Social norms towards smoking and vaping and associations with product use among youth in England, Canada, and the US

My friends made me do it: Peer influences and different types of vaping in adolescence

Vaping is one of the most common forms of substance use among adolescents. Social influences play a key role in the decision to use substances and frequency of use during adolescence, and vaping is no exception. Using a sample of 891 adolescents across two time points (Mage = 15.1 and Mage = 17.2) in this pre-registered study, we explored whether the frequency of vaping nicotine and the frequency of vaping marijuana at age 17 were related to concurrent reports of resistance to peer influence (RPI), perceptions of friends vaping, and perceptions of classmates vaping. Then, we investigated whether resistance to peer influence reported at age 15 was similarly related to age 17 vaping of both substances. Higher RPI at both ages 15 and 17 was associated with a higher probability of abstaining from vaping both substances but was not related to the frequency of vaping among those who vaped. Perceiving that a higher proportion of friends - but not classmates - vaped was associated with a lower probability of abstaining and a greater frequency of vaping among those who vape (for both substances). Higher RPI had an attenuating effect on the relation between perceptions of vaping among peers and an adolescent's own vaping behavior, but that differed by age and peer group (e.g., friends vs. classmates). Overestimation about the prevalence of classmate vaping may have played a role in the findings, but our results suggest that interventions to strengthen peer resistance across adolescence are warranted.

Dynamic Norms and Vaping: A Test of Four Mediators

Background: The prevalence of vaping among young people is a public health crisis. Social norms can contribute to the problem, but also to the solution. Objective: The current study examined young adults' responses to anti-vaping messages that varied on two features: social norms and behavioral framing. Methods: College students (N = 270) were randomly assigned to one of five conditions in a 2 (social norm: dynamic norm, static norm) X 2 (behavioral framing: vaping, not vaping) between-subjects factorial design with a no message control condition (n range = 49-58 in each condition). Results: Independent samples t-test, univariate analysis of variance, and structural equation modeling were used to test hypotheses and answer research questions. Results showed main effects of social norm, such that the dynamic (vs. static) norm message led to higher preconformity (p <.001) and self-efficacy (p = .012), and lower freedom threat (p = .040) and reactance (p < .001). There was also an indirect effect of dynamic norm on attitude as mediated by self-efficacy (p = .040). No main effect of behavioral framing was observed. Few interactions between social norm and behavioral framing were observed on preconformity (p < .001), anger (p < .001), and negative cognitions (p = .003). Conclusion: Overall, findings suggest a persuasive advantage for a dynamic norm relative to a static norm. Theoretically, these findings add to the literature suggesting the persuasiveness of dynamic norms. Practically, these results imply anti-vaping campaigns targeting young populations should communicate the changing (dynamic) norms in regard to (not) vaping.

Electronic cigarette social norms among adolescents in New South Wales, Australia

The use of electronic cigarettes (e-cigarettes) is common and increasing, especially among youth. In 2022/2023, 30% of 12- to 17-year-olds reported ever using e-cigarettes in Australia-a >50% increase from 2017 (14%). Several adverse e-cigarette health effects have been identified and most effects remain unknown. Social norms, rules that govern social behaviours, are associated with current and future adolescent e-cigarette use. Understanding social norms in Australian adolescents is critical to the development of targeted and effective e-cigarette prevention activities. This study aims to explore e-cigarette social norms among adolescents living in New South Wales, Australia. A total of 32 online single or paired semi-structured qualitative interviews were conducted involving 46 participants aged 14-17 years, as part of the Generation Vape project. Reflexive thematic analysis was applied within a constructivist perceptive. Adolescents perceived e-cigarettes use as prolific among their peers, with use considered common, acceptable and normal. Fuelled by social exposure to e-cigarettes, 'everyone' was generally thought to be using them (descriptive norms). E-cigarette use was considered so entrenched that it was part of adolescent identity, with abstinence regarded as atypical. Use was driven by an internalised desire to fit it (injunctive norm), rather than being attributed to overt/external 'peer-pressure'. Positive e-cigarette norms exist among Australian adolescents with norm formation strongly influenced by social exposure, including e-cigarette promotion. Prevention efforts should include limiting adolescent exposure to e-cigarette marketing to help redefine existing pro-e-cigarette social norms and protect health.

