Adolescent E-cigarette Use Research Articles

Association between electronic cigarette use in children and adolescents and coughing a systematic review.

The use of electronic cigarettes (e-cigarettes) among adolescents is increasing worldwide. E-cigarettes are marketed as a safe alternative to other tobacco products. The aim of this systematic review is to evaluate whether e-cigarette use in children and adolescents is associated with coughing. Studies were identified through systematic searches of Excerpta Medica Database, Medline, Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, OVID Emcare, Health Management Information Consortium, PsycINFO, and Allied and Complementary Medicine. The Grey Literature was also searched. Selected studies either contained only children and adolescents as study participants or if adults were included, the data for adolescents and children must be presented separately. Seven studies were selected from 104. Three studies compared e-cigarette users with nonusers; two studies found a significant association between coughing and e-cigarette use in adolescence. Two studies investigated whether adolescents attributed their symptoms to their e-cigarette use. One study reported that coughing was the most likely negative symptom reported by adolescents on initiation of e-cigarette use; the other study found that adolescents, on initiation of e-cigarette use, reported coughing. Two studies looked at the cases of children and adolescents who had presented to the hospital after e-cigarette use and found coughing was a common presenting symptom. This systematic review shows that adolescent use of e-cigarettes is associated with increased coughing and e-cigarette users are more likely to report coughing compared to non-users.

Exploring the gateway hypothesis of e-cigarettes and tobacco: a prospective replication study among adolescents in the Netherlands and Flanders

BackgroundStudies demonstrated that adolescent e-cigarette use is associated with subsequent tobacco smoking, commonly referred to as the gateway effect. However, most studies only investigated gateways from e-cigarettes to tobacco smoking....

Community- and individual-level risk factors of past month e-cigarette use among adolescents in France

PurposeStudies of adolescent e-cigarette use infrequently consider how environmental effects impact use. Adolescent e-cigarette use in France is also understudied, yet an important contrast since e-cigarette use rarely precedes conventional tobacco use and daily tobacco use is common. We examine whether there is significant variation in e-cigarette use across the geographic unit of départements (n = 95), and whether community factors explain these differences and individual-level probabilities of e-cigarette use. MethodsThe ESCAPAD survey is a cross-sectional, nationally representative survey collected at a day of civic and military information mandatory for French 17-year-olds. We use the 2014 (n = 22,023) and 2017 (n = 39,115) surveys and geographic information from Eurostat and INSEE. Multilevel, multiple logistic regression models examine any and daily past month e-cigarette use. ResultsWe find significant département-level variation in both outcomes, with a considerable proportion of this variation explained by département-level factors. Net of numerous significant individual-level covariates, département-level unemployment (OR = 1.049, p < .05), poverty (OR=0.975, p < .05), age structure (OR=0.720, p < .01), and population growth (OR=0.987 p < .01) were associated with any past month use. The département-level percentage of adolescents using conventional tobacco daily was associated with individual-level any (OR=1.029, p < .001) and daily (OR=1.033, p < .01) e-cigarette use. Predicted probabilities demonstrate that département-level and individual-level tobacco use together were associated with e-cigarette use. ConclusionsResearchers should incorporate community effects into studies of e-cigarette use. Particularly, the tobacco use environment contributes to risk of e-cigarette use. For policymakers, resources may be mobilized to address local socioeconomic, demographic, and tobacco use patterns to potentially affect adolescent e-cigarette use.

