Adolescent E-cigarette Use Research Articles

Commentary on Foxon & Selya (2020): Social gradients in long-term health consequences of cigarette use-will adolescent e-cigarette use follow the same trajectory?

Commentary on Foxon & Selya (2020): Social gradients in long-term health consequences of cigarette use-will adolescent e-cigarette use follow the same trajectory?

Associations Between Family and Peer E-Cigarette Use With Adolescent Tobacco and Marijuana Usage: A Longitudinal Path Analytic Approach.

Research indicates a link between adolescent e-cigarette use and combustible tobacco cigarette (CTC) initiation, and recent studies suggest their connection with marijuana uptake. Our 3-year longitudinal cohort study investigated the implications of adolescent, peer, and family e-cigarette use with adolescents' expectations and willingness to initiate CTC use, and subsequent CTC and marijuana use. Relationships were examined in a secondary analysis of a 3-year longitudinal cohort subsample involving adolescents enrolled in alternative California high schools (N = 1025). Analyses examined responses over three yearly observations. Family, peer, and respondents' e-cigarette use, respondents' positive cigarette expectancies and willingness to use CTCs were assessed in the study's first year (T1). CTC use in the survey's second year (T2) and marijuana use in the third year (T3) were assessed via path analysis. Respondents reporting at least one family member or peer using e-cigarettes were more likely to use e-cigarettes at T1 than those whose peers/family members did not. They reported more positive expectancies about CTCs and greater willingness to initiate use. These variables predicted CTC use at T2, which directly anticipated marijuana use in the survey's third year (T3), as did adolescents' use of e-cigarettes at T1. All model relations were statistically significant. Analysis demonstrated the strong association of family members' and peers' behaviors with adolescent e-cigarette use, and the temporal precedence of e-cigarette use with subsequent CTC and marijuana uptake. The predictive implications of e-cigarettes for other dangerous substance use should be examined in future prevention campaigns. The presented study expands upon existing literature connecting adolescent e-cigarette use and later CTC and marijuana use. The findings indicate the significant implications of exposure to e-cigarette use by parents and peers and demonstrate in a longitudinal 4-year panel survey the direct and indirect predictive implications of e-cigarette use for CTC and marijuana uptake. The research illustrates the utility of programs and campaigns that target peer and family groups to maximize impacts on adolescent willingness to try CTCs, positive expectancies, and possible onset of CTC and marijuana use.

Dissemination of CATCH My Breath, a middle school E-Cigarette prevention program

ObjectivesIn 2016, the US Surgeon General issued a Call to Action to address adolescent e-cigarette use and school-based prevention interventions are an effective component of comprehensive tobacco control. This study describes the development and dissemination of CATCH My Breath, an e-cigarette prevention program for middle and high school students. MethodsStarting in 2014, a university and nonprofit collaboration designed, formatively evaluated, pilot tested, and disseminated the CATCH My Breath Program (CMB). The team used Social Cognitive Theory to develop the program and Diffusion of Innovations Theory to disseminate the program. Dissemination strategies were applied beginning in 2016. This paper describes the application of both theories and the resulting reach of CMB. ResultsSince dissemination began, CMB has been rapidly adopted, following the typical diffusion normal curve. As of June 2020, approximately 4,000 schools in the United States have adopted the program, 70,000 teachers have taught the program, and 1,400,000 students have been exposed to program materials. ConclusionThe application of Social Cognitive Theory and Diffusion of Innovation Theory resulted in effective prevention results and rapid, widespread adoption of the CMB. This level of adoption and implementation represents 25% of the school marketplace. CMB should be considered as the school component of the recommended combustible and e-cigarette prevention and control toolkit, alongside mass media, marketing restrictions, retail access, taxation, flavor ban, and FDA premarket approval. Other public health interventions seeking rapid adoption should consider applying principles of Diffusion of Innovation as a guide for development and dissemination.

Characterizing e-cigarette vaping-associated lung injury in the pediatric intensive care unit.

