Adolescent Vaping Research Articles

The Association Between Adolescent Vaping and Subsequent Use of Other Substances and Risk Factors for Polysubstance Use

Abstract Objectives Adolescent vaping has become a public health concern. The aim of this study was to examine the associations between adolescent vaping and subsequent use of other substances and risk factors for polysubstance use. Methods The Well-being and Experiences Study is a longitudinal, intergenerational study conducted in Manitoba, Canada. The sample for this study consisted of adolescents and emerging adults who participated in Waves 1 (N = 1,002; 2017-18; aged 14–17 years) and 2 (n = 756; 2019; aged 15–20 years). Multinomial logistic regression analysis was performed. Results Adolescent vaping was associated with continued use of alcohol, cannabis, and cigarettes (adjusted relative risk ratio [aRRR] range: 12.92–19.39), new onset use of cannabis (aRRR: 6.04) and cigarettes (aRRR: 3.66), and concurrent and simultaneous polysubstance use (aRRR range: 3.14–24.25). Several risk factors were identified for concurrently using three or four substances in the past year (aRRR range: 1.76–2.86) and simultaneously using alcohol, cannabis, and nicotine (aRRR range: 1.99–3.11). Among those who reported vaping nicotine at Wave 2, 33.6% of males and 24.2% of females reported doing so as a coping mechanism. Conclusions Adolescent vaping is a risk factor for subsequent use of other substances and polysubstance use. Efforts are needed to prevent vaping initiation and help adolescents with cessation. Strategies should include selective interventions for those with histories of childhood adversity and mental health disorder.

Barriers and facilitators to address vaping in Massachusetts schools: a mixed-methods study of school-based stakeholders.

We assessed vaping behaviors, environments, COVID-19 influences, and barriers and facilitators of existing approaches that address adolescent vaping in Massachusetts middle and high schools. Findings from this study will provide considerations for individual schools or districts as they advance adolescent vaping prevention and treatment efforts. We analyzed 310 open-ended comments from Massachusetts school administrators who completed a survey between November 2020 and January 2021. Further, we analyzed nine semi-structured interviews with administrators (e.g., principals, vice principals, school nurses) from Massachusetts school systems (n = 6) and school-based anti-tobacco advocates (n = 3); interviews took place between May and December 2021. Informed by Green's PRECEDE model, we conducted a framework analysis using deductive codes based on the model constructs (enabling, reinforcing, and predisposing factors) and inductive codes of key themes emerging from the interviews. Challenges to addressing adolescent vaping included staff capacity, funding, and lack of mental health and counseling supports. The COVID-19 pandemic was a major barrier to conducting usual in-person vaping programs, but also reduced student vaping at school due to new social distancing practices and bathroom use policies. Facilitators of vaping interventions included peer-led initiatives and parental involvement. Participants discussed the importance of educating adolescents on the harms of vaping and the move toward alternatives-to-suspension programs rather than disciplinary action. School-based anti-vaping program implementers-such as school districts, state departments of education, or local health departments-will need to leverage facilitators such as peer-led initiatives, alternatives-to-suspension approaches, and parental involvement, to increase the potential impact of these programs.

Low Self-Control, Peer Risk Factors, and Adolescent Vaping Activity

Recent research has identified several risk factors for adolescent vaping. However, limited research has directly explored how low self-control and peer vaping activity are related to adolescent vaping. This study addresses these gaps in the literature by examining relationships between low self-control, peer risk factors for vaping, and adolescent nicotine vaping using a sample of Florida adolescents collected in 2019. In addition, this study examines whether peer risk factors moderate the relationship between low self-control and nicotine vaping. The findings suggest that low self-control and peer nicotine vaping are linked with adolescent nicotine vaping. The findings also provide evidence that peer risk factors may moderate the relationship between low self-control and adolescent nicotine vaping.

A randomized controlled trial of varenicline and brief behavioral counseling delivered by lay counselors for adolescent vaping cessation: Study protocol.