Impact of social networks and norms on e-cigarette use among adolescents in Southern California: a prospective cohort study

Objective

Using social network analysis, we assessed the mechanisms of social influence that promote e-cigarette use in adolescent networks.

Methods

Data on health behaviours and friendship networks from a cohort of 10 high schools in Southern California (N=1599) were collected in grade 9 Spring 2021 (W1), grade 10 Fall 2021 (W2) and Spring 2022 (W3). Two mixed effects logistic regression models were estimated (full sample and subsample of non-vapers only) to evaluate the associations of W1 and W2 pro-vaping norms, peer e-cigarette use exposure and prior e-cigarette use (full sample) on past 6-month vaping at W3, adjusting for demographic covariates and school clustering.

Results

Previous vaping was the strongest predictor of past 6-month vaping at W3 among the full sample. Greater exposure to friend e-cigarette use at W2 (adjusted OR (AOR)=12.2, 95% CI 4.04 to 36.5) and greater pro-vaping norms at W2 (AOR=2.63, 95% CI 1.24 to 5.55) were significantly and positively associated with increased odds of initiating e-cigarette use at W3 among students with no lifetime e-cigarette use.

Conclusion

Peer network exposure and pro-vaping norms are significant predictors of vaping initiation even when network vaping prevalence is low.

Perceptions of cigarettes and e-cigarettes: does health literacy matter?

OBJECTIVE

This study assessed the relationship between health literacy, perceptions of traditional and electronic cigarettes, and smoking status among college students.

PARTICIPANTS

Participants (N = 150; Mage= 20.41 years, SD 3.48), included nonsmokers (78%) and smokers (21%) of traditional (12%) and e-cigarettes (17%).

METHOD

Participants completed a novel questionnaire to assess perceptions of traditional and e-cigarettes, and the Health Literacy Skills Instrument to evaluate health literacy.

RESULTS

Traditional cigarettes were perceived as having a greater negative impact on physical health than e-cigarettes, whereas e-cigarettes were perceived as having a greater positive impact on social-emotional health than traditional cigarettes. Most participants (57%) had below basic health literacy skills.

CONCLUSIONS

This study did not find a relationship between health literacy skills and smoking status or smoking perceptions. Further research is needed to investigate correlates of smoking status and perceptions to inform prevention and cessation efforts.

Predictors of polysubstance vaping in emerging adults

BACKGROUND

Polysubstance use, which increases the risk for negative consequences of substance use, is common among emerging adults who regularly consume substances by vaping. Examining predictors of polysubstance vaping is crucial for understanding whether this novel form of substance consumption lends itself equally efficaciously to established forms of intervention for smoked substances.

OBJECTIVE

The current study aimed to examine whether modifiable cognitive risk factors for increased vaping in the form of attitudes, expectancies and norms can predict co-use of nicotine and cannabis among vapers over and above the effect of demographics, personality risk factors and anxiety, depression symptoms.

METHODS

Regular nicotine and cannabis vapers between 18 and 30 years were recruited online in Canada via a Qualtrics panel. Hierarchical binary logistic regression was used to predict membership in a polysubstance or a single substance vaping group. Demographics, personality risk factors, depression and anxiety symptoms were included as predictors in block 1; attitudes, expectancies and perceived norms of vaping were added in block 2.

RESULTS

Attitudes, expectancies and norms predicted polysubstance use over and above the effect of demographics, personality risk factors and anxiety, depression symptoms. Positive expectancies played a uniquely significant role in the prediction of polysubstance vaping.