Adolescent e-cigarette use has risen to epidemic levels in the US, revealing a new phenomenon of e-cigarette vaping-associated lung injury (EVALI). It is important to better characterize EVALI in critically ill adolescents as this is a vulnerable and rapidly growing demographic. This was a retrospective case series of patients ≤21 years old with confirmed or probable EVALI (as defined by the Centers for Disease Control) that resulted in admission to the pediatric intensive care unit (PICU) of a large tertiary academic children's hospital between August 2019 and January 2020. There were six eligible patients, with a median age of 17 years. All patients reported tetrahydrocannabinol as well as nicotine e-cigarette use. Half of the patients had a preexisting diagnosis of asthma and four patients had mental health comorbidities. All patients presented with respiratory alkalosis and chest radiography showing diffuse bilateral infiltrates; two patients had pneumomediastinum, subcutaneous air and/or pneumothorax. The lowest documented ratio of oxygen saturation to inspired oxygen (SpO2:FiO2 or S/F ratio) ranged from 146 to 296. Two patients required an arterial line, with the lowest ratio of arterial oxygen to inspired oxygen (PaO2:FiO2 or P/F ratio) of 197 and 165. Two patients tested positive for rhinovirus and respiratory cultures were negative for all patients. Four patients underwent chest computed tomography imaging, which showed diffuse ground-glass opacities. Every patient required noninvasive positive pressure ventilation, with one progressing to invasive ventilation. All patients received broad-spectrum intravenous antibiotics and steroids, though there was considerable variability in dose, frequency, and duration of steroids. The hospital length of stay ranged from 5 to 16 days (median 8.3 days) with PICU length of stay ranging from 4 to 10 days (median 5.5 days). Four patients had pulmonary function testing before discharge, two of which showed decreased diffusing capacity of the lung for carbon monoxide. There were no patient deaths. This single-center case series describes the presentation, course, and treatment of EVALI in a pediatric intensive care unit setting. Our results show nuanced differences in the presentation and management of the critically ill adolescent, and raise many questions about the long term implications on lung health, morbidity, and mortality. Importantly, these cases illustrate the critical care consequences of a public health phenomenon and should spur further research and policy to address the negative health effects of vaping.

Exposure to e-cigarette advertising, attitudes, and use susceptibility in adolescents who had never used e-cigarettes or cigarettes

BackgroundTobacco advertisements have been banned in Hong Kong, but low intensity e-cigarette (EC) advertising can still be found in various media outlets. We investigated the associations between exposure to EC advertising and susceptibility to EC use in adolescents who had never used cigarettes or ECs, with potential mediation by attitudes towards ECs and the tobacco industry.MethodsThe School-based Smoking Survey 2016/17 assessed exposure to EC advertising in the past 30 days, attitudes towards ECs and the tobacco industry, susceptibility to EC use, and other covariates. Generalised linear mixed models and multiple mediation analysis methods were used in data analyses.ResultsAmong 7082 students (mean age 14.9 years), 28.8% reported exposure to EC advertising. Exposure was associated with being uncertain about the harm of EC use, being tolerant towards ECs, believing the tobacco industry is respectable, and being susceptible to EC use; the magnitudes of these associations increased with the number of types of advertising exposed (0, 1, and ≥ 2) (all p-values < 0.01). These attitudinal factors were in turn associated with EC use susceptibility (all p-values < 0.001). The perception that tobacco companies make youth smoke was not associated with the advertising exposure or EC use susceptibility. Of the total effects of EC advertising on use susceptibility, only 16.6% were mediated by attitudinal factors: perceived harm (3.1%), attitudes towards ECs (8.2%), and attitudes towards the tobacco industry (4.9%).ConclusionsEven exposure to low intensity EC advertising was associated with susceptibility to EC use in adolescents who had never used cigarettes or ECs. The association was weakly mediated by tolerant attitudes towards ECs and the tobacco industry. The government should reinforce the regulations on EC advertising to protect adolescent health.

Association between school-based tobacco retailer exposures and young adolescent cigarette, cigar and e-cigarette use

BackgroundAssociations between retail tobacco availability and tobacco use have been mixed. This study examined associations between school-based retail environment exposures and current use of cigarettes, cigar products and e-cigarettes among...