Approximately one-fifth of high-school seniors and college students currently vape nicotine. Adolescents express a desire to quit vaping, and case reports have shown promise for e-cigarette tapering with dual behavioral and pharmacologic therapies. However, there are no published clinical trials to date that test these intervention approaches for adolescent nicotine vaping cessation. In this three-arm randomized, placebo-controlled, parallel-group study, we aim to assess the efficacy of varenicline in combination with brief behavioral counseling and texting support on vaping cessation in adolescents dependent on vaped nicotine. The study will enroll 300 individuals between the ages of 16-25 with daily or near-daily nicotine vaping who reside in the Greater Boston area. Participants will be randomly assigned in a 1:1:1 ratio in blocks of six to one of the three arms: (1) a 12-week course of varenicline titrated to 1 mg bid, brief behavioral counseling delivered by a lay counselor, and an introduction to This is Quitting (TIQ) texting support created by the Truth Initiative; (2) a 12-week course of placebo, brief behavioral counseling, and TIQ; and (3) 12 weeks of enhanced usual care, consisting of advice to quit and an introduction to TIQ. The primary outcome will be biochemically verified continuous vaping abstinence at the end of the treatment (week 12). Secondary outcomes include continuous abstinence at follow-up (week 24), 7-day point prevalence abstinence at weeks 12 and 24, safety and tolerability of varenicline in an adolescent vaping population, as well as change in mood and nicotine withdrawal symptoms across the intervention period. Exploratory outcomes include change in comorbid substance use behaviors and nicotine dependence. Analysis will be intent-to-treat, with multiple imputation sensitivity analyses for participants with missing or incomplete outcome data. This is the first study to evaluate varenicline in combination with a novel, brief, lay counselor delivered vaping cessation program for adolescents who vape nicotine. Results will inform clinicians on the effectiveness and acceptability of this promising, but not yet tested intervention.Clinical trial registration: ClinicalTrials.gov, identifier NCT05367492.

Social Network Influences on Adolescent E-cigarette Use

Background: Determine if individual adolescent vaping is associated with the vaping behavior of their school-based friendships; whether that association stems from peer influence or peer selection; and whether it varies by age. Methods: Two wave longitudinal survey of 1,208 students in one Midwestern US school district. Students were asked if they ever vaped and to name their seven closest friends within the school district. A roster of all eligible students was pre-loaded into the survey to facilitate network data collection. Terms for network exposure, the proportion of vaping friends; and selection, the number of new friends who vape, were created. Logistic regression and Stochastic Actor Oriented Models were used to test both influence and selection effects. Results: A cross-sectional logistic regression model indicated that friend vaping was associated with individual vaping (AOR = 4.96, p < 0.01); and lagged logistic models indicated that increased friend vaping was associated with individual vaping initiation (AOR = 1.72, p < 0.05). Selecting new friends who vape was also associated with becoming a vaper (AOR = 1.25, p < 0.01). Both influence and selection were present for those less than 14 years old. Conclusions: This is the first study to use social network analysis to show that adolescents who vape or initiate vaping are more likely to do so if their friends vape, and/or they make new friends who vape. Prevention and cessation programs should address the role of friend influence and selection on e-cigarette use; particularly at younger ages.

Assessing Adolescent Vaping Norms and Perceptions in a Statewide Multi-Community Project

Background: Adolescent e-cigarette use has increased dramatically in recent years and is quickly becoming a serious public health issue. While studies have identified the influence of social norms on the use of traditional cigarettes, few have examined these factors in the context of e-cigarettes and other vaping devices. Objective: The goal of this study was to examine social norms predictors of past 30-day e-cigarette use among high school students in 10 communities located in Minnesota. Results: In our sample (N = 3,285), students who believe most students in their school vape daily are more likely to have vaped in the past 30 days than those who believe most students vape weekly or less frequently. Further, students were likely to have used e-cigarettes in the past 30 days if they perceived that most students approved of vaping (i.e., they disagreed with the statement that, “vaping is not a good thing for anyone their age to do”). Findings from this study highlight social norms related to perceptions that increase the likelihood of past 30-day e-cigarette use. Conclusions: Results from this study lend themselves to norms-based prevention science strategies that are critical to reducing e-cigarette use among high school students.

Adolescents Who Vape Nicotine and Their Experiences Vaping: A Qualitative Study.