CONCLUSIONS

Cognitive interventions targeting attitudes, expectancies and norms may be effective in prevention of polysubstance vaping, although positive expectancies appear to be the main unique factor that has an influence above and beyond all other cognitive factors related to vaping. Treatment and prevention programs should put special focus on lowering positive expectancies.

Scoping review of guidance on cessation interventions for electronic cigarettes and dual electronic and combustible cigarettes use

BACKGROUND

Although evidence-based smoking cessation guidelines are available, the applicability of these guidelines for the cessation of electronic cigarette and dual e-cigarette and combustible cigarette use is not yet established. In this review, we aimed to identify current evidence or recommendations for cessation interventions for e-cigarette users and dual users tailored to adolescents, youth and adults, and to provide direction for future research.

METHODS

We systematically searched MEDLINE, Embase, PsycINFO and grey literature for publications that provided evidence or recommendations on vaping cessation for e-cigarette users and complete cessation of cigarette and e-cigarette use for dual users. We excluded publications focused on smoking cessation, harm reduction by e-cigarettes, cannabis vaping, and management of lung injury associated with e-cigarette or vaping use. Data were extracted on general characteristics and recommendations made in the publications, and different critical appraisal tools were used for quality assessment.

RESULTS

A total of 13 publications on vaping cessation interventions were included. Most articles were youth-focused, and behavioural counselling and nicotine replacement therapy were the most recommended interventions. Whereas 10 publications were appraised as "high quality" evidence, 5 articles adapted evidence from evaluation of smoking cessation. No study was found on complete cessation of cigarettes and e-cigarettes for dual users.

INTERPRETATION

There is little evidence in support of effective vaping cessation interventions and no evidence for dual use cessation interventions. For an evidence-based cessation guideline, clinical trials should be rigorously designed to evaluate the effectiveness of behavioural interventions and medications for e-cigarette and dual use cessation among different subpopulations.

The State of Norm-Based Antismoking Research: Conceptual Frameworks, Research Designs, and Implications for Interventions

This synthesis review examined 189 qualified studies on norms and smoking in terms of conceptual frameworks, types of social norms, research designs, dependent variables, independent variables and covariates, and findings related to norms. Results show that 7.9% were experimental, and the remaining were cross-sectional. By far, the reasoned action approach (RAA) was the most-cited theory, but RAA was not used to guide experimental designs. The social norms approach, norm focus theory, social cognitive theory guided the intervention experiments. Harmful norms were more frequently examined than healthful norms. Pro-smoking norms positively predicted smoking intentions and behaviors, whereas antismoking norms positively predicted antismoking intentions and behaviors. The over-application of RAA in cross-sectional antismoking research has yielded repetitive findings. Norm-based experiments can adopt other theoretical perspectives to offer insights into antismoking interventions. The RAA constructs are still applicable and can be integrated into intervention designs.

An examination of the social perceptions and vaping preferences of young electronic nicotine delivery system users

Background

Little research has been conducted on social aspects and preferences of electronic nicotine delivery system (ENDS) use among young ENDS users, and none have examined differences in these aspects and preferences by gender and tobacco use status.

Methods

A total of 558 young regular vapers (ages 16-24; vaped at least once a week for the last 3 months) from Nova Scotia were recruited to complete a demographic and vaping questionnaire. A 2 x 3 study design was used to compare participants on social aspects and vaping preferences based on gender (male or female) and tobacco use status (never, former, or current smoker). Chi-square tests were used to determine significant differences, and Bonferroni tests were used to assess over- and under-representation within significant variables.

Results

Current tobacco-using male vapers had a higher frequency of experiencing pressure to vape from friends and current employment as compared to females. Former and never tobacco-using male vapers had a higher frequency of parental awareness of their vaping behavior than females. Former tobacco-using female vapers had a higher frequency of being influenced to vape by others they know on social media than males. Both never and former tobacco-using females reported a higher frequency of exposure to vaping content on social media than males. Never tobacco-using female vapers preferred vape pen devices relative to males.