Estimating E-Cigarette Use Prevalence among US Adolescents UsingVaping-Related Online Search Trends

Introduction: Adolescent e-cigarette use is a developing phenomenon. Greater surveillance of underage use is necessary to inform e-cigarette policy and mitigate adolescent e-cigarette use. Accurate prevalence estimates for adolescent e-cigarette use are provided by large national surveys. However, these surveys are costly and provide only annual estimates. To obtain more affordable estimates faster and more frequently, novel methods are required. Methods: Online search term popularity data were taken from Google Trends. Interest in vaping-related search terms were followed monthly from January 2011 to November 2020. Time-lagged zero-normalized cross-correlations were performed between the Google data and current (past 30 day) high-school e-cigarette use prevalence estimates from the National Youth Tobacco Survey (NYTS). The search interest data were then calibrated to the NYTS data to estimate adolescent e-cigarette use prevalence using online searches. Results: Maximum correlation coefficients of 0.979 for “vapes” and 0.938 for “vape” were obtained when search interest lagged use prevalence by one month, and 0.970 for “vape pen” when the lag was two months (p < 0.001 for all). Calibrating the search term data to NYTS provided a high-school current e-cigarette use prevalence estimate of 12.1–18.4% for November 2020, suggesting adolescent use of e-cigarettes has continued to decline since the NYTS estimate of 19.6% for January–March 2020. Conclusions: Online search trend data may provide reasonably reliable and more frequent estimates of adolescent e-cigarette use prevalence at substantially lower costs than traditional surveys. Such additional data may help to assess immediate impacts of policies and events.

Adolescent Use and Perceptions of JUUL and Other Pod-Style e-Cigarettes: A Qualitative Study to Inform Prevention.

JUUL, a discrete pod-style e-cigarette, popular among adolescents, delivers high levels of nicotine. Limited research has assessed social and environmental influences that contribute to use of JUUL and other pod-style devices. We examined how these factors, as well as individual characteristics, shape adolescent use. Twenty-nine middle and high school students participated in six focus groups in June 2019 (58.6% female, 65.5% White, 27.6% Hispanic). Groups were stratified by e-cigarette use status and grade to understand perceptions and experiences among groups. Transcripts were coded using thematic analysis for individual, social, and environmental factors contributing to use. Users (n = 13) described their first experience with JUUL as mostly negative, mentioning reactions such as burning in the throat, coughing, wheezing, and headaches. Despite a negative first experience, stress relief and addiction were mentioned as reasons for continued use. Users and non-users identified vaping as a source of disruption to their daily life. Social factors included peer and parental influences, lack of support for quitting, and accessibility. Environmental factors included contrasting messages about long- and short-term health effects of e-cigarettes, as well as a lack of school vaping policy enforcement, health education, medical screenings, and cessation resources. Findings highlight the complex social system that influences adolescent e-cigarette use and have important implications for school and community responses. Strategies to prevent or reduce use may include reviewing existing school tobacco policies, providing counseling and cessation resources, training staff, and increasing knowledge through public education campaigns.

Vaping and E-Cigarette Use in Children and Adolescents: Implications on Perioperative Care From the American Society of Anesthesiologists Committee on Pediatric Anesthesia, Society for Pediatric Anesthesia, and American Academy of Pediatrics Section on Anesthesiology and Pain Medicine.

Electronic cigarettes (e-cigarettes) or vaping use in adolescents has emerged as a public health crisis that impacts the perioperative care of this vulnerable population. E-cigarettes have become the most commonly used tobacco products among youth in the United States. Fruit and mint flavors and additives such as marijuana have enticed children and adolescents. E-cigarette, or vaping, product use-associated lung injury (EVALI) is a newly identified lung disease linked to vaping. Clinical presentation of EVALI can be varied, but most commonly includes the respiratory system, gastrointestinal (GI) tract, and constitutional symptoms. Clinical management of EVALI has consisted of vaping cessation and supportive therapy, including supplemental oxygen, noninvasive ventilation, mechanical ventilation, glucocorticoids, and empiric antibiotics, until infectious causes are eliminated, and in the most severe cases, extracorporeal membrane oxygenation (ECMO). Currently, although there is an insufficient evidence to determine the safety and the efficacy of e-cigarettes for perioperative smoking cessation, EVALI clearly places these patients at an increased risk of perioperative morbidity. Given the relatively recent introduction of e-cigarettes, the long-term impact on adolescent health is unknown. As a result, the paucity of postoperative outcomes in this potentially vulnerable population does not support evidence-based recommendations for the management of these patients. Clinicians should identify "at-risk" individuals during preanesthetic evaluations and adjust the risk stratification accordingly. Our societies encourage continued education of the public and health care providers of the risks associated with vaping and nicotine use and encourage regular preoperative screening and postoperative outcome studies of patients with regard to smoking and vaping use.