Understanding adolescent perceptions of vaping and roles it plays in their lives is needed to design effective interventions to help adolescents quit. We explored vaping experiences of 11 adolescents from initiation through quit attempts. A convenience sample of students who vaped in the last 90 days was recruited from one suburban high school in Massachusetts. Qualitative interviews were transcribed and coded. An inductive thematic analysis approach was employed. Areas of agreement and range of responses in code reports were summarized. Eleven open-ended semi-structured interviews were conducted (mean = 32.5 minutes each). Vaping initiation often occurred when socializing with friends who also supplied vaping devices. Vaping was "something to do" and new flavors engaged adolescents further. Solitary activities coupled with vaping included video gaming, getting ready for school, talking on the phone, or studying. Peak hours for vaping included morning, before and after school, before parents returned from work, and after parents went to bed. Several vaped to address anxiety/stress. For some, anxiety control was a main reason for vaping. Participants were concerned about health effects and nicotine dependence. Cost and health effects were drivers of quitting. Quit strategies relied on willpower and distraction. Peers have powerful influences on the initiation and maintenance of adolescent vaping. Vaping habits can become routinized into adolescent lives. Addiction is a concern although nicotine's anxiolytic effects were valued by many. Social connection was enhanced by communal vaping, sharing, and common vernacular, secrecy and rule-breaking. We describe the context in which adolescents vape nicotine, their reasons for vaping, and reasons to quit. This information can inform the development of interventions to better address adolescents' triggers to vape, and social and psychosocial barriers to quitting. Our findings suggest a desire to quit vaping but a limited awareness of quitting strategies.

Launching a New Generation of Nicotine Users: The Dangers of Vaping in Adolescents

According to the Centers for Disease Control and Prevention (2021), 68 deaths due to the use of e-cigarettes with associated lung injury have been reported. Vaping has become a popular trend in the movement against combustible cigarettes, especially among adolescents. Many individuals view vaping as a healthier alternative to cigarette use, but the high percentage of nicotine can have lasting effects. The use of nicotine at young ages has been found to harm the parts of the brain that control attention, learning, mood, and impulse control. The U.S. Preventative Services Task Force (2020) recommends education by primary care clinicians to prevent initiation of these substances among adolescents. To combat this health disparity in America’s youth, vaping educational programs are necessary. This project sought to implement the CATCH My Breath evidenced-based vaping prevention program into a rural community’s middle-school. Advanced health students grades 7th-8th were recruited for the study based on parental consent and student assent. The students participated in four educational sessions over one-month with a pre/post-questionnaire project design. Results showed a 23% increase in student knowledge regarding vaping use. Attitudes towards e-cigarettes and vaping were unchanged. Post-intervention results revealed that 97.8% of students reported that the CATCH My Breath program increased their knowledge on e-cigarette and vaping use. The goal of this project was to ultimately change knowledge and attitudes of the study participants to reduce the prevalence of adolescent vaping.

Substance use prevention during adolescence: Study protocol for a large-scale cluster randomized trial of Botvin High School LifeSkills Training

BackgroundConcerns about the rise in adolescent vaping and cannabis use suggest the need for effective substance use prevention programs. Botvin LifeSkills Training (LST) has a strong evidence base at the middle school level for preventing or reducing tobacco use and related problems. A high school (grades 9–10) version of the LST program was also developed and shows promising initial evidence for reducing tobacco use in a single pilot study. However, the high school version of LST has not been sufficiently tested in an experimental trial, despite being widely implemented in high schools across the U.S. This paper outlines the study protocol for a large-scale cluster randomized trial of Botvin High School LST, with objectives of documenting the design of prospective research and promoting transparency. MethodsA total of 60 high schools in Colorado and Ohio were randomized to the 10-session, teacher-led intervention group (n = 33 schools) or business-as-usual control group (n = 27 schools). Across two cohorts of schools, 9th-grade students complete self-report surveys at pretest, immediate posttest, 1-year follow-up, and 21-month follow-up. Primary outcomes are tobacco (nicotine) use and cannabis use. Secondary outcomes are alcohol use, illicit drug use, psychosocial behaviors (e.g., violence and mental health), and academic achievement. Intent-to-treat analyses will use multilevel modeling to estimate intervention effects across assessment points. ConclusionThis independent evaluation will help to determine whether the intervention is appropriate for large-scale adoption. This trial is preregistered with the Open Science Framework (https://osf.io/dnz5q/).