Conclusions

Important gender differences by tobacco use status exist and demonstrate differential patterns of social influence for ENDS use and their experiences within this demographic.

The reciprocal relationships of social norms and risk perceptions to cigarette, e-cigarette, and cannabis use: Cross-lagged panel analyses among US young adults in a longitudinal study

INTRODUCTION

Given the distinct and evolving social norms, research on health implications, and regulations regarding cigarettes, e-cigarettes, and cannabis, it is important to understand the interplay between social norms, risk perceptions, and use of these products.

METHODS

We analyzed 3 waves of longitudinal data (Fall 2018, 2019, 2020) from 3006 young adults (Mage=24.56, 54.8% female, 31.6% sexual minority, 39.6% racial/ethnic minority) from 6 US metropolitan statistical areas. Cross-lagged panel models (CLPMs) examined reciprocal relationships of (a) perceived social norms (i.e., peer use, social acceptability) and risk perceptions (i.e., harm, addictiveness) to (b) number of days of cigarette, e-cigarette, and cannabis use in the past 30 days, respectively.

RESULTS

At baseline, lifetime and past 30-day use prevalence was: 61.8% and 26.9% for cigarettes, 57.7% and 37.7% for e-cigarettes, and 70.7% and 39.2% for cannabis. Perceived social norms and use of cigarettes and e-cigarettes decreased over time, and risk perceptions increased (except cigarettes showed stable perceived harm). Regarding cannabis, perceived social norms and use increased, yet perceived harm and addictiveness also increased. CLPM indicated that greater perceived social norms predicted greater cigarette, e-cigarette, and cannabis use over time, and vice versa. While greater perceived risk predicted less e-cigarette and cannabis use and vice versa, this did not hold true for cigarettes: use predicted lower perceived risk, but risk perceptions did not predict later use.

CONCLUSIONS

Tobacco and cannabis intervention and regulatory efforts should address health risks of use, particularly of e-cigarettes and cannabis, as well as denormalizing use.

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

Research on youth use of electronic nicotine delivery systems (ENDS) has explored the correlates of initiation and use; however, little is known about the factors that predict continued youth use of ENDS. We used an ecological momentary assessment (EMA) burst design to explore both daily variability within adolescents over a two-week observation period and variability over time two years later (2018 and 2020). The contribution of device characteristics, motivations for use, contextual factors, and community factors to daily use occasions were explored. Youth participants (n = 35) at the start of the study were past two-week nicotine vapers, 14 to 17 years old, who resided within 100 miles of Louisville, KY, and reported past two-week ENDS use. Close to a quarter of participants ceased all tobacco use two years later, suggesting that some youth, despite prior regular vaping habits, may have only been experimenting with ENDS. The regular continued use of ENDS was predicted by trying to quit using cigarettes, appealing flavors, and being in locations where cigarette use was prohibited. Except for flavors, these factors did not affect ENDS use in year one. These findings suggest that tobacco policy might target ENDS use by prohibiting all tobacco use, including ENDS, in locations where smoking is already banned.

Prevalence and use of cannabis products and routes of administration among youth and young adults in Canada and the United States: A systematic review

BACKGROUND

The current systematic review aimed to summarize the literature on the prevalence of routes of administration and cannabis products used among youth and young adults in Canada and the United States (US).

METHODS

Five academic databases were searched in April 2020 and February 2021. Peer-reviewed articles were included if they were a population-based quantitative observational study describing the prevalence of a cannabis product or route of administration among youth and young adults in Canada or the US. Risk of bias was assessed using Hoy and colleagues' risk of bias assessment tool. A narrative review was conducted.

