Pilot Ecological Momentary Assessment Study of Subjective and Contextual Factors Surrounding E-Cigarette and Combustible Tobacco Product Use among Young Adults

Abstract

Background: Dual use of e-cigarettes and combustible tobacco products is common in young adults. We aimed to explore how ratings of subjective and contextual factors differed between discrete episodes of e-cigarette use vs. combustible tobacco product smoking among a sample of young adults. Methods: Young adults (N = 29, ages 18–30) who used e-cigarettes and ≥1 combustible tobacco product at least once weekly completed a 1-week smartphone-based ecological momentary assessment (EMA). Twice daily random prompts assessed past-15-min use of tobacco products, ratings of subjective factors (e.g., negative affect, craving), and contextual factors related to activity, location, and companionship. A multivariable GEE model assessed whether subjective or contextual factors were associated with e-cigarette vs. combustible tobacco product episodes. Results: 184 tobacco use episodes were reported (39.7% e-cigarette, 60.3% combustible tobacco product). High baseline cigarette dependence, as measured by the Fagerström Test for Cigarette Dependence, was associated with lower odds of e-cigarette vs. combustible tobacco product episodes (aOR 0.01, 95% CI (0.002–0.08); p < 0.001). Neither between- or within-subjects negative affect or craving scores were associated with e-cigarette use. Activities of eating/drinking (aOR 0.20, 95% CI (0.08–0.49); p = 0.001) and being in the companionship of a person who smoked cigarettes (aOR 0.13, 95% CI (0.04–0.43); p = 0.001) were associated with lower odds of e-cigarette vs. combustible tobacco product use episodes. However, traveling (aOR 12.02, 95% CI (3.77–38.26); p ≤ 0.001) and being in a public space (aOR 2.76, 95% CI (1.10–6.96); p = 0.03) were associated with higher odds of e-cigarette than combustible tobacco product use episodes. Conclusions: This pilot data suggests that unique contextual factors may be associated with e-cigarette use, compared to combustible tobacco smoking in a sample of young adults who use both e-cigarettes and combustible tobacco products. Future research with larger samples is needed to better characterize varying contexts and cues for tobacco use among young adults who are dual users.

Contextual and community factors associated with daily exclusive ENDS use and dual use with tobacco cigarettes among adolescent vapers: an ecological momentary assessment study

“…This nding supports other research that suggests that day-to-day contexts and situations drive nicotine product choice (29,30). Our study extends these ndings by demonstrating that even among adolescents who dual use, product choice might be driven by motivations related to their need to continue using nicotine, even in situations where tobacco cigarettes are unacceptable (29,39,40). Importantly, our study did not nd any signi cant associations between ENDS use and motivations to quit.…”

“…Speci cally, dual use days were predicted by the motivation of "vaping because tobacco use is prohibited." This nding supports other research that suggests that day-to-day contexts and situations drive nicotine product choice (29,30). Our study extends these ndings by demonstrating that even among adolescents who dual use, product choice might be driven by motivations related to their need to continue using nicotine, even in situations where tobacco cigarettes are unacceptable (29,39,40).…”

“…EMA studies have demonstrated that certain high-risk ecological contexts are associated with tobacco use behaviors (28). Various EMA studies have examined use behaviors and associations among young adults, assessing exclusive ENDS use, exclusive tobacco cigarette use (29,30), or use of any tobacco products (30,31). However, EMA studies have not examined exclusive ENDS use and dual use with tobacco cigarettes among adolescents, leaving a gap in knowledge of the day-to-day contextual and community factors that in uence adolescents' dual use of ENDS and tobacco cigarettes.…”

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

“…Contextual interviews with participants at year three confirmed instances of swapping ENDS and CC use and youth using CC at work and with "older friends" when in the early stages of CC initiation. These findings are similar to those found in studies with young adults, where they were more likely to use CC in contexts where they were allowed (e.g., at work or around others who use CC) and more likely to use ENDS in contexts where CC use was not allowed (e.g., traveling, in public spaces) [39]. Again, these levels and patterns of use could also reflect the circumstances of the first year of the pandemic when youth were less likely to be in school or socializing with large groups of friends due to state stay-at-home orders [40].…”

Socio-temporal contextual and community factors associated with daily exclusive ENDS use and dual use with tobacco cigarettes among adolescent vapers: an ecological momentary assessment study

“…EMA studies have demonstrated that certain high-risk ecological contexts are associated with tobacco use behaviors [ 28 ]. Various EMA studies have examined use behaviors and associations among young adults, assessing exclusive ENDS use, exclusive tobacco cigarette use [ 29 , 30 ], or use of any tobacco products [ 30 , 31 ]. However, EMA studies have not examined exclusive ENDS use and dual use with tobacco cigarettes among adolescents, leaving a gap in knowledge of the day-to-day contextual and community factors that influence adolescents’ dual use of ENDS and tobacco cigarettes.…”