to tobacco cigarette use among Australian young adults. Findings suggest that increasing the availability of e-cigarettes by relaxing current strict regulations surrounding their sale may have unintended consequences.