Adolescent Electronic Cigarette Use Research Articles

Factors Associated With the Changes in Smoking and Electronic cigarette use in Adolescents During the COVID-19 Pandemic: A Longitudinal Analysis

PurposeExplore the factors associated with the changes in smoking and electronic cigarette (e-cigarette) use and susceptibility among adolescents during the COVID-19 pandemic. MethodsWe surveyed a cohort of students (7th–12th grade) from private schools in Guatemala. Baseline (May–September 2019) was conducted in-person and follow-up (June–November 2020) online during the lockdown. Separate Generalized Estimating Equations logistic models regressed current smoking (n = 3,729), current e-cigarette use (n = 3,729), smoking susceptibility among never-smokers (n = 2,596), and susceptibility to e-cigarette use among never-users (n = 1,597) on online ad exposure, visiting stores, social network smoking/e-cigarette use, substance use (alcohol, marihuana, and cigarette or e-cigarette), perceived harm of using cigarettes/e-cigarettes, sociodemographic characteristics, and survey wave. Interactions were assessed between time and ad exposures, friends smoking and e-cigarette use. ResultsFrequency of store visits, exposure to online ads, and the use of cigarette and e-cigarette lowered at follow-up. Online e-cigarette ads, having family and friends who smoke, and current e-cigarette use increased the likelihood of being a current smoker. Frequent exposure to online e-cigarette ads, having family who use e-cigarettes, and being a current smoker were associated with higher likelihood of current e-cigarette use. Exposure to either online ads or having friends that smoke or use e-cigarettes, increased susceptibility to using either product. Interaction results showed that high exposure to online e-cigarette ads overtime increased the susceptibility to use e-cigarettes. DiscussionExposure to online ads and friends and family cigarette and e-cigarette use increased adolescent consumption and susceptibility during the pandemic.

Fabrication and Validation of an Economical, Programmable, Dual-Channel, Electronic Cigarette Aerosol Generator.

Vaping (inhalation of electronic cigarette-generated aerosol) is a public health concern. Due to recent spikes in adolescent use of electronic cigarettes (ECIGs) and vaping-induced illnesses, demand for scientific inquiry into the physiological effects of electronic cigarette (ECIG) aerosol has increased. For such studies, standardized and consistent aerosol production is required. Many labs generate aerosol by manually activating peristaltic pumps and ECIG devices simultaneously in a predefined manner. The tedium involved with this process (large puff number over time) and risk of error in keeping with puff topography (puff number, duration, interval) are less than optimal. Furthermore, excess puffing on an ECIG device results in battery depletion, reducing aerosol production, and ultimately, its chemical and physical nature. While commercial vaping machines are available, the cost of these machines is prohibitive to many labs. For these reasons, an economical and programmable ECIG aerosol generator, capable of generating aerosol from two atomizers simultaneously, was fabricated, and subsequently validated. Validation determinants include measurements of atomizer temperatures (inside and outside), electrical parameters (current, resistance and power) of the circuitry, aerosol particle distribution (particle counts and mass concentrations) and aerosol delivery (indexed by nicotine recovery), all during stressed conditions of four puffs/minute for 75 min (i.e., 300 puffs). Validation results indicate that the ECIG aerosol generator is better suited for experiments involving ≤100 puffs. Over 100 puffs, the amount of variation in the parameters measured tends to increase. Variations between channels are generally higher than variations within a channel. Despite significant variations in temperatures, electrical parameters, and aerosol particle distributions, both within and between channels, aerosol delivery remains remarkably stable for up to 300 puffs, yielding over 25% nicotine recovery for both channels. In conclusion, this programmable, dual-channel ECIG aerosol generator is not only affordable, but also allows the user to control puff topography and eliminate battery drain of ECIG devices. Consequently, this aerosol generator is valid, reliable, economical, capable of using a variety of E-liquids and amenable for use in a vast number of studies investigating the effects of ECIG-generated aerosol while utilizing a multitude of puffing regimens in a standardized manner.

