Electronic Cigarette Use Among Youth: Understanding Unique Risks in a Vulnerable Population

Communicative Processes Underlying DIY eJuice Mixing Among Young Adult International ENDS Users

The use of electronic nicotine delivery systems (ENDS) is increasing around the world, with contemporary trends outpacing scientific understanding of the health implications. Such trends include do-it-yourself eJuice mixing (DIY eJuice), which involves the unregulated homemade mixing of fogging agents, nicotine salts, and flavorants to create personalized liquid for ENDS products. The purpose of this study was to employ a grounded theory approach to gather formative data on the communicative processes surrounding the behavior of DIY eJuice mixing among international, young adult ENDS users. Participants were recruited locally for mini focus group discussions via SONA (n = 4) and internationally for an open-ended survey via Prolific (n = 138). Questions explored experiences with the online DIY eJuice community, motivations for mixing, information seeking strategies, flavor preferences, and perceived benefits of mixing. Thematic analysis and flow sketching revealed the underlying processes of social cognitive theory to explain the communicative processes of DIY eJuice mixing behaviors. Specifically, environmental determinants emerged in the form of online and social influences; personal determinants in the form of curiosity and control; and behavioral determinants following a benefits/barriers analysis, particularly regarding cost. These findings provide theoretical implications for the role of health communication constructs in understanding contemporary trends in ENDS use and practical implications for tobacco prevention messaging and tobacco control regulations.

Comparative systematic review on the safety of e-cigarettes and conventional cigarettes

BACKGROUND

This systematic review evaluated the health risks of electronic cigarettes (e-cigarettes) compared to traditional cigarettes. It examines various studies and research on the subject to provide a comprehensive analysis of potential health risks associated with both smoking methods.

METHODS

The systematic review, incorporating searches in PubMed, Scopus, Web of Science, and the Cochrane Library up to July 2023, examines the results obtained in relevant studies, and provides a critical discussion of the results.

RESULTS

E-cigarettes exhibit reduced exposure to harmful toxins compared to traditional cigarettes.

CONCLUSION

However, concerns persist regarding respiratory irritation and potential health risks, especially among youth, emphasizing the need for comprehensive, long-term research and protective legislation.

[Perception of ENDS among French high school students in Nord and Pas-de-Calais]

INTRODUCTION

Electronic nicotine delivery systems (ENDS) have been gaining popularity for over a decade, particularly among young people. The aim was to understand how these devices were perceived, in general and according to different characteristics: gender, smoking status, experimentation or possession of SEDEN.

METHODS

A cross-sectional observational study was conducted by an online questionnaire to 15 high schools between 14 May and 23 October 2021. Perception was assessed by a constructed score.

RESULTS

In total, 772 responses from 10 high schools were analysed; 44.7% had already experimented with ENDS. The main reason for use was pleasure (33.8%). Only 15% of smokers or former smokers reported using ENDS to stop smoking as their main reason. The majority of ENDS (72.8%) are perceived as harmful. This negative perception is more important among women, non-smokers, non-experimenters and non-owners of ENDS. More than 50% of the respondents consider ENDS as distinct from tobacco.

CONCLUSIONS

ENDS are perceived as potentially harmful and their use is often motivated by pleasure. Their perception as a practice distinct from smoking, combined with unknown long-term consequences, justifies increased vigilance in the face of the emergence of these new uses.

Effects of electronic cigarette e-liquid flavouring on cigarette craving

BACKGROUND

E-liquid flavour restrictions may discourage electronic cigarette (e-cigarette) uptake among youth. However, possible unintended consequences may include reduced appeal and effectiveness of e-cigarettes for smoking cessation. Non-tobacco flavours appear to be important for smoking cessation, but how and why are currently unclear.

METHODS

We conducted an experimental study in a UK sample of adult daily smokers using an independent groups design (N=84). Participants were randomised to use an e-cigarette with nicotine-containing fruit/sweet-flavoured e-liquid (blackcurrant, strawberry, vanilla, caramel) or unflavoured e-liquid for 1 week. The primary outcomes were average, peak and cue-elicited cigarette craving (the latter was assessed using a cue exposure task). The secondary outcomes were smoking lapse occurrence, enjoyment of the e-cigarette, ease of transitioning from smoking to using an e-cigarette, intentions to continue using an e-cigarette, intentions and motivation to quit smoking, return to smoking, and continuation of e-cigarette use.