The emerging norms of e-cigarette use among adolescents: A meta-ethnography of qualitative evidence.

While qualitative research has indicated that adolescents' motivation for e-cigarette use is different than adults', this body of literature has not yet been brought together and synthesised. We reviewed qualitative evidence on perceptions and uses of e-cigarettes in order to explore the emerging norms of vaping among adolescents. We searched five databases for qualitative research in October 2019 with no restrictions on date of publication or data collection. We identified fifteen papers from thirteen studies. Using a meta-ethnographic approach, we identified a spectrum of descriptive and injunctive norms of vaping across the themes of addiction; perceptions of comparative harm; parental perceptions and peer perceptions. We found addiction and perceptions of comparative harm to reflect descriptive norms, while we found clearer evidence explaining the use and non-use of e-cigarettes through parental and peer approval of vaping. However, these norms were fluid, diverse and sometimes contradictory. This review provides a resource for researchers, policymakers and practitioners to better understand the ways that emerging norms could be influenced through policy and practice.

Associations of childhood executive control with adolescent cigarette and E-cigarette use: Tests of moderation by poverty level

BackgroundAdolescent cigarette smoking has continued to decline, whereas electronic cigarette (e-cigarette) use has increased dramatically among youth. Nicotine use in any form, even at low levels, during adolescence can have adverse consequences, particularly for low-income individuals. To elucidate potential early intervention targets, this study examined childhood executive control (EC), a set of cognitive processes for directing attention and behavior, in relation to adolescent cigarette and e-cigarette onset, testing for differential prediction by poverty level. MethodParticipants were 313 children (51% female, 64% European American) recruited in a small city in the Midwestern United States beginning in 2006 and then followed into adolescence between ages 14 and 16 years. EC was measured in the laboratory with performance-based tasks when children were age 5 years, 3 months. Self-reports of cigarette onset and e-cigarette onset were obtained in adolescence (Mage = 15.65 years). Overall, 24% of the sample was at or below the poverty line. ResultsCigarette onset was higher in the poverty group (17%) than in the non-poverty (8%) group, but e-cigarette onset did not differ by poverty level (36% poverty versus 38% non-poverty). Multiple group structural equation modeling revealed a statistically significant group difference such that EC ability was a significant negative predictor of e-cigarette onset for poverty but not for non-poverty youth. A similar group difference was evident as a trend for cigarette onset. ConclusionsBecause EC has been shown to be modifiable, early interventions to improve EC for children living in poverty might help prevent adolescent e-cigarette onset.

Improvement in Pulmonary Function Following Discontinuation of Vaping or E-Cigarette Use in Adolescents with EVALI.

Introduction: In 2019, an alarming number of cases coined as e-cigarette, or vaping, product use-associated lung injury (EVALI) were described in adolescents ranging from mild respiratory distress to fulminant respiratory failure. Limited data have been published on outcomes at short-term follow-up. We aimed to describe pulmonary manifestations, function, and radiologic findings after corticosteroid therapy in a cohort of adolescent patients. Methods: A retrospective chart analysis of all patients presenting to our institution between July 2019 and December 2019 with EVALI was conducted. Patients who had pulmonary follow-up were included. Spirometry was performed before discharge from the hospital and during outpatient follow-up. A paired t-test was used to compare serial spirometry data between visits. Results: Eight patients (6 males) were included. Two patients required intubation with mechanical ventilation, 2 required bilevel positive airway pressure, and 3 required oxygen supplementation. All patients received glucocorticoids (3 receiving pulse dosing). Initial spirometry revealed decreased forced expiratory volume in one second and forced vital capacity with clinically and statistically significant improvement at follow-up (mean follow-up was 46.5 days). Radiographic manifestations also improved after vaping was discontinued. Conclusion: In our cohort of patients with EVALI, at short-term follow-up, all normalized their spirometry parameters and showed clinical resolution of symptoms.