Validation of the Electronic Cigarette Expectancy Scale for Adolescents

ABSTRACT Introduction Expectancies of costs and benefits can be predictive of tobacco use, as well as cessation attempts and success. Measuring electronic cigarette (ECIG) expectancies is in its infancy, particularly among adolescents. However, the popularity of adolescent ECIG use demonstrates the need to understand better these contributing factors. Our aim was to evaluate the factor structure and initial psychometric properties of an ECIG expectancies questionnaire adapted from an existing validated scale for conventional cigarette smoking (Smoking Expectancy Scale for Adolescents; SESA). Methods Five-hundred sixty-nine adolescents (14-18 years; 60.1% female; 84.1% White) were recruited from high schools and an adolescent medicine clinic. Participants completed a battery of self-report measures, including the ECIG Expectancies Scale for Adolescents (EESA). Exploratory factor analyses were used to examine the underlying factor structure, and convergent validity was evaluated using variables conceptually related to ECIG expectancies. Results A three-factor solution was chosen based on statistical evidence and conceptual relevance. All three factors - Costs, Social Benefits, and Affective/Weight Benefits - had strong internal consistencies and demonstrated convergent validity via significant associations with peer ECIG use and Conscientiousness. The Costs and Affective/Weight Benefits factors also demonstrated convergent validity with sensation-seeking, intention to use ECIGs, and ECIG use status (current, lifetime, nonuser). Conclusion Results support the initial reliability and validity of the EESA scores. This factor structure is related to, yet different from, that observed not only for the SESA but also for other ECIG-expectancy measures among adult populations.

Enhancing Adolescent Risk Perception of Electronic Cigarette Use.

Adolescent electronic cigarette use has been steadily increasing since first being introduced commercially in 2007. The aim of this pilot study was to determine if adolescents who watched an educational video during a wellness visit would increase their perception of risk related to electronic cigarette use. Seventy-nine adolescents participated and were randomly assigned to the intervention (n = 40) or control (n = 39) group. Results included risk perception, perceived benefit, and provider discussion about electronic cigarettes. There was no statistical difference between intervention and control groups for electronic cigarette risk or perceived electronic cigarette benefit. Adolescents who watched the video intervention compared to those who did not watch a video intervention were significantly more likely to report having discussed electronic cigarettes with their provider (p < .001). Watching a video intervention on electronic cigarettes increased the likelihood of a reported discussion between provider/patient about electronic cigarettes but did not increase risk perception or decrease perceived benefit of electronic cigarettes. Utilizing video education is one tool that could potentially be used to augment provider education during wellness visits.

A commentary on adolescent electronic cigarette use and nicotine addiction.

Adolescent electronic cigarette (e-cigarette) use has continued due to the ongoing struggle with nicotine addiction affecting teenagers. By briefly discussing the timeline of the emergence of e-cigarettes and nicotine addiction in adolescents, this author hopes to shed some light on mitigation strategies to curtail this ongoing epidemic of youth e-cigarette use and nicotine addiction through public health education and advocacy.

Predicting Adolescent Electronic Cigarette Use: Differences by Never, Ever, and Current Users.

Rising rates of adolescent electronic cigarette (ECIG) use is concerning because it can lead to adverse health outcomes and increased risk behavior. There are known predictors of ever versus never ECIG use, but less are known about risk factors for ever versus current use of ECIGs. Problem behavior theory (PBT) was used to evaluate possible risk factors for different ECIG use status. Participants were 573 high school students who completed questionnaires measuring ECIG use, as well as constructs within the Social Environment, Perceived Environment, Personality, and Behavior domains of PBT. Multinomial logistic regression was used to evaluate how predictor variables differentiated between participants who reported (a) never use, (b) ever ECIG use, or (c) current ECIG use. Adolescents were more likely to endorse ever ECIG use than never use if they reported peer ECIG use, perceived more benefits and fewer costs (e.g., health) of ECIG use, higher extraversion, alcohol and cigarette use (never vs. ever vs. past 30 days), or attended a school with a higher percentage of socioeconomically disadvantaged students. Adolescents were more likely to report current ECIG use than ever ECIG use if they perceived fewer costs of ECIG use or used cannabis in their lifetime (yes/no). PBT variables differentiated between ever ECIG use and never ECIG use. However, these variables did not differentiate between ever and current ECIG use. Identifying unique risk factors for current versus ever ECIG use is important to understanding persistent ECIG use and subsequent targeted prevention and intervention programs.

Adolescent electronic cigarette use and tobacco smoking in the Millennium Cohort Study