RESULTS

E-liquid flavouring did not appear to have an effect on average cigarette craving (b 0.18, 95% CI -0.44 to 0.79, p=0.57), peak cigarette craving (b -0.12, 95% CI -0.59 to 0.35, p=0.62) or cue-elicited cigarette craving (b -0.21, 95% CI -3.86 to 3.43, p=0.91). We did not find evidence of a difference in secondary outcomes.

CONCLUSIONS

We did not find evidence to suggest that nicotine-containing fruit/sweet-flavoured and unflavoured e-liquids have different effects on cigarette cravings after 1 week of use. Further research is needed to establish if differences emerge over longer periods of exposure and extend to smoking cessation outcomes.

Using the Theory of Planned Behavior to Anticipate DIY E-juice Mixing among Young Adult International E-cigarette Users

BACKGROUND

Trends in young adult use of electronic nicotine delivery systems (ENDS) and experimentation with do-it-yourself (DIY) e-juice mixing are growing around the world. Theoretical frameworks for examining secondary behaviors (i.e., mixing) embedded within a primary behavior (i.e., vaping) are limited, leading to challenges in scholarly understanding of behavioral performance. This study explored the theoretically driven factors surrounding ENDS users' decision to mix DIY e-juice through a multiple behavior test of the theory of planned behavior (TPB).

METHODS

An international sample of young adult participants aged 18-19 (n=203) was recruited from Prolific for an online crosssectional survey. Path modeling tested four theoretically driven models to explore behavioral performance of mixing.

FINDINGS

The data supported TPB expectations and revealed new paths for secondary behavior. Primary perceptions of attitudes, norms, and intention were predictive of the same secondary perceptions. In addition, for both primary and secondary behaviors, perceived norms were a function of perceived attitudes. For the secondary behavior, normative influence was experienced indirectly through perceived attitudes.

CONCLUSION

DIY e-juice mixing is a product of perceived attitudes and behavioral control surrounding mixing as well as perceived attitudes, norms, and intention surrounding general ENDS use. While unregulated DIY experimentation increases among youth, these findings provide a lens for public health efforts seeking to reach and reduce use. Understanding DIY e-juice behaviors is essential to anticipate stockpiling behaviors and negative outcomes from amateur experimentation.

The Use of E-Cigarettes among High School Students in Poland Is Associated with Health Locus of Control but Not with Health Literacy: A Cross-Sectional Study

Since their introduction, the use of electronic cigarettes has increased considerably in the population and among adolescents. Determinants of smoking conventional cigarettes were thoroughly studied in various social groups. However, we know less about the predictors of the use of e-cigarettes in younger generations. The main aim of this study was the assessment of the factors associated with the use of electronic cigarettes among high school students. Specifically, the roles of health literacy (HL) and health locus of control (HLC) were addressed. The analysis was based on the data from a 'pen-and-pencil' survey performed in a large sample of 2223 high school students from southern Poland. The tools used in the survey encompassed 133 items, including a 47-item European Health Literacy Survey questionnaire, an 18-item Multidimensional Health Locus of Control Scale, and a set of questions asking about the health behaviors, and sociodemographic and economic characteristics of respondents. In the study sample, 47.5% of the respondents had used e-cigarettes in the past, and 18.6% had used them in the last month. HL was not significantly associated with dependent variables reflecting the use of e-cigarettes. Two types of external HLC were associated with using e-cigarettes in the past, and 'Chance' HLC (CHLC) was also associated with their use in the last month. Males, students of schools providing vocational training, and students declaring more Internet use during the week showed a higher likelihood of ever using e-cigarettes or using them in the last month. Students smoking conventional cigarettes were also more prone to use e-cigarettes. To sum up, it was an unexpected result that HL is not associated with the use of e-cigarettes. A greater likelihood of using e-cigarettes was positively associated with higher CHLC scores, as in the case of smoking traditional cigarettes.