Adolescent Risk and Protective Factors for the Use of Electronic Cigarettes

The use of electronic cigarettes (e-cigarettes) by adolescents is a serious public health concern. The major aim of the current study is to conduct a comprehensive examination of adolescent e-cigarette use in relation to risk and protective factors for a school-based sample. The present study is based on a secondary data analysis of the 2017 Prevention Needs Assessment (PNA) Survey that is administered every 2 years in the state of Utah to a large sample of students ( n = 54,853) in Grades 6, 8, 10, and 12 from more than 400 schools. The PNA Survey measures substance use, mental health symptoms, and antisocial behavior as well as their associated risk and protective factors. Almost 9% of adolescents in this study reported using e-cigarettes in the past 30 days. Adolescents who reported infrequent (1–5 days) and frequent (6+ days) use of e-cigarettes also indicated lower levels of protection (e.g., perceived harm) and higher levels of risk (e.g., favorable attitudes) compared with students who did not report using e-cigarettes in the past 30 days. The frequency of adolescent e-cigarette use can distinguish between risk and protective factors. Findings suggest that the risk and protective factors relevant for adolescent alcohol, cannabis, and tobacco use extend to the use of the e-cigarettes. Certain risk factors (e.g., favorable attitudes toward substance use) and protective factors (e.g., perceived risk for use of e-cigarettes) hold promise for preventive interventions in addressing this public health concern.

Exploring Stakeholder and Parent Perspectives of a County Response to Adolescent Vaping and E-Cigarette Use

In the United States, regular cigarette use has steadily declined over the years; however, it has been met with an increase in vaping and e-cigarette use. In Tampa, Florida, this trend has been found especially prevalent among school-aged youth. To combat issues of substance use among youth and prevent criminalization for nonviolent crimes, school-age youth cited for use and possession of tobacco products in Hillsborough County were mandated to attend the Youth Tobacco Awareness Course (YTAC). The aim of this study was to investigate YTAC for its perceived effectiveness and usefulness in mitigating adolescent e-cigarette use. Classroom observations, parent focus groups, and program stakeholder interviews were conducted to comprehensively evaluate this program. Findings from this evaluation led to a deeper understanding of the barriers and facilitators to an effective course, the needs and perceptions of program stakeholders, as well as recommendations for improved future interventions.

109. Adolescent E-Cigarette Use and Access Before and During the COVID-19 Pandemic

Understanding the latest e-cigarette products used, patterns of use and access during COVID-19 is important since e-cigarettes increase risk for COVID-19. We identify device types, brands and flavors used by youth (aged <21 & ≥21) before and since COVID-19 sheltering-in-place went into effect, and since FDA’s announcement to prioritize enforcement of non-tobacco/non-menthol flavored “cartridge-based” e-cigarettes.

The effect of e-cigarettes on smoking cessation and cigarette smoking initiation: An evidence-based rapid review and meta-analysis.