AbstractAimsTo evaluate the catalyst, diversion and common liability hypotheses by examining associations between e‐cigarette use and tobacco cigarette smoking at modal ages 14 and 17 years, controlling for adolescent and infancy risk factors.DesignIntergenerational, prospective cohort data from the Millennium Cohort Study (MCS). Nationally representative sample of infants born September 2000 to January, 2002.SettingUnited Kingdom.ParticipantsParent and child data from 10 625 youth assessed in infancy and modal ages 11, 14 and 17 years.MeasurementsAge 14 and 17 e‐cigarette and combustible cigarette use (recency, frequency). Potential confounders were age 11 risk factors (e.g. alcohol use, externalizing behaviors, parental tobacco use, permissiveness), infancy risk factors (e.g. maternal smoking during pregnancy, smoke exposure in infancy) and demographic characteristics.FindingsAmong youth who had not smoked tobacco by age 14 (n = 9046), logistic regressions estimated that teenagers who used e‐cigarettes by age 14 compared with non‐e‐cigarette users, had more than five times higher odds of initiating tobacco smoking by age 17 [odds ratio (OR) = 5.25, 95% confidence interval (CI) = 3.28–8.38] and nearly triple the odds of being a frequent tobacco smoker at age 17 (OR = 2.91, 95% CI = 1.56–5.41), net of risk factors and demographics. Among youth who had not used e‐cigarettes by age 14 (n = 9078), teenagers who had smoked tobacco cigarettes by age 14 had three times higher odds of initiating e‐cigarettes by age 17 (OR = 2.98, 95% CI = 1.74–5.09) compared with non‐tobacco smokers and nearly three times higher odds of frequently using e‐cigarettes at age 17 (OR = 2.90, 95% CI = 1.21–6.95), net of confounders. Similar links between e‐cigarette and tobacco cigarette use were observed in regressions following coarsened exact matching.ConclusionsE‐cigarette use by age 14 is associated with increased odds of tobacco cigarette initiation and frequent smoking at age 17 among British youth. Similarly, tobacco smoking at age 14 is associated with increased odds of both e‐cigarette initiation and frequent use at age 17.

Development of a Risk Behavior Diagnosis Scale for E-cigarette Use.

Objectives: Adolescent use of electronic cigarettes has risen dramatically, prompting concerns about the health effects. There is need for brief measures to assess adolescents' perceived threat and efficacy related to e-cigarette use and cessation. A 12-item Likert-type scale was modeled after the Risk Behavior Diagnosis Scale and designed to assess threat (ie, severity and susceptibility of threat) and efficacy (ie, self-efficacy and response efficacy) as they relate to e-cigarette use. Methods: The scale was administered online to a developmental sample of 674 adolescents to examine internal consistency and factor structure. Participants (52.1% female, M age = 14.6) were representative of the surrounding community (60% non-Hispanic white; 27% non-Hispanic black; 8% Hispanic). Results: Factor analysis and Velicer's minimum average partial test revealed 2 factors (as expected), which explained 68% of the variance. Analyses revealed strong internal consistency, with Cronbach's alpha of .93 overall and alphas of .92 and .87 for threat and efficacy subscales, respectively. The measure also exhibited good convergent and discriminant validity with other constructs. Conclusions: The measure demonstrates strong preliminary reliability and validity for a developmental sample of adolescents.

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.

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.

Evidence that an intervention weakens the relationship between adolescent electronic cigarette use and tobacco smoking: a 24-month prospective study

BackgroundThe electronic cigarette (e-cigarette) use to subsequent smoking relationship in adolescents has received much attention. Whether an intervention to reduce smoking initiation attenuated this relationship was assessed.MethodData were from 3994...

Do population trends in adolescent electronic cigarette use coincide with changes in prevalence of cigarette smoking?

Adolescents who initiate electronic cigarette (EC) use without having ever used tobacco are more likely than those that have not initiated EC use to try cigarette smoking over time. However, whether rates of EC use coincide with cigarette smoking rates at the population level remains unknown. This study aimed to compare trends in ever, current, and daily use of EC and cigarette smoking among adolescents in Iceland from 2015 to 2018. We analyzed four waves of pooled cross-sectional population-based school survey data with students enrolled in the 8th, 9th and 10th grades in the national Icelandic school system (n = 42,440, boys = 50.1%). Response rates ranged between 83.3% and 86.0%. Findings for 8th, 9th, and 10th grade students, and the combined sample, revealed a consistent pattern: prevalence of cigarette smoking either remained unchanged or decreased minimally over the study period. In the combined sample rates of ever smoking remained between 9 and 10% during the entire study period, whereas the prevalence of daily cigarette smoking was around 1%. The use of EC increased 2- to 3-fold in all age groups. Ever use increased from 12% to roughly 30% in the combined group and daily use increased from about 2% to 6% during the same period. We conclude that the prevalence of adolescent cigarette smoking in Iceland remained mostly unchanged between the years 2015 and 2018, whereas EC use increased exponentially during the same period. The prevalence of EC use now far outweighs cigarette smoking in 8th–10th grade youth in Iceland.

Weight Status and Cigarette and Electronic Cigarette Use in Adolescents.