Daily variation in the patterns and characteristics of adolescent ENDS use.

Adolescents are more likely than young adults to use electronic nicotine delivery systems (ENDS), yet most of what is known is concluded from young adult ENDS use as young adults are easier to survey. Additionally, while evidence about the prevalence and trends of adolescent ENDS use comes from cross-sectional studies, ecological momentary assessment (EMA) studies provide greater detail about the ways in which adolescents vape and the environments that are favorable to adolescent vaping, providing important guidance for policy, prevention, and intervention. We conducted a 2-week EMA study with 50 adolescents to assess behaviors, contexts, and characteristics of ENDS use. Given longitudinal research showing strong associations between ENDS use and use of other substances, we also examined tobacco cigarettes use, and daily concurrent use with tobacco cigarettes and marijuana. There was little daily variability in motivations, willingness, and intentions, or in product characteristics. ENDS use varied by day and was more frequent on weekends, whereas cigarette use was less likely on weekends. We found daily variability in contexts and the characteristics of situations where adolescents used, which were largely social-normative, including whose device was used, which flavors were used, and where and with whom adolescents used ENDS. Unexpectedly, marijuana accompanied more than a quarter of ENDS use occasions. Socio-ecological context is important for explaining adolescent ENDS use and it is critical to developing adolescent ENDS prevention, intervention, and treatment resources. Prevention messaging may be most relevant and effective on weekends when youth exposure to advertising and peer influences are greatest. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

1.4 Use of Project ECHO to Provide Education on Best-Practice Clinical Management of Adolescent Vaping

As adolescent vaping reaches epidemic rates in the United States, it is imperative that pediatric clinicians have access to up-to-date, best-practice medical knowledge for screening, assessing, and treating adolescent vaping-related substance use. The Indiana Teen Vaping ECHO (Extension for Community Healthcare Outcomes) program was developed using the Project ECHO model to offer timely, practical learning sessions focused specifically on clinical management of adolescent vaping in community healthcare settings.

2.6 Clinical Interventions for Adolescent Vaping of Nicotine and Cannabis

The use of vapes or electronic cigarettes to consume nicotine and cannabis continues to be a major health concern in the pediatric age group. Recent studies show that 1 in 5 high school students in the United States have vaped nicotine in the past month and that vaping of cannabis has doubled among US and Canadian adolescents between 2013 and 2020. The limited evidence for the use of medications to treat nicotine and cannabis is a barrier to effective treatment. This lecture will discuss clinical interventions for cessation of nicotine and cannabis use via vapes and will provide practical considerations from experience in ambulatory and inpatient clinic settings.

Examining the Efficacy of Project ECHO to Improve Clinicians' Knowledge and Preparedness to Treat Adolescent Vaping.

As adolescent vaping reaches epidemic rates in the United States, it is imperative that pediatric clinicians have access to medical knowledge on best practices for screening, assessing, and treating vaping-related substance use. The Teen Vaping ECHO (Extension for Community Healthcare Outcomes) program was developed to offer practical learning sessions focused on clinical management of adolescent vaping. This study describes the development, implementation, and evaluation of the program's impact on participants' knowledge, attitudes, and practices regarding treatment of adolescent vaping from registration to the end of the series. Participants were generally knowledgeable about vaping at registration and reported significant increases in comfort talking with patients about vaping, counseling patients on nicotine replacement products, and frequency of implementing best-practice screening strategies at the end of the series. This study suggests ECHO programs focused on improving clinical management of adolescent vaping may increase accessibility of evidence-based care and reduce harms associated with vaping in youth.

Association between the implementation of tobacco control policies and adolescent vaping in 44 lower-middle, upper-middle, and high-income countries.