High-dose adolescent nicotine exposure permits spontaneous nicotine self-administration in adult male rats

IntroductionWhile cigarette smoking rates have been steadily decreasing over the past decade, there has been a dramatic increase in nicotine use via e-cigarettes, especially during adolescence. Adolescent e-cigarette use is associated with a greater risk of future cigarette smoking, and increased rates of cigarette smoking in individuals who may have otherwise never tried cigarettes. In humans and rodents, early initiation of nicotine use has been associated with greater consumption, dependence, and persistent nicotine use. The present study sought to investigate the long-lasting effect of daily high-dose nicotine exposure during adolescence on nicotine consumption in adulthood. MethodMale Sprague-Dawley rats were exposed daily to nicotine (1.0 mg/kg, subcutaneous), or vehicle (1 mL/kg saline, subcutaneous) during adolescence (post-natal day [P] 28–41). Adult nicotine self-administration (0.02 mg/kg/infusion, intravenous) was assessed beginning on P75 on fixed-ratio 1 (FR1), fixed-interval 1 min (FI1), and progressive ratio (PR) schedules of reinforcement. ResultsAdolescent nicotine pre-exposure did not affect adult nicotine self-administration on the simple FR1 schedule, however increased intake and responding for nicotine was observed when a short delay was implemented on an FI1 schedule of reinforcement. ConclusionsAdolescence is a critical period when the brain is especially vulnerable to the effects of nicotine. Nicotine exposure in adolescence enhances susceptibility to increased nicotine intake in adulthood on a reinforcement schedule more reflective of human nicotine intake patterns, and this effect can extend into adulthood even after termination of nicotine exposure during adolescence.

JUULing Epidemic Among Youth: A Guide to Devices, Terminology, and Interventions.

JUULing Epidemic Among Youth: A Guide to Devices, Terminology, and Interventions.

School-based e-cigarette education in Alabama: Impact on knowledge of e-cigarettes, perceptions and intent to try

Background and objectivesEducational programs are needed to combat the sharp rise in adolescent e-cigarette use. We assessed adolescent knowledge about e-cigarettes, perceptions of harmfulness and addictiveness and intent to try e-cigarettes before and after an e-cigarette educational session. MethodsWe conducted a one-group pre- and post-test study among middle and high school students in Alabama in 2019. The intervention included a 30-minute educational session based on the Stanford Tobacco Prevention Toolkit on e-cigarette types, contents, marketing and advertising, health effects and nicotine addiction. McNemar tests of paired proportions and multi-level, mixed-effects logistic regression models were used to analyze intervention effects. ResultsSurveys were completed by 2,889 middle and high school students. The intervention was associated with significantly increased knowledge about e-cigarettes and perceptions that e-cigarettes are harmful and addictive, and with significantly lower intent to try e-cigarettes. At pre-test, middle school students had lower knowledge, believed that e-cigarettes were not as addictive and showed higher intent to try both e-cigarettes and cigarettes compared to high school students. Groups that were associated with lower perceived harmfulness and addictiveness were: ever-users of e-cigarettes, ever-users of both e-cigarettes and cigarettes and prior users of mint/menthol flavored e-cigarettes. ConclusionsA school-based educational session was significantly associated with improved adolescent knowledge about e-cigarettes, increased the perceived harmfulness and addictiveness of e-cigarettes, and reduced intent to try e-cigarettes. E-cigarette education should be prioritized for middle school students due to lower levels of knowledge and higher intent to try tobacco compared to high school students.

Vaping in adolescents: epidemiology and respiratory harm.

This review highlights epidemiologic changes in e-cigarette use in adolescents, discusses recent advances in aerosolized nicotine delivery, and provides and updated profile of research related to the lung-specific harm of e-cigarettes. In the past decade, nicotine-containing e-cigarettes have emerged as the most popular tobacco and nicotine delivery modality among adolescents in the United States. The surge in popularity of these devices has coincided with an outbreak of vaping-related lung injury, bringing e-cigarette use to national attention, and creating a great deal of confusion regarding their potential for respiratory harm. Newer pod-based devices and formulations of e-liquids have resulted in products appeal to youth and deliver nicotine with increasing efficiency. E-liquid aerosols are associated with direct harm to respiratory epithelium and have been shown to alter pulmonary function, inflammation, mucociliary clearance, and lung histology. Although the long-term harms of regular e-cigarette use are unknown, numerous studies including early longitudinal data suggest e-cigarette use is associated with incidence of respiratory disease, independent of concurrent traditional cigarette use. Improved understanding and recognition of harm will contribute to the basis of further studies examining the role of e-cigarettes on chronic respiratory disease and will inform future prevention education.

The Food and Drug Administration Is Not Positioned to Deter Adolescent E-Cigarette Use.

The Food and Drug Administration Is Not Positioned to Deter Adolescent E-Cigarette Use.