INTRODUCTIONThe contribution made by e-cigarettes to smoking cessation continues to be controversial. Reports suggest that teenagers are becoming increasingly addicted to e-cigarettes and that e-cigarette use in adolescents is associated with subsequent cigarette smoking.METHODSSystematic searches of eleven databases were conducted (January 2015 to June 2020). Systematic reviews, randomized controlled trials (RCTs) and cohort studies comparing e-cigarettes with placebo e-cigarettes, nicotine replacement therapy (NRT) or no e-cigarette use were included. The two primary outcomes were smoking cessation among smokers and smoking initiation among non-smoking teenagers. The secondary outcome was adverse events. Data were synthesized using risk ratio (RR) or adjusted odds ratio (AOR) with 95% confidence interval (CI).RESULTSSix systematic reviews, 5 RCTs and 24 cohort studies were identified. For smoking cessation, findings from 4 systematic reviews indicated that e-cigarettes contributed to cessation while one found the opposite. Meta-analysis of 5 RCTs suggested that e-cigarettes were superior to NRT or placebo for smoking cessation (RR=1.55; 95% CI: 1.00–2.40; I2=57.6%; low certainty; 5 trials, n=4025). Evidence from 9 cohort studies showed that e-cigarette use was not associated with cessation (AOR=1.16; 95% CI: 0.88–1.54; I2=69.0%; n=22220). Subgroup analysis suggested that intensive e-cigarette use may be associated with cessation. In terms of smoking initiation, adolescents who ever used e-cigarettes had a greater risk for smoking initiation than non-users (AOR=2.91; 95% CI: 2.61–3.23; I2=61.0%; 15 trials, n=68943), the findings were consistent with one included systematic review. No serious adverse events were reported in the included studies.CONCLUSIONSLow certainty evidence suggests that e-cigarettes appear to be potentially effective for smoking cessation. The use of e-cigarettes in adolescents may be associated with smoking initiation. No serious adverse events were reported.

Do Parents Still Matter? The Impact of Parents and Peers on Adolescent Electronic Cigarette Use

PurposeVaping among adolescents has reached epidemic levels. Identifying factors associated with electronic cigarette (e-cigarette) use initiation could inform prevention programming. This study examined whether parental attitudes toward e-cigarettes impacted adolescent e-cigarette use intentions, positive expectancies of use, and actual use when accounting for adolescent attitudes and peer norms. Parents' negative attitudes toward e-cigarettes were expected to reduce teen e-cigarette use intentions. Low e-cigarette use intentions were expected to mediate the association between parental attitudes and teen e-cigarette use. Peer norms were expected to be associated with positive expectancies. Positive expectancies were expected to mediate the association between peer norms and teen e-cigarette use. MethodsA sample of e-cigarette naïve adolescents (n = 176, aged 14–17 years, 52% female, 82% Latinx/Hispanic) and their parents were assessed. Parents and adolescents rated harm associated with e-cigarette use. Adolescents reported their perceptions of peer e-cigarette norms, intentions, positive expectancies, and e-cigarette use. Cross-sectional models were estimated for e-cigarette use intentions and positive expectancies. Prospective mediation models (n = 142) characterized pathways to e-cigarette use. ResultsParents' attitudes toward e-cigarettes were associated with weaker intentions. Intentions mediated the association between parental attitudes and e-cigarette use. Adolescents reporting favorable e-cigarette peer norms endorsed more positive expectancies. Positive expectancies did not mediate the association between peer norms and e-cigarette use. ConclusionsParents actively shape adolescent e-cigarette use even when accounting for peer norms and adolescent attitudes. Involving parents in prevention programming may help reduce vaping among teens. These associations should be examined with a larger and more diverse sample.

Association between observing peers vaping on campus and E-cigarette use and susceptibility in middle and high school students

BackgroundThis study examines the association between exposure to e-cigarette use on school campus and e-cigarette use behaviors among adolescents in the United States. MethodsData were obtained from the 2019 National Youth Tobacco Survey. First, two multivariate logistic regression models examined the association between in-school exposure to e-cigarette use and ever and past 30-day (i.e., current) e-cigarette use. Next, a multivariate logistic regression model to examine the relationship between in-school exposure to e-cigarette use and susceptibility to use was conducted among a subsample (n = 11,958) of never e-cigarette users. Covariates included grade, race/ethnicity, marketing exposure, and ever use of other tobacco products. ResultsApproximately 64.3 % of adolescents reported seeing someone use an e-cigarette on school campus; the most common locations being in the bathroom/locker room (34.4 %) and parking lot (34.0 %). In-school exposure to e-cigarette use was associated with greater odds of ever (Adj OR: 2.06; 95 % CI: 1.82–2.33) and current (Adj OR: 1.70; 95 % CI: 1.46–1.98) e-cigarette use among adolescents as well as greater odds of susceptibility to use (Adj OR: 2.00; 95 % CI: 1.82–2.20) among never e-cigarette users. ConclusionsObserving e-cigarette use on school campus was associated with greater odds of e-cigarette use and susceptibility. It is plausible that observing e-cigarette use on campus reinforces the social acceptability of adolescent e-cigarette use. Findings inform on the prevalence of e-cigarettes use on-campus as well as how this phenomenon may influence e-cigarette use/susceptibility among youth. The observed relationship highlights the role of schools in the efforts to reduce adolescent e-cigarette use.