To (i) estimate the prevalence of adolescent vaping in 47 lower-middle, upper-middle and high-income countries, and (ii) test the association between implementation of World Health Organisation (WHO) tobacco control policies and adolescent e-cigarette use (also known as vaping) in 44 countries where implementation data were available. Cross-sectional surveys. A total of 47 lower-middle, upper-middle and high-income countries. A total of 151 960 adolescents (typically ages 13-15) who participated in WHO's Global Youth Tobacco Survey between 2015 and 2018. Prevalence of past-30-day vaping and past 30-day frequent vaping (≥10 days) were estimated from the surveys. Data on the implementation of six tobacco control measures including monitoring, smoke-free policies, cessation programs, warning about the dangers of tobacco, advertising bans and taxation were taken from WHO's report on global tobacco epidemic. The overall weighted prevalence of adolescent vaping and frequent vaping in the past 30 days was 8.6% (95% CI, 8.3-8.9) and 1.7% (95% CI, 1.6-1.8), respectively. For five of WHO's policies (monitoring, smoking-free environment, cessation programs, health warning and advertising bans), their association with adolescent vaping was inconclusive because of large variation of their effects across countries. Higher tax on combustible tobacco products was associated with higher adolescent vaping (> = 75% tax vs < 25% tax; odds ratio = 2.58; 95% CI, 1.25-5.21). In 47 lower-middle, upper-middle and high-income countries from 2015 to 2018, ~1 in 12 (8.6%) adolescents reported vaping in the past 30 days, but prevalence of frequent vaping was low (1 in 60; 1.7%). A higher tobacco tax was associated with higher adolescent vaping.

Investigating Factors Associated with Adolescent Vaping and Cessation: A Qualitative Study

Background: Since 2015, electronic-cigarette (e-cigarette) use increased among adolescents, necessitating research on effective cessation strategies. This qualitative research examined adolescents’ vaping behaviour and the perceived effectiveness of existing and proposed cessation resources, particularly Health Canada’s 2019 “Consider the Consequences of Vaping” video. Methods: In 2019, we conducted semi-structured interviews with 14 youth (ages 14-18) with e-cigarette use experience in Calgary, Alberta, Canada. The interviews were analyzed using qualitative description in NVivo. Results: Participants were introduced to vaping through members of their social groups. Parental guardians and friend groups were highly influential in encouraging and discouraging vaping. Almost all participants held the belief that vaping is healthier than smoking and said that Health Canada’s 2019 “Consider the Consequences of Vaping” campaign video required improvement. Many participants desired to cease vaping but lacked the resources to do so. Conclusions: This research suggests that a presentation from an ex-vaper, in addition to counselling might be the most useful resources to aid young people to cease vaping.

Identifying Promising Themes for Adolescent Vaping Warnings: A National Experiment.

IntroductionAdolescent vaping remains a problem in the United States, yet little is known about what health warning themes most discourage vaping among adolescents. We sought to identify the most compelling themes for vaping warnings for US adolescents.MethodsParticipants were a national probability sample of 623 US adolescents aged 13–17 years, recruited in the summer of 2020. Adolescents were randomized to one of the five warning message themes about the potential health effects of vaping: 1. chemical harms, 2. lung harms, 3. Coronavirus Disease 2019 (COVID-19) harms, 4. nicotine addiction, or 5. control (messages about vape litter). The primary outcome was perceived message effectiveness (PME; 3-item scale). Secondary outcomes were negative affect (fear), attention, anticipated social interactions, and message novelty.ResultsAdolescents rated the chemical, lung, and COVID-19 harms warning messages higher on PME than nicotine addiction and control (all p < .05), while nicotine addiction was rated higher than control (p < .05). The chemical, lung, and COVID-19 harms warning themes also elicited greater negative affect than nicotine addiction and control (all p < .05). For all other secondary outcomes, the COVID-19 harms warning message theme was rated higher than nicotine addiction and control (all p < .05).ConclusionAdolescents perceived warning message themes about lung, chemical and COVID-19 health effects of vaping as more effective than nicotine addiction. To discourage vaping, the FDA and others should communicate to youth about the health effects of vaping beyond nicotine addiction.ImplicationsAdolescents rated warning message themes about the lung, chemical, and COVID-19 health effects of vaping as more effective than nicotine addiction, while nicotine addiction was rated as more effective than control themes about vaping litter. To discourage vaping among adolescents, health messaging should expand message themes to communicate about a broader set of health effects of vaping beyond nicotine addiction.