Longitudinal investigation of the bidirectional associations between initiation of e-cigarettes and other substances in adolescents

ABSTRACT Background: Although research on adolescent e-cigarette use is growing, several questions remain unanswered, including the timing of initiation and the co-occurrence with initiation of other substances. The current study longitudinally evaluated the risk for initiation of e-cigarettes and examined associations with this risk and initiation of other substances (alcohol, traditional tobacco products, and marijuana). Methods: 141 youth from a single high school were in 9th and 10th grade at the initial data collection. Data were collected annually for the following two years. Rates of initiation were calculated. Cross-lagged panel models estimated how prior initiation of e-cigarette use affected the risk for initiation of other substances and vice-versa. Results: Risk for initiation of e-cigarettes was comparable across the two years. Youth were most at risk for having used alcohol at baseline. As youth aged through high school, they were most at risk for initiation of e-cigarettes relative to other substances. There is preliminary evidence that endorsement of alcohol use at baseline increased the risk for initiation of e-cigarettes one year later. Conclusions: Rates of e-cigarette initiations increased throughout the two-year period. These preliminary findings support the notion that efforts to prevent initiation of e-cigarettes should target adolescents who have used alcohol.

Public Health Considerations for Adolescent Initiation of Electronic Cigarettes.

Adolescent use of electronic cigarettes (e-cigarettes) has increased dramatically, with younger and nicotine-naive adolescents starting to use these devices and use them more frequently than combustible cigarettes. In emerging evidence, it is shown that e-cigarettes are not effective in helping adult smokers quit and that youth using e-cigarettes are at risk for becoming nicotine dependent and continuing to use as adults. Important gaps in our knowledge remain regarding the long-term health impact of e-cigarettes, effective strategies to prevent and reduce adolescent e-cigarette use, and the impact of provider screening and counseling to address this new method of nicotine use.

E-Cigarette Use Associated With Asthma Independent of Cigarette Smoking and Marijuana in a 2017 National Sample of Adolescents

PurposeKnowledge about the health consequences of e-cigarette use in adolescence remains limited. Available studies of asthma among adolescents are based on data collected five or more years ago, and evidence from more recent generations of e-cigarette products is needed. MethodsWe analyzed data from the 2017 Youth Risk Behavior Survey, a cross-sectional study with a representative U.S. national sample of high school students. Multivariable analyses tested for associations of ever and 30-day e-cigarette use with asthma controlling for cigarette smoking, marijuana use, demographics, and obesity. ResultsA significant association with asthma was found for ever use of e-cigarettes, adjusted odds ratio (AOR) = 1.15 (confidence interval [CI], 1.02–1.30; p = .02) and for currently using e-cigarettes, AOR = 1.30 (CI, 1.10–1.53; p = .002). Also related to asthma were current cigarette smoking, AOR = 1.24 (CI, 1.03–1.51; p = .03) and obesity, AOR = 1.48 (CI, 1.30–1.68; p < .0001). E-cigarettes had an additive effect for asthma beyond smoking (p = .03). Differentials in asthma prevalence by race/ethnicity were found, with lower prevalence of asthma for non-Hispanic Asian (p = .02) and Hispanic (p = .03) and higher prevalence for non-Hispanic black (p < .0001) and non-Hispanic multirace (p < .0001) relative to non-Hispanic white populations. ConclusionsE-cigarette use was significantly associated with asthma in recent data on adolescents, controlling for several disease-relevant covariates. The results are consistent with studies based on previous generations of e-cigarettes and support the significance of e-cigarettes as a continuing public health concern.

The Course of E-Cigarette Use in Adolescence: A Cohort Study over 18 Months

Description of adolescent e-cigarette use over time. In 2017 and 2019, 261 adolescents from North Rhine-Westphalia who had used e-cigarettes at least once a month (mean age: 14.9 years; 33.5 % female) took part in a questionnaire study. In 2017, 84 adolescents (32.2 %) reported exclusive e-cigarette use (single users), 177 adolescents were classified as dual users (67.8 %) because they consumed a tobacco product (conventional cigarette and/or hookah) in addition to e-cigarettes. During the observation period of 18 months, 83 adolescents (31.8 %) quit nicotine products altogether. Dual users quit nicotine less often than single users (N = 39 or 22.0 % vs. N = 44 or 52.4 %, p < 0.001). Seven single users (8.3 %) did not change their behavior, 11 began to use tobacco exclusively (13.1 %), another 22 (26.2 %) started dual use. Seventy-eight dual users (44.1 %) did not change their behavior, 57 (32.1 %) switched to tobacco use only, 3 dual users (1.7 %) stopped tobacco use, but continued to use e-cigarettes. Taken together, at the end of the study, 10 (5.6 %) of the remaining 178 adolescents consumed only e-cigarettes, while 168 (94.4 %) smoked tobacco or were dual-users. More than two thirds of all young e-cigarette users and more than three quarters of dual users also used nicotine products 18 months later. The remaining consumers showed a less frequent stay or switch to single use, instead a more frequent use of tobacco or dual use.