Sensation seeking and adolescent e-cigarette use

ABSTRACT Background: A growing health concern is e-cigarette use among adolescents. Several correlates of this behavior have been elucidated, but few studies have examined whether sensation seeking is associated with e-cigarette use. The current study explores whether this personality dimension is related to e-cigarette use and whether the relationship is moderated by gender, race/ethnicity, or peer substance use. Methods: The analysis utilized data from 17,858 U.S. 8th – 10th grade students from the 2017 and 2018 Monitoring the Future (MTF) studies, who responded to questions about past 12-month e-cigarette use. The association with sensation seeking and four types of e-cigarette use – nicotine only, marijuana only, flavoring only, or nicotine and marijuana – was explored with a multinomial logistic regression model. Results: The results demonstrated that sensation seeking is positively associated with all four types of e-cigarette use, with a slightly stronger association with e-cigarette use involving marijuana. The associations were not moderated by gender, race/ethnicity, or peer substance use. Conclusions: The analysis suggested that sensation seeking consistently predicted several types of adolescent e-cigarette use. Research using longitudinal data and measures of e-cigarette use by family members and friends is needed, though, to better understand this association.

Multi-directional pathways of tobacco and marijuana use, including comorbid use, among a population-based cohort of adolescents in Texas: A six-wave cross-lagged model

PurposePast 30-day tobacco and marijuana use commonly occur among adolescents. It is unclear whether use of one product precedes the other, especially given the new climate surrounding marijuana legalization and the increasing popularity of e-cigarettes. MethodsSix-panel cross-lagged regression models, with six months between each panel/Wave (2014–17), were used to model stability paths, bi-directional paths, and comorbid paths (i.e., correlations) between past 30-day use of marijuana and tobacco products. Data were derived from three cohorts of adolescents (n = 3907; weighted N = 461,069) in 6th, 8th, and 10th grades at baseline. ResultsFew bidirectional relationships between past 30-day tobacco and marijuana use were observed in early adolescence (6th grade). During the middle adolescence developmental period (8th grade), past 30-day marijuana use was prospectively associated with greater risk of past 30-day tobacco use. In late adolescence (10th grade), increased odds of past 30-day marijuana use given prior past 30-day e-cigarette use, and vice versa, were observed. For all cohorts, stability paths were common, especially for past 30-day marijuana use. Comorbid use was common in middle adolescence (8th grade) but small in magnitude. ConclusionsThis is the first study to longitudinally situate comorbid, past 30-day use of tobacco and marijuana and simultaneously examine bi-directional past 30-day use of these products for adolescents. Marijuana use more often and more strongly predicted subsequent tobacco use than the reverse, especially during middle adolescence (13–15 years old). Marijuana use should be considered when creating interventions that address adolescent e-cigarette use in the U.S.

A Breath of Knowledge: Overview of Current Adolescent E-cigarette Prevention and Cessation Programs.

