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

Abstract

Objective: 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 crosssectional 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. Method: 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. Results: 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. Conclusions: 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. Public Health Significance StatementOur study found that adolescent ENDS use was more frequent and adolescent cigarette use was less frequent on weekends. We found daily variability in the contexts and the characteristics of situations where adolescents used ENDS, which were largely social-normative. Socio-ecological context is likely important in developing prevention messaging relevant to the context where adolescents use.

Changes in the Patterns and Characteristics of Youth ENDS Use over Time

“…All models statistically controlled for age, biological sex, white race, spending money per week, and day type (weekday vs. weekend). Preliminary analyses suggested that the weekday (i.e., Sunday 4 p.m. through Friday 4 p.m.) vs. weekend (Friday 4 p.m. to Sunday 4 p.m.) contrast explained much of the variability in the day of the week [21]. The effect size r (or r = [(t 2 )/(t 2 + df )] 5 for Gaussian models and r = z/N 5 for dichotomous models) [30] with 95% confidence intervals was calculated to examine the magnitude of the effects.…”

“…Eligibility criteria for the first study included youth between 13 and 17 years of age who lived within 100 miles of Louisville, KY and reported vaping nicotine in the past two weeks on a screener. Additional details on the sample and methods are published elsewhere [20,21]. Of these 50 youth, 35 participated in the follow-up study.…”

“…Specifically, they were asked: (a) with whom they used ENDS (myself, friend, several friends, sibling, or parent); (b) what type of ENDS flavors were used (any flavor; menthol; candy, sweets, or chocolate; tobacco; mint; or fruit); (c) what characteristics their device had (e.g., whether it was their own, a JUUL device, and had a nicotine strength of 18 mg or greater); (d) where they used (someone else's home, my home, outdoors, school, or work); and (e) a checklist of motivations for why they may have used (curiosity, a friend wanted to, saw an advertisement, trying to quit smoking cigarettes, e-cigarettes do not have an odor, it was easy to get, only e-cigarettes are allowed, it comes in flavors I like, it feels good, like the attention, like doing vape tricks, and was bored). To maintain consistency between single and multiple EMA days in year one, we used the last occasion reported for year one weekends [20,21].…”

“…Similar to longitudinal studies, ecological momentary assessment (EMA) approaches have identified important factors that precede or predict youth ENDS use; however, EMA studies are usually conducted over a shorter period of time with multiple time-intensive observations. These approaches often yield more accurate measurements of ENDS use [18,19] as well as allow for more detailed, real-time information about the time-varying characteristics of youth ENDS use [20,21]. As such, EMA studies can yield uniquely helpful information for prevention and policy.…”

“…As such, EMA studies can yield uniquely helpful information for prevention and policy. Evidence from EMA studies also suggests that youth ENDS use is affected by contextual and community factors, as youth ENDS use largely occurs in environments where combustible cigarette (CC) use cannot be concealed and in social contexts with peers; however, there has been no evidence to suggest motivations (e.g., easy to get, curiosity) as a primary driver of use [21,22].…”