Risk Factors for Exclusive E-Cigarette Use and Dual E-Cigarette Use and Tobacco Use in Adolescents

Abstract

To describe electronic cigarette (e-cigarette) use and cigarette use among adolescents and determine whether established risk factors for smoking discriminate user categories.METHODS: School-based survey of 1941 high school students (mean age 14.6 years) in Hawaii; data collected in 2013. The survey assessed e-cigarette use and cigarette use, alcohol and marijuana use, and psychosocial risk and protective variables (eg, parental support, academic involvement, smoking expectancies, peer smoking, sensation seeking). Analysis of variance and multinomial regression examined variation in risk and protective variables across the following categories of ever-use: e-cigarette only, cigarette only, dual use (use of both products), and nonuser (never used either product).RESULTS: Prevalence for the categories was 17% (e-cigarettes only), 12% (dual use), 3% (cigarettes only), and 68% (nonusers). Dual users and cigarette-only users were highest on risk status (elevated on risk factors and lower on protective factors) compared with other groups. E-cigarette only users were higher on risk status than nonusers but lower than dual users. E-cigarette only users and dual users more often perceived e-cigarettes as healthier than cigarettes compared with nonusers.CONCLUSIONS: This study reports a US adolescent sample with one of the largest prevalence rates of e-cigarette only use in the existing literature. Dual use also had a substantial prevalence. The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use. WHAT'S KNOWN ON THIS SUBJECT:There is a debate about whether e-cigarettes will benefit public health. However, there is little knowledge about how e-cigarette users and dual users (those using both e-cigarettes and tobacco cigarettes) differ from other adolescents on a range of variables. WHAT THIS STUDY ADDS:Teenagers who only used e-cigarettes were intermediate in levels of risk and protective factors between nonusers and those who used both cigarettes and e-cigarettes. This raises a question about whether e-cigarettes recruit low-risk youth to tobacco product use.

Electronic Nicotine Delivery Systems

“…6,9,10,12,15 Among youth, self-reported e-cigarette use was also associated with higher odds of ever or current conventional cigarette smoking. 15 Compared with nonusers, youth who used e-cigarettes perceived them as healthier than cigarettes 10 ; however, youth using e-cigarettes were less likely to achieve abstinence from conventional cigarettes. 15 Youth exposure to ENDS secondhand and thirdhand aerosol has also potentially increased with the increase in adult ENDS use.…”

“…[6][7][8][9] Other surveys of high school students have found higher current use at 17% to 18%, with ever use as high as 29%. 10,11 The 2014 NYTS and Monitoring the Future survey both documented for the first time that more teenagers used e-cigarettes in the past 30 days than any other tobacco products, including conventional cigarettes. 8,11 ENDS use has been documented as highest among male subjects, non-Hispanic white youth, and Hispanic youth.…”

“…8,12 A 2013 survey of high school students found that e-cigarette-only users had fewer social and behavioral risk factors than conventional cigarette users, raising concern that ENDS are attracting youth who may not otherwise have used tobacco products. 10 In addition, high levels of dual use of ENDS and conventional cigarettes have been noted in both adults 13,14 and youth. 6,9,10,12,15 Among youth, self-reported e-cigarette use was also associated with higher odds of ever or current conventional cigarette smoking.…”

“…10 In addition, high levels of dual use of ENDS and conventional cigarettes have been noted in both adults 13,14 and youth. 6,9,10,12,15 Among youth, self-reported e-cigarette use was also associated with higher odds of ever or current conventional cigarette smoking. 15 Compared with nonusers, youth who used e-cigarettes perceived them as healthier than cigarettes 10 ; however, youth using e-cigarettes were less likely to achieve abstinence from conventional cigarettes.…”

Personality dimensions and social variables – predictors of cigarette smoking and alcohol consumption in adolescence

“…Based on current research of Big Five Model of Personality Structure, personality dimensions correlate positively with risk behavior [12][13][14], but they correlate negatively with unexcused absence from school as well as with cigarette and alcohol use [15]. Previous study on correlation between personality dimensions and risky health behavior has shown that agreeableness correlates negatively with alcohol and cigarette use among both sexes, neuroticism and introversion correlate positively with female adolescents, while extroversion correlates positively with male adolescents [16].…”