PurposeAdolescent use of electronic cigarettes (e-cigarettes) has risen rapidly, which is concerning given the health effects of e-cigarettes and youth susceptibility to nicotine addiction. It is critical that efforts to educate, prevent, and reduce adolescent use of e-cigarettes are developed and evaluated. The purpose of this paper is to review available current prevention and cessation programs.FindingsA web-based search of currently available e-cigarette prevention and cessation/treatment programs was conducted using Google in May of 2020. Programs were then reviewed on whether they included theory- and evidence-based practices of effective adolescent prevention and cessation programs. Eight prevention programs, seven cessation programs, and one program that addressed both prevention and cessation were identified and included in this review. Most prevention programs included the importance of understanding flavored e-cigarette products, addressed industry-targeted marketing, included social learning activities to develop refusal skills, delivered free-of-cost, available online, and explicitly stated their incorporation of theory. Five prevention programs and two cessation programs had empirically evaluated their e-cigarette-related components.ConclusionsAlthough the programs reviewed largely incorporated theory and included key components known to be effective, there are some gaps in the programs’ overall ability to prevent and stop adolescents from using e-cigarettes, such as lack of dedicated e-cigarette materials. More evidence-based tools, resources, and evaluations are needed to best inform adolescent e-cigarette cessation. Addressing the gaps that existing prevention and cessation programs present requires intervening at multiple systematic levels, conducting more rigorous program evaluations, and bolstering the availability of cessation programs.

Associations Between Peer Use, Costs and Benefits, Self-Efficacy, and Adolescent E-cigarette Use.

Prior research identified peer use as a salient risk factor of adolescent electronic cigarette (e-cigarette) use, but has not expanded on the mechanisms of this association. Participants were 562 adolescents recruited from rural and suburban public high schools and an adolescent medicine clinic in the mid-Atlantic United States. Participants completed a packet of questionnaires that assessed demographics, substance use, expectations about the consequences of e-cigarette use, and perceptions of their own self-efficacy to resist using e-cigarettes. We estimated a series of mediation models using the MODEL INDIRECT command in MPLUS statistical software. In all models, significance of indirect effects from peer e-cigarette use to self-reported e-cigarette use were tested via two variables: (a) expected costs, (b) benefits of e-cigarette use, and (c) the perceived self-efficacy of the individual to refrain from e-cigarette use. Adolescents with more peers using e-cigarettes were more likely to have ever used an e-cigarette and perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 1). Those with more peers using e-cigarettes were more likely to be currently using e-cigarettes themselves because they perceived greater benefits and fewer costs, which was associated with a reduced self-efficacy to refrain from e-cigarette smoking (Model 2). Peer use, self-efficacy to resist use, and expectations of cost and benefits of e-cigarette use should be considered as possible targets when devising tailored interventions and policies to prevent or reduce negative health consequences of long-term e-cigarette use.

Electronic cigarette use among 14- to 17-year-olds in Europe.

BackgroundStudies comparing adolescent e-cigarette use in different countries are scarce. We study students’ e-cigarette and conventional cigarette ever-use, their social correlates and e-liquid use in seven EU countries.MethodsSILNE-R data (N=12 167, response rate 79.4%) of 14–17-year-olds from Amersfoort (NL), Coimbra (PT), Dublin (IR), Hanover (GE), Latina (IT), Namur (BE) and Tampere (FI) were used. E-cigarette and conventional cigarette ever-use, dual-use, type of e-liquid and social correlates were measured with a school survey and analyzed with cross-tabulations and multinomial logistic regression.ResultsAbout 34% had tried e-cigarettes, but the variation was large between the cities (Latina 50%; Hanover 23%). Of e-cigarette ever-users, 37% had used nicotine e-liquid, 43% exclusively non-nicotine liquid and 20% did not know the content. Nicotine e-liquid was more prevalent among monthly e-cigarette users and weekly smoking e-cigarette users. The social correlates were mainly the same for exclusive e-cigarette ever-use, exclusive conventional cigarette ever-use and dual-use. Boys had greater odds for exclusive e-cigarette and dual-use compared to girls. Of social correlates, low academic achievement and parental smoking were positively associated with all categories of use, but parental education and immigrant background were not. The strongest association was found between peer smoking (most/all best friends smoke) and dual-use (OR 34.29).ConclusionsStudents’ e-cigarette ever-use varies greatly between EU countries. E-cigarettes seem not to be a substitute for conventional cigarettes but more a complementary product. Tobacco control policies might also prevent e-cigarette use but specific regulations on e-cigarettes are needed to prevent nicotine addiction originating from them.