RESULTS

Twenty-six studies were identified for the following routes of administration: smoking (n = 16), vaping (n = 21), dabbing (n = 3), oral (n = 13), topical (n = 1); and products: dried flower (n = 2), and concentrates (n = 8). Smoking had the highest prevalence rates among youth and young adults; however, rates of use appeared to reduce over time. Conversely, prevalence of vaping appeared to increase over time. Fewer studies focused on oral or dabbed cannabis but those that did reported prevalence estimates of approximately a third among recent cannabis consumers.

DISCUSSION

The heterogeneity of cannabis routes of administration restricted our ability to collate average prevalence estimates. In jurisdictions where non-medical cannabis is legal, policymakers should provide guidance and education to youth on each type of product and routes of administration.

OTHER

Funding for this study was provided by a Canadian Institutes of Health Research (PJT-153342). The current review was registered with PROSPERO (CRD42020169275).

Substance Use Descriptive Norms and Behaviors among US College Students: Findings from the Healthy Minds Study

BACKGROUND

Social norms have been associated with alcohol use in college populations; however, more research is needed to confirm the associations between social norms and a range of substance use behaviors during the COVID-19 pandemic.

METHODS

We analyzed data from the Healthy Minds Study (September 2020-December 2020), a non-probability sample administered online to college students. We used multivariable logistic regression to test for associations between respondents' perceptions of substance use behaviors in their respective colleges and their own substance use behaviors, adjusting for age, gender, race/ethnicity, and international student status.

RESULTS

We found that those who overestimated the prevalence of alcohol use, cigarette use, cannabis use, and vaping were significantly more likely to use these substances when compared with those who did not overestimate. These associations persisted even when using different prevalence estimates of substance use, though some associations lost statistical significance when applying the survey weights to account for non-response.

CONCLUSION

College students overestimated the prevalence of substance use in their respective colleges, even during the early stages of the pandemic when social interactions were limited, and these beliefs were associated with substance use. Future studies may test the utility of campaigns to alter perceptions of social norms and interventions that use personalized normative feedback to reduce substance use during pandemics.

Social norms as a predictor of smoking uptake among youth: a systematic review, meta-analysis and meta-regression of prospective cohort studies

BACKGROUND AND AIMS

Social norms towards smoking are a key concept in tobacco control policy and research. However, the influence and strength of different types of social norms on youth smoking uptake is unclear. This study aimed to examine, quantify and compare evidence of the longitudinal associations between different types of social norms towards smoking and youth smoking uptake (initiation and escalation).

METHODS

Systematic review searching four databases (MEDLINE, EMBASE, PsycInfo, CINAHL) from January 1998 to October 2020. Evidence synthesis via narrative review, meta-analysis pooling unadjusted associations (initiation only, due to heterogeneity in escalation outcomes) and meta-regression comparing effect sizes by norm type and study characteristics. Studies included observational prospective cohort studies using survey methodology with youth aged ≤24 years. Measurements included longitudinal associations between descriptive norms (perceived smoking behaviour) and injunctive norms (perceived approval/disapproval of smoking) among social network(s) and subsequent smoking initiation or escalation.

RESULTS

Thirty articles were identified. In the narrative review, smoking initiation (but not escalation) was consistently predicted by two norms: parental and close friend smoking. Associations between smoking uptake and other descriptive norms (smoking among siblings, family/household, partner, peers, adults) and all injunctive norms (perceived approval of smoking among parents, siblings, close friends/peers, partner, teachers, people important to you, the public) were less consistent or inconclusive. In the meta-analysis pooling unadjusted associations, 17 articles were included (n = 27 767). Smoking initiation was predicted by the following descriptive norms: smoking among parents [Odds Ratio (OR) = 1.88, 95% Confidence Interval (CI) = 1.56-2.28], close friends (OR = 2.53, 95% CI = 1.99-3.23), siblings (OR = 2.44, 95% CI = 1.93-3.08), family/household (OR = 1.55, 95% CI = 1.36-1.76) and adults (OR = 1.34, 95% CI = 1.02-1.75), but not peers (OR = 1.14, 95% CI = 0.92-1.42). Smoking initiation was also predicted by two injunctive norms, perceived approval of smoking among parents (OR = 1.74, 95% CI = 1.27-2.38) and the public (OR = 4.57, 95% CI = 3.21-6.49), but not close friends/peers (OR = 2.36, 95% CI = 0.86-6.53) or people important to the individual (OR = 1.24, 95% CI = 0.98-1.58).