Measuring e-cigarette addiction among adolescents

Background and objectivesWith high rates of use and uncertain consequences, valid electronic cigarette (e-cigarette) use frequency and addiction measures for adolescents are needed. This cross-sectional study examined correlations for multiple...

Timing of vape use among adolescents: Differences by family structure

BackgroundThe prevalence of adolescent e-cigarette (vape) use has increased significantly over the past several years. Given the risks associated with vape use, it is important to identify predictors of adolescent vape use onset. PurposeThe primary aim was to examine the time to vape use among adolescents, as a function of parental marital status and living arrangements. MethodsA sample of 863 adolescents (Mage = 12.73, SD = 0.70; 52% girls; 61% non-Hispanic White) from public middle schools in the Northeast United States were asked about whether they vaped over the course of three years (fall 2016-spring 2019). Cox proportional hazards (PH) regression models were conducted to examine associations between parental divorce and the timing of vape use, gender differences in the association, and potential differences in the association as a function of living arrangements. ResultsFindings indicated that adolescents with divorced parents at Time 1 vaped earlier, and were 51% more likely to vape than adolescents with married parents. There were no gender differences, or differences in timing among those with divorced parents as a function of living with a step-parent. ConclusionThese findings highlight the importance of identifying familial risk factors associated with early vape use in adolescents.

E-Cigarette, Cigarette, and Dual Use in Korean Adolescents: A Test of Problem Behavior Theory

ABSTRACTE-cigarettes are becoming increasingly popular among adolescent cigarette users. However, little is known about the various factors related to adolescents’ use of e-cigarettes, cigarettes, or both in South Korea. Using nationally representative data from the 2017 Korea Youth Risk Behavior Web-based Survey, this study examined the possible problem behavior theory factors that contribute to (1) current e-cigarette use among those who have ever used cigarettes (Model 1), (2) current cigarette use among those who have ever used e-cigarettes (Model 2), and (3) current dual use among current cigarette or e-cigarette users (Model 3). In all three models, our analysis showed that tobacco accessibility and sexual intercourse were significant factors. For Model 2, reasons for using e-cigarettes and alcohol use were correlated with current cigarette use. Except for gender, the significant factors, which included secondhand smoke exposure at home and school type, were the same in Models 1 and 3. Based on these findings, we encourage the South Korean government to pay close attention to potential increase in dual use among adolescents and to take the necessary steps in addressing adolescent e-cigarette use in tobacco prevention and control programs.

Adolescent E-cigarette use trajectories and subsequent alcohol and marijuana use

IntroductionAs electronic cigarette (e-cigarette) use has become more prevalent among adolescents, there is a growing body of evidence linking e-cigarette use to the initiation of other substances. Whether there is a threshold level of e-cigarette use that is predictive of other substance use is unknown. The current study examines patterns of e-cigarette use over time and determines whether different patterns of early adolescent e-cigarette use are concurrently and prospectively associated with alcohol and marijuana use in late adolescence. MethodEight hundred and one adolescents (13–15 years old at baseline recruitment) completed five on-line surveys over a two-year period. Latent class growth analysis was used to model different developmental courses of e-cigarette, alcohol (drinking to intoxication), and marijuana use. Logistic regression was used to test the association between e-cigarette use trajectory patterns and alcohol and marijuana use trajectories. ResultsThree developmental courses of e-cigarette use were identified: 1) high and increasing, 2) low and increasing, and 3) never. Compared to adolescents who had never used e-cigarettes, those in the other two groups were more likely to have been intoxicated and to be in the moderate and increasing marijuana use group. ConclusionBoth high and low levels of e-cigarette use patterns are associated with increasing use of other substances (alcohol and marijuana use) over time. Findings highlight the need for early intervention and prevention of e-cigarette use among adolescents.

Corrigendum: Is adolescent e-cigarette use associated with smoking in the United Kingdom?: A systematic review with meta-analysis

[This corrects the article DOI: 10.18332/tpc/108553.].