Age-varying associations between e-cigarette use and peer use, household use, and exposure to e-cigarette commercials among alternative high school students in Southern California

Pubertal development at age 14 is associated with male adolescents' combustible cigarette smoking and dual use, but not with e-cigarette use - Findings from the UK Millennium Cohort Study

BACKGROUND

Adolescent nicotine exposure via electronic cigarettes (e-cigarettes) is a global health concern. Pubertal development earlier than peers increases the risk of tobacco smoking compared to peers experiencing on-time or late maturation, yet relationships of pubertal timing with e-cigarettes are unknown. We examine whether early pubertal timing is associated with risk for e-cigarette use, tobacco cigarettes, or both by age 14.

METHODS

The Millennium Cohort Study follows a representative cohort of 18,552 9-month-old children born 2000-2002 in the United Kingdom. Our sample includes 11,445 adolescents (5697 boys, 5748 girls) classified at age 14 as early, on-time, or late in pubertal development timing (PDT) relative to same-age, same-sex peers using the Pubertal Development Scale. Outcomes were use of e-cigarettes, tobacco cigarettes, or both by age 14. We included childhood liability confounders and demographics measured from age 7-11.

RESULTS

For girls, no PDT differences in age 14 e-cigarette or tobacco cigarette use were observed. All relative to on-time PDT boys, early maturing boys' odds of tobacco cigarette use were 59% higher (OR=1.59, 95% confidence interval (CI)=1.08,2.35), and odds of dual-use were 49% higher (OR=1.49, CI=1.11,1.99), both compared to odds of never use. Among late PDT boys, dual-use odds were lower than never use by 35% (OR=0.65, CI=0.47,0.91) and lower than e-cigarette use only by 36% (OR=0.64, CI=0.42,0.97).

CONCLUSIONS

At age 14, PDT was not associated with e-cigarette use for either sex, yet it was linked with tobacco use and dual use among boys.

Prevalence, Correlates, and Perception of E-cigarettes among Undergraduate Students of Kathmandu Metropolitan City, Nepal: A Cross-Sectional Study

Introduction

The use of e-cigarettes has been increasing globally especially among the youth population due to rigorous advertisement, marketing, and promotion which has become a significant public health concern. Hence, this study is aimed at identifying the prevalence, correlates, and perception of e-cigarettes among undergraduate students of Kathmandu city.

Methods

A cross-sectional study was conducted among 405 undergraduates of capital city of Nepal from April 2022 to December 2022. A two-stage systematic random sampling was used to select the respondents. An anonymous, semistructured, self-administered questionnaire was used for data collection. A descriptive, bivariable, and multivariable analysis was done using SPSS version 20.

Results

The prevalence of ever use and current use of e-cigarettes was 21.2% and 5.9%, respectively. Number of close friends (AOR = 5.23, CI: 1.26, 16.39), number of friends using e-cigarettes (AOR = 7.23, CI: 0.93, 22.82), male sex (AOR = 2.88, CI: 2.15, 10.35), and age (COR = 5.07, CI: 0.93, 8.19) were the major predictors of current e-cigarette usage. Similarly, number of friends using e-cigarettes (AOR = 5.90, CI: 2.15, 10.35), male sex (AOR = 3.53, CI: 2.15, 10.35), age (COR = 4.56, CI: 0.98, 6.24), and place of residence (COR: 5.19, CI: 0.83, 8.02) were the major predictors of ever e-cigarette usage. The prevalence of e-cigarette consumption was higher in males than females (5.4% vs. 0.5%). Approximately, 34.8% respondents had perceived e-cigarettes as a means to help in smoking cessation. 56.5% adults knew that e-cigarettes promoted conventional smoking. Majority (64.7%) of the undergraduate students had presumed e-cigarettes as less harmful to conventional smoking.

Conclusion

Ever use, current use, and misconception on e-cigarettes were widespread among the undergraduate students. Age, male sex, number of close friends, number of peers using e-cigarette, and place of residence were the major predictors for e-cigarette usage. To deal with the increased e-cigarette consumption state, awareness on the harmful addictive properties of e-cigarettes along with its adverse health consequences must be propagated and an appropriate intervention must be implemented.

Associations between use of specific social media sites and electronic cigarette use among college students

OBJECTIVE

To examine dose-response associations between use of specific social media sites and the use of electronic cigarettes (e-cigarettes) and traditional cigarettes.

METHODS

This was a cross-sectional study of 298 first-year college students enrolled in the fall 2019 semester at a large state university. Heckman selection and Probit model were used to estimate associations between use of specific social media sites and e-cigarette/traditional cigarette use.

RESULTS

Each additional hour per day spent on Snapchat was associated with a 4.61% increase in the probability of lifetime e-cigarette use. In addition, among current e-cigarette users, more time spent on Snapchat was associated with more frequent e-cigarette use (marginal effects: 0.13, p = 0.001). Facebook, Twitter, Snapchat and Instagram were not associated with traditional cigarette smoking.

CONCLUSION

Snapchat was the only major social media platform associated with both lifetime and current e-cigarette use.

Mutual pathways between peer and own e-cigarette use among youth in the United States: a cross-lagged model

BACKGROUND

Electronic cigarettes (e-cigarettes) have become the most common tobacco product used among adolescents in the United States (US). Prior research has shown that peer e-cigarette use was associated with increased risk of own e-cigarette use. Nonetheless, there is little empirical evidence on the directionality of these associations-if peer use predicts own use (peer influence) or if own use predicts peer use (peer selection).