CONCLUSIONS

In this systematic review (narrative and meta-analysis), descriptive norms of parents' and close friends' smoking behaviour appeared to be consistent predictors of youth smoking initiation, more so than the descriptive norms of more distal social networks and injunctive norms.

Initiation or cessation: what keeps the prevalence of smoking higher in Quebec than in the rest of Canada?

INTRODUCTION

We compared smoking initiation and cessation in Quebec versus the rest of Canada as possible underpinnings of the continued higher cigarette smoking prevalence in Quebec.

METHODS

Data were drawn from the Canadian Community Health Survey (CCHS). We compared average and sex-stratified prevalence estimates of (1) current cigarette smoking in persons aged 15 years and older; (2) past-year initiation of cigarette smoking in those aged 12 to 17 and 18 to 24 years; and (3) past-year cessation in adults aged 25 years and older in Quebec versus the other nine Canadian provinces in each two-year CCHS cycle from 2007/08 to 2017/18.

RESULTS

The prevalence of current smoking decreased from 25% to 18% among adults aged 15 years and older in Quebec from 2007/08 to 2017/18, and from 22% to 16% in the rest of Canada. Initiation among those aged 12 to 17 years decreased from 9% to 5% in Quebec, and from 7% to 3% in the rest of Canada. Neither initiation among people aged 18 to 24 (at 6% and 7%, respectively) nor cessation among adults aged 25 and older (approximately 8%) changed over time in Quebec or in the rest of Canada. In each two-year CCHS cycle, past-year initiation among those 12 to 17 years of age was consistently higher in Quebec than in the rest of Canada, but there were no substantial or sustained differences in initiation among people aged 18 to 24 or in past-year cessation. Findings were similar when stratified by sex.

CONCLUSION

Higher levels of smoking initiation among youth aged 12 to 17 years could be a proximal underpinning of the continuing higher prevalence of smoking in Quebec versus the rest of Canada.

Vaping identity in adolescent e-cigarette users: A comparison of norms, attitudes, and behaviors

INTRODUCTION

Using the tenets underlying social identity theory and the theory of planned behavior, the current study compared the perceptions, attitudes, and behaviors of e-cigarette users that reported vaping as self-defining ("vapers") compared to users that denied vaping was central to their identity ("non-vapers").

METHOD

Secondary analyses of data from the 2017-2018 California Student Tobacco Survey were utilized. A weighted, multivariable regression model (N = 82,217) compared the demographic characteristics, beliefs, and behaviors of vapers and non-vapers. A path analytic model examined whether norms and attitudes mediated the relationship between vaper identity and use behavior.

RESULTS

Self-identified sexual and/or gender minority youth were more likely to identify as vapers compared to heterosexual and cisgender respondents. Youth that identified as vapers viewed e-cigarette use as more normative, held more favorable attitudes (i.e., lower harm beliefs), used e-cigarettes more frequently and in greater quantities, were more likely to use fruit and mint flavored e-cigarettes, and were more likely to acquire e-cigarettes from commercial sellers (i.e., vape/tobacco shops; all p < 0.05). Additionally, descriptive norms and attitudes mediated the relationship between vaper identity and use frequency/quantity.

CONCLUSIONS

Differences in e-cigarette beliefs and behaviors were found for youth e-cigarette users that perceived vaping as self-defining versus those that did not view vaping as part of their self-concept. Future studies are needed to examine causal directionality between identity, norms, attitudes, and behavior. Tobacco control efforts might use these findings to further denormalize vaping using evidence-based media campaigns and policy implementation.