Research shows that adolescents who are overweight or obese may be at greater risk of cigarette smoking, and that this relationship may vary by gender. However, this relationship is understudied for electronic cigarettes (e-cigarettes). Given the high rate of adolescent obesity and the rise in e-cigarette use in adolescents, this relationship should be investigated. Data are from the third wave (collected October 2015-January 2016) of the Texas Adolescent Tobacco and Marketing Surveillance system. Students were in the seventh, ninth, and 11th grades (n=2,733) from five counties surrounding four major Texas metropolitan areas (Houston, Austin, San Antonio, Dallas). Weighted logistic regression was used to determine if weight status (healthy weight, overweight, or obese) was correlated with ever and past 30-day cigarette or e-cigarette use, controlling for sociodemographics. Models were stratified by gender. Data analyses were conducted in March 2017. Compared with healthy-weight boys, obese boys had higher odds of past 30-day e-cigarette use (AOR=3.45, 95% CI=1.34, 8.33) and cigarette smoking (AOR=4.52, 95% CI=1.32, 15.51). There was no significant relationship between weight status and cigarette or e-cigarette use in girls. This study supports that there is a positive relationship between weight status and past 30-day cigarette and e-cigarette use for boys, but that there is no association for girls.

Follow-up of adolescent electronic cigarette use in Finland

Follow-up of adolescent electronic cigarette use in Finland

Temporal Changes in the Correlates of U.S. Adolescent Electronic Cigarette Use and Utilization in Tobacco Cessation, 2011 to 2013.

To examine temporal changes in the correlates of experimental and current e-cigarette use and associations with tobacco quit attempts. Repeated cross-sectional analyses of data from the 2011 ( n = 17,741), 2012 ( n = 23,194), and 2013 ( n = 16,858) National Youth Tobacco Surveys-a nationally representative sample of U.S. middle and high school students. Respondents were asked about lifetime and past-month e-cigarette use, conventional cigarette use, and number of quit attempts made in the prior year among current smokers. Multinomial logistic regression models indicate higher odds of experimental or current e-cigarette use versus abstinence in the 2012 and 2013 survey years (vs. 2011). Respondents in the 2013 survey were more likely to use e-cigarettes in 2012, and they were significantly more likely to be current versus experimental users. Temporal increases in past-month e-cigarette use were uneven across demographic subgroups. Among current smokers of conventional cigarettes, fully adjusted models show that across all survey years the probability of past-month e-cigarette use was not significantly different for those who attempted to quit using tobacco in the past year from those who did not. Adolescent e-cigarette use has become more common between 2011 and 2013 and shows signs of becoming increasingly characterized by current rather than experimental use. Temporal patterns suggest that recent population increases were initially driven by select subgroups (e.g., Whites), with other subgroups contributing to the increase more recently (e.g., Black). Tobacco cessation has remained unrelated to current e-cigarette use over time, suggesting that e-cigarette use may be contributing to increased nicotine use.

An examination of the shift in school-level clustering of US adolescent electronic cigarette use and its multilevel correlates, 2011–2013

The percent of US high school students reporting use of electronic cigarettes (i.e., e-cigarettes) tripled in recent years. Little is known about the temporal shifts in school-level e-cigarette prevalence or the multilevel correlates of teen e-cigarette use. Using multilevel regression techniques and data from the 2011 and 2013 US National Youth Tobacco Surveys, we investigate how the school-level clustering of e-cigarette use has shifted between 2011 and 2013, whether school-level e-cigarette use is associated with individual-level use, and whether this association is explained by perceptions of harm attributed to e-cigarettes. Results indicate that school-level clustering of pastmonth e-cigarette use increased between 2011 and 2013. Multilevel models show that school-level e-cigarette use is positively associated with individual use, with a small proportion of this relationship explained by perceived harm of e-cigarettes. Our findings suggest that schools could have become more differentiated from each other based on their prevalence of e-cigarette use, and that certain types of school environments facilitate e-cigarette use more efficiently than others.

Adolescent Use of Electronic Cigarettes: An Emergent Health Concern for Pediatric Nurses

Recent statistics show an increasing trend of electronic cigarette usage among adolescents. Despite common misconceptions, electronic cigarette use does not reduce cigarette use among adolescents and can potentially increase cigarette dependence via nicotine addiction and modeling of smoking behaviors. Pediatric nurses and health care providers should be aware of the popularity and safety concerns of electronic cigarettes so that they can properly provide education regarding the possible negative health effects of adolescent electronic cigarette use, raise awareness of this public health concern, and impact policies in their communities.