Reasons for E-cigarette Use, Vaping Patterns, and Cessation Behaviors Among US Adolescents

Abstract

Introduction This study sought to examine reasons for youth e-cigarette use in association with vaping patterns and cessation behaviors. Methods A national representative sample of current (past 30-day) e-cigarette users in grades 6-12 was analyzed using the National Youth Tobacco Survey, conducted from January to March 2020. An exploratory oblique factor analysis using a rotated pattern matrix to select salient variable-factor relationships yielded four subscales related to reasons for youth e-cigarette use. Multivariate logistic regressions were performed to assess the associations of each subscale with vaping patterns (frequent e-cigarette use, dual use of e-cigarettes and other tobacco products) and vaping cessation behaviors (intention to quit vaping and past-year quit attempts). Results The 2020 NYTS sampled 180 schools with 1,769 current e-cigarette users. Four main reasons for vaping were identified through factor analysis, including 1) replacing cigarettes, 2) product characteristics (e.g., flavors, concealability, and vape tricks), 3) family/friend use, and 4) curiosity. Curiosity was associated with lower odds of frequent e-cigarette use (AOR= 0.5, p<.0001) and dual use of e-cigarettes and other tobacco products (AOR=0.6, p=.01) but higher odds of intention to quit (AOR=1.2, p=.26) and past year quit attempts (AOR=1.5, p=.01). Vaping due to product characteristics was associated with higher odds of frequent e-cigarette use (AOR=1.7, p<.0001) and lower odds of intention to quit (AOR=0.3, p<.0001) and past year quit attempts (AOR=0.9, p=.01). Conclusions Adolescents vape for various reasons that follow distinct patterns and user characteristics. Overall, interventions tailored to address heterogeneous reasons for vaping may help optimize reduction in youth e-cigarette use. Implications E-cigarettes have surpassed cigarettes and become the most commonly used tobacco product by U.S. youths. Adolescents choose to vape for different reasons. This study examined reasons for youth e-cigarette use and their associations with vaping patterns and cessation behaviors. The product characteristics factor (e.g., flavors, concealability, and vape tricks) was associated with more frequent e-cig use and lower odds of cessation behaviors, suggesting a need for flavor bans and product design regulation.

e-Cigarette Tobacco Flavors, Public Health, and Toxicity: Narrative Review

“…Therefore, when their favorite flavors are integrated back into tobacco flavors, it is expected that they would prefer the mixed flavor. Since the availability of flavors was among the top reasons for vaping and its initiation, especially in adolescents and young adults, the addition of these flavors in tobacco flavors would likely resuscitate the motivation for vapers to continue to vape [ 44 , 45 ].…”

ENDS Tobacco Flavors, Public Health, and Toxicity

“…Since the availability of flavors was among the top reasons for vaping and its initiation, especially in adolescents and young adults, the addition of these flavors in tobacco flavors would inevitably resuscitate the motivation for vapers to continue to vape. [35,36] Through applying generalized estimating equation (GEE) models on over 3,000 Reddit posts that co-mention e-cigarette use and health symptoms in the same Reddit posts from January 2013 to April 2019, it was found that tobacco flavor was more likely to be co-mentioned with respiratory and throat symptoms than other symptoms. [37] A specific examination of the JUUL pod tobacco flavor with health symptoms showed a high probability of co-mention of the JUUL tobacco flavor with the throat, respiratory, and cardiovascular symptoms using similar GEE models and Reddit posts from September 2016 to April 2019.…”

e-Cigarette Tobacco Flavors, Public Health, and Toxicity: Narrative Review (Preprint)

“…Since the availability of flavors was among the top reasons for vaping and its initiation, especially in adolescents and young adults, it is likely that the addition of these flavors in tobacco flavors would resuscitate the motivation for vapers to continue to vape. 34,35 Through applying generalized estimating equation (GEE) models on over 3,000 Reddit posts that co-mention e-cigarette use and health symptoms in the same Reddit posts from January 2013 to April 2019, it was found that tobacco flavor was more likely to be co-mentioned with respiratory and throat symptoms than other symptoms. 36 A specific examination of the JUUL pod tobacco flavor with health symptoms showed a high probability of co-mention of the JUUL tobacco flavor with the throat, respiratory, and cardiovascular symptoms using similar GEE models and Reddit posts from September 2016 to April 2019.…”