Descriptive and Injunctive Norms Related to E-Cigarettes

INTRODUCTION

E-cigarette use has rapidly increased in prevalence in the United States, and rates of use are even higher among military personnel compared to the general population. Descriptive and injunctive norms have previously been shown to impact tobacco use. However, little research has been conducted related to e-cigarette descriptive and injunctive norms, and no research has addressed e-cigarette norms among a military population.

MATERIALS AND METHODS

From July, 2018 to February, 2019, 22 focus groups (N = 164) were conducted among airmen, military training leaders, and technical training instructors. The focus groups aimed to gain insight into facilitators and barriers to tobacco use during technical training, where airmen receive training for their specific jobs. Study procedures were approved by the institutional review board of the 59th Medical Wing in San Antonio. Focus group recordings were transcribed, and transcripts coded. Themes related to descriptive and injunctive norms were examined for the current study.

RESULTS

Many interviewees mentioned the prevalence of e-cigarette use, either generally ("…a lot of people vape but that's kind of the thing nowadays") or with specific estimates of how many airmen use ("vaping, probably at least 60-70%"). However, injunctive norms were not commonly discussed, with only a couple of interviewees mentioning that e-cigarette use is the "cool" trend or they feel peer pressure.

CONCLUSIONS

Descriptive norms were more commonly mentioned than injunctive norms, which may indicate that injunctive norms are not as influential for e-cigarette use. Additionally, all estimates related to e-cigarette prevalence were higher than actual rates of use, showing an overestimation of use, which previous literature has shown increases likelihood of e-cigarette use. Future research should specifically ask about injunctive norms as well as determine if descriptive and injunctive norms influence actual e-cigarette use behaviors among military personnel.

Youth Observation of E-Cigarette Use in or Around School, 2019

INTRODUCTION

E-cigarette use increased dramatically among U.S. students during 2017-2019, and school plays an important role in preventing and reducing youth substance use. This study examines the prevalence and correlates of self-reported youth observation of e-cigarette use on school grounds.

METHODS

Data from the 2019 National Youth Tobacco Survey (N=19,018) were analyzed to examine the prevalence and factors associated with youth observation of e-cigarette use in or around the school. Multivariable logistic regressions were performed to assess the associations between youth observation of e-cigarette use and the susceptibility to initiate cigarettes or e-cigarettes. Analyses were conducted in 2020.

RESULTS

In 2019, about 63.9% of students (16.8 million) reported noticing youth use of e-cigarettes in or around the school, with bathroom or locker room as the most common location (33.2%). Female (versus male) students; high-school (versus middle-school) students; non-Hispanic Whites (versus other groups); former and past 30-day e-cigarette users (versus never users); students with exposure to tobacco marketing (versus none); and students living with a household member using e-cigarettes (versus not) had higher odds of reporting the observation of vaping in schools. Among never tobacco users (n=11,518), observation of vaping in schools was associated with higher odds of being susceptible to smoking cigarettes (AOR=1.2, 95% CI=1.0, 1.3) and using e-cigarettes (AOR=1.7, 95% CI=1.6, 1.9), especially among middle-school students.

CONCLUSIONS

E-cigarette use is common on school grounds, and youth observation of vaping in schools may increase the risk of initiating tobacco use in the future. School vaping policy and education programs are needed to curb youth e-cigarette use.

Association between e-cigarette use and future combustible cigarette use: Evidence from a prospective cohort of youth and young adults, 2017-2019

INTRODUCTION

A surge in popularity of e-cigarettes prompts concern given the association between e-cigarettes and future cigarette use. However, much of the evidence for this association comes from early, less efficient, and lower nicotine e-cigarettes than are available and widely used now. The goal of this study was to examine the relationship between e-cigarette use in 2018 and subsequent smoking initiation and continued e-cigarette use.