The role of virtual socializing and unstructured socializing in adolescent vaping

PurposeEmerging research suggests that adolescent patterns of socializing have shifted in recent years towards more virtual socializing and less traditional in-person socializing. At present, limited research has explored how this shift in socializing may influence outcomes traditionally linked with in-person socializing among adolescents (i.e., substance use). ProceduresThis paper addresses this gap in the literature by utilizing logistic regression techniques to examine the relationship between virtual socializing and an emerging form adolescent substance use (i.e., vaping) using data from the 2018 Monitoring the Future (MTF) cohort. FindingsOur findings reveal that time spent socializing in the virtual sphere is significantly associated with a greater likelihood of vaping nicotine, marijuana, and flavor. In addition, our findings reveal that while the relationship between virtual socializing and vaping is attenuated by unstructured socializing (i.e., unsupervised socializing or “hanging out”) in person to some degree, time spent socializing virtually is still a significant predictor of adolescent vaping activity even after taking time spent socializing in person into account. ConclusionsIn conclusion, our findings indicate that virtual socializing is an important predictor of adolescent vaping activity. The implications of these findings for policy are discussed.

The First State Tobacco Flavor Ban: High School Tobacco Control Needs in a Changing Landscape.

Despite recent tobacco control efforts, adolescent vaping remains an epidemic in the United States. The purpose of our study was to understand high school student vaping behaviors using the perceptions of Massachusetts school personnel during the critical window from when the Massachusetts statewide flavor ban legislation was passed in November 2019 through the first year of the COVID-19 pandemic. High school personnel throughout Massachusetts were invited to complete a cross-sectional survey. Analysis of survey responses was conducted in R. A total of 162 respondents completed the survey representing 137 schools that draw enrollments from 216 (61%) of the 352 cities and towns in Massachusetts. The most popular products that respondents believed their students were using were JUULs (95.7%), other e-cigarettes (85.3%), and disposable vapes (79.6%). Following the flavor ban, the majority (90.7%) did not report an increase in combusted tobacco product use. All participants (100%) reported wanting more access to prevention and treatment resources. Our findings suggest that a comprehensive flavor ban may be an effective tobacco control policy that does not appear to promote student switching from vaping products to combusted tobacco products. These data also indicate that schools report needing additional resources to address the vaping epidemic.

A snapshot of parenting practices useful for preventing adolescent vaping

IntroductionSmoking research demonstrates that parents can influence their adolescent’s tobacco smoking perceptions and behaviors, but little is known about the protective effects of different parenting practices on adolescent vaping. In this study we investigate how adolescent perceptions of parents’ knowledge of their activities and parental media mediation are associated with adolescents’ perceptions of vaping and adolescent vaping behaviors. MethodSix hundred thirty-nine youth (65.7% female, average age: 14.71 years old) recruited through 4-H clubs in nine states participated in a study evaluating a substance use intervention program. Because the evaluation design could influence participants, we used only baseline data. An online self-reported survey was administrated. Most youth self-identified as White (87.3%) and only handful youth indicated Asian (3.4%), African American (3.4%), American Indian (1.1%), and other or unreported (4.8%). Approximately 60% of youth lived in small town or rural areas in US. ResultsAnalyses revealed that parental knowledge was positively related with adolescent perceived harm of vaping and perceived prevalence of vaping, but was negatively related with perceived acceptability of vaping and social expectancy of vaping. In addition, youth who reported greater parental media mediation were more likely to perceive the harm of vaping and less likely to vape compared with youth with lower parental media mediation. ConclusionThese findings suggest that parental education about vaping, including those promoting conversations regarding vaping and vaping ads, may be important to the prevention of adolescent vaping.

Identifying Promising Themes for Adolescent Vaping Warnings: A National Experiment

Identifying Promising Themes for Adolescent Vaping Warnings: A National Experiment