Knowledge, Attitudes, and Perceptions of Young Adults About Electronic Nicotine Delivery Systems in the United States

Abstract

Background: The causal link between cigarettes and cardiovascular disease is well known. The long-term effects of e-cigarettes are yet unknown, although early studies show biomarkers indicating inflammation and damage to endothelial cells associated with later development of cardiovascular disease. With the rapid rise in e-cigarette use, especially in young adults, it is imperative that health professionals understand the knowledge, perceptions, and motivations for use among young adults. Objectives: The purpose of this integrative review is to explore existing literature on young adults' knowledge, attitudes, values, and perceptions about e-cigarettes, as well as the social norms they experience. Methods: The Whittemore and Knafl model for integrative review guided the methodology. Three databases were searched from January 2010 through December 2018. The study selection process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion and exclusion criteria were applied. Studies were evaluated for quality and strength. Key themes were extracted, coded, and synthesized. Results: Seventy-one full-text studies were assessed for inclusion criteria; 15 articles were included, coded, and analyzed for quality and thematic content. Current e-cigarette users represented just 3% to 35% of study participants. Three themes arose from a synthesis of the literature: "Is it bad for me?," "I just like it," and "Is it cool or not?" Conclusions: Young adults are not armed with the accurate knowledge to make informed choices about using e-cigarettes. E-cigarette users are understudied and tend to value appearance and physical sensation over health. Social norms related to e-cigarette use are linked to perception of identity and the current technology-focused culture.

What differentiates youths who use e-cigarettes from those who smoke traditional tobacco products?

“…This phenomenon is confirmed by studies regarding reasons for e-cigarette use that indicate that curiosity, fashionability, and social popularity are salient motives for use [ 50 – 52 ]; these are likely to be prevalent among lower-risk adolescents. The availability of attractive flavorings and the perception that e-cigarettes are healthier than cigarettes [ 2 , 18 , 52 ] would also tend to encourage experimentation among youths who are less influenced by a desire to take risks, be rebellious or unconventional, which characterize adolescent cigarette smokers [ 20 , 53 ]. Moreover, we observed that the prevalence of e-cigarette use fell over time relative to non-users or users of tobacco [ 54 ].…”

Employing the theory of planned behaviour to design an e-cigarette education resource for use in secondary schools

“…The overriding aim of this research project was to assess prevalence and predictors of e-cigarette use and experimentation in young people aged 11-16 years in Northern Ireland (NI) Objectives: (1) An elicitation study was conducted to identify factors that influenced young peoples' motivations to use e-cigarettes; (2) a TPB-based questionnaire was constructed from the elicited beliefs; (3) the questionnaire was administered to a representative sample of young people, which determined knowledge, attitudes, prevalence of e-cigarettes use, experimentation, and identified the potential predictors of use (4), this informed the design of an framework for an educational resource to be used in post primary schools, to prevent e-cigarette uptake and experimentation [37,47]. This will be the first theory driven, evidenced based e-cigarette intervention for young people in the UK, designed to be incorporated into the curriculum [10].…”