METHODS

Participants included members of a national longitudinal panel of youth and young adults aged 15-27 who, in 2017, reported never having used a nicotine containing product (n = 3360). Logistic regression analyses assessed associations between participants' self-reported ever e-cigarette use in 2018 and ever cigarette use, current cigarette use, and current e-cigarette use in 2019, after controlling for demographic and psychosocial variables.

RESULTS

Compared with those who still had never used an e-cigarette, those who reported ever e-cigarette use in 2018 had significantly higher odds of ever cigarette use (aOR = 7.29, 95% CI [4.10, 12.97]), current cigarette use (aOR = 8.26, 95% CI [3.17, 21.53]), and current e-cigarette use (aOR = 9.70, 95% CI [6.41, 14.69]) one year later in 2019.

CONCLUSIONS

These findings show that the pod mod style, high nicotine containing e-cigarettes subject young users to the same risks of transitioning to combustible cigarettes as their earlier, less efficient predecessors. Strong regulation of all nicotine products, including e-cigarettes, is needed to prevent the trajectory of e-cigarette to cigarette use among youth and young adults.

It's Not All Smoke and Mirrors: The Role of Social Norms, Alcohol Use, and Pandemic Partying in e-Cigarette Use During COVID-19

E-cigarette use among college students is increasing. In the era of COVID-19, such usage is especially dangerous given that the virus can be deadly for those with impaired respiratory systems. A small but growing body of research suggests that social norms may predict e-cigarette use. However, one's perception of e-cigarette use behaviors (descriptive norms) and approval by peers (injunctive norms) have yet to be studied in college students. The overarching purpose of this study is to determine whether descriptive and injunctive norms for e-cigarette use contribute unique variance to past 30-day e-cigarette use. Methods: Using a sample of 191 students (138 women) surveyed from introductory-level courses at a university in the northeastern United States, we explored the relationships between student demographic characteristics, alcohol use, binge drinking, COVID-19 non-compliant party attendance on and off campus, and social norms with past 30-day e-cigarette use using sequential regression. Two models were utilized to determine if descriptive and injunctive e-cigarette use norms predicted e-cigarette use after controlling for demographic characteristics in the social norms model, and above and beyond demographics and COVID-19 noncompliant party attendance, alcohol use, and binge drinking in the party behaviors model. Results: The results demonstrated that descriptive and injunctive norms for e-cigarette use significantly predicted e-cigarette use in both models, controlling for all covariates. Conclusions/Importance: Findings highlight the importance of social norms in predicting e-cigarette use during the COVID-19 pandemic, identifying areas for prevention and intervention for public health officials and higher education administrators.

World vaping update

PURPOSE OF REVIEW

Although death and injury related to e-cigarette use and vaping products has decreased since the peak in 2019, concern over the popularity of electronic nicotine delivery systems (ENDS - a term which includes vape pens, electronic or e-cigarettes, and products that produce vapor for inhaling rather than combusting to produce smoke) continues. ENDS are used as an aid to quit smoking and for harm reduction.

RECENT FINDINGS

This review covers peer-reviewed literature from January 2019 through February 2020 on vaping (the process of using ENDS). Prevalence, risk factors for use, and health risks and benefits from use predominated. Policy articles, commentaries and editorials were excluded from review. E-cigarette or vaping product use-associated lung injury (EVALI)-related injury and death were in the news and literature this year. Because most EVALI-related injury and death occurred among young people who had vaped tetrahydrocannabinol (THC), data from the Healthy Minds (United States) study are reviewed to consider variation in risk factors for vaping THC compared with nicotine.

SUMMARY

Findings provide up-to-date information on vaping as a way to consume a drug, whether THC or nicotine. Harm reduction benefits were shown in a year-long follow-up of smoking cessation; harms continue to accumulate, including from passive consumption.