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

Abstract

Objective 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. Methods 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. Results 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). Conclusion 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.

Friends and family matter Most: a trend analysis of increasing e-cigarette use among Irish teenagers and socio-demographic, personal, peer and familial associations

“…As our findings provide further support for the many studies that have found that peer smoking influences teenage e-cigarette use [ 20 , 47 – 50 ], we suggest that health education interventions that take account of peer influences remain important, particularly as higher levels of peer e-cigarette use [ 51 , 52 ] and favourable e-cigarette peer norms [ 53 ] have been found by other researchers to be related to higher odds of personal e-cigarette use.…”

Examining the Survey Setting Effect on Current E-Cigarette Use Estimates among High School Students in the 2021 National Youth Tobacco Survey

“…Higher prevalence in the school setting could be a function of both response bias because they are in the presence of peers, and/or peer influences that promote use (e.g., peer pressure, increased access to e-cigarettes). Youth e-cigarette use is heavily influenced by the e-cigarette-related perceptions and behavior of their peers [ 25 , 26 , 27 ], and has been increasingly likely to take place in or around school campuses [ 28 , 29 ]. One recent study found that, among sixth-grade students in urban Texas, on-campus learners had greater odds of reporting e-cigarette use susceptibility and ever using e-cigarettes than remote learners [ 18 ].…”

Association of e-Cigarette Advertising, Parental Influence, and Peer Influence With US Adolescent e-Cigarette Use

“… 28 , 29 , 30 Our study also found that having best friends using e-cigarettes was associated with higher odds of e-cigarette initiation and susceptibility, consistent with what has been reported previously using convenience samples. 31 , 32 According to multiple health theories and models, 44 , 45 , 46 perceived peer approval and use of substances play key roles in influencing early stages of substance use during adolescence. Our findings indicate that these theories and models are also applicable to e-cigarette use.…”

“…Current evidence about associations of parental and peer use with tobacco use is almost entirely from studies of cigarettes and other tobacco products, 27 , 28 with most of these studies focusing on the associations between adolescents’ cigarette smoking and the smoking status of their friends. 28 , 29 , 30 A few studies have suggested that a similar pattern exists for e-cigarettes 31 , 32 ; however, these studies relied primarily on regional data collected from convenience samples. Nationally representative studies are needed to estimate the associations between parental and peer e-cigarette use and adolescents’ e-cigarette use outcomes.…”