METHODS

We estimated the association between peer and own e-cigarette use among US adolescents 12-17 years of age. We used the cross-lagged model to investigate the mutual relationship between peer and own e-cigarette use over time using data from a population-based longitudinal study, Population Assessment of Tobacco and Health. Stratified analyses were conducted by sex and age subgroups.

RESULTS

Results from a cross-lagged model showed a statistically significant predicting path leading from peer use at the prior time point to own use at the following time point, but not vice versa.

CONCLUSIONS

We found strong relationships between peer e-cigarette use and own e-cigarette use at within-individual levels. Peer influence paths were more robust than peer selection paths for e-cigarette use. Incorporating peers into prevention and intervention programs may help enhance these strategies.

Remote Versus In-Person Learning During COVID-19: Comparison of E-Cigarette Susceptibility and Ever Use Among a Diverse Cohort of 6th-Grade Students in Texas

BACKGROUND

In response to SARS-CoV2 (COVID-19), school districts incorporated remote learning as a mitigation strategy. This study examines the association between classroom setting (ie, on-campus versus remote) and e-cigarette susceptibility or ever use among a sample of Texas public middle school students.

METHODS

Data from n = 985 students enrolled in the CATCH My Breath E-Cigarette Prevention Program trial were collected in Spring 2021. Participants were 6th-grade students in urban Texas. E-cigarette use was examined using the "at-risk" definition described by FDA, indicating either: (1) susceptible never user; or (2) experimental ever use. A multilevel, logistic regression model examined the association between classroom setting and e-cigarette susceptibility/ever use. Covariates included sex, race/ethnicity, academic achievement, household e-cigarette use, perceived school connectedness, and school-level economic status. Models account for nesting within school district. Analyses stratified by race/ethnicity were also conducted.

RESULTS

Overall, 36.3% of the sample were susceptible never users or ever e-cigarette users. The sample was comprised of 55.0% on-campus and 45.0% remote learners. On-campus learners had greater odds of reporting e-cigarette susceptibility or ever use (aOR: 1.45; p = .014). These findings were observed among Latino (aOR: 1.77; p = .026) and White (aOR: 2.10; p = .099) but not African American/Black (aOR: 0.86; p = .728) youth.

CONCLUSIONS

On-campus learning during the Spring 2021 semester was associated with greater risk for e-cigarette susceptibility or ever use among a diverse sample of 6th-grade students. E-cigarette susceptibility and ever use is a risk factor for progression to long-term e-cigarette use in later adolescence.

IMPLICATIONS

As school districts prepare to return to on-campus learning in 2022, a focused approach to e-cigarette prevention may be needed to prevent widespread e-cigarette initiation and continued use. Further, study findings demonstrate a need for further research on the school environment as a determinant of e-cigarette use.

An International Systematic Review of Prevalence, Risk, and Protective Factors Associated with Young People's E-Cigarette Use

While the prevalence of young people's conventional cigarette use has decreased in many countries, the use of e-cigarettes has risen. To effectively counteract the growing popularity of e-cigarettes among young people internationally, researchers should know the exact prevalence as well as the protective and risk factors associated with vaping. Based on five eligibility criteria, 53 articles were chosen and analyzed by general characteristics, prevalence, sample characteristics, gender difference, protective factors, and risk factors. In this study, the international pooled prevalence of young people's lifetime e-cigarette use was 15.3%, the current use was 7.7%, and dual use was 4.0%. While the highest lifetime, current, and dual prevalence were found in Sweden, Canada, and the United Kingdom, respectively, the lowest prevalence was found in Germany, followed by South Korea and Sweden. Some protective and risk factors include perceived cost and danger of vaping, parental monitoring, internal developmental assets, cigarette use, family and peer smoking, exposure to online advertisements, and the presence of nearby retail stores. Based on this review, researchers and practitioners can develop different intervention programs and strategies for young smokers.

Dual Use of Nicotine and Cannabis Through Vaping Among Adolescents

INTRODUCTION

This study seeks to identify adolescent nicotine and cannabis vaping patterns and the characteristics of those adolescents who comprised each pattern.

METHODS

This prospective longitudinal survey study measured the relationship between nicotine and cannabis vaping among 1,835 adolescents from 4 public high schools outside of Philadelphia, Pennsylvania. Adolescents completed in-classroom surveys, including questions of lifetime and past 30-day nicotine and cannabis vaping, at Wave 1 (fall 2016, ninth grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). Data were analyzed in 2021.

RESULTS

A sequential processes growth mixture model revealed 4 latent conjoint classes of nicotine and cannabis vaping: early, declining dual use (Class 1: n=259); rapidly increasing dual use (Class 2: n=128); later, slower dual use (Class 3: n=313); and no use (Class 4: n=1,136). Increased odds of belonging to Class 1 and Class 2 versus belonging to Class 4 were significantly associated with cigarette smoking (OR=3.71, OR=2.21), alcohol use (OR=2.55, OR=4.39), peer vaping (OR=1.24, OR=1.20), sensation seeking (OR=1.03, OR=1.11), positive E-cigarette expectations (OR=1.21, OR=1.17), and cigar smoking (OR=2.39 Class 2 only). Increased odds of belonging to Class 3 versus Class 4 were significantly associated with alcohol use (OR=1.66), perceived benefits of E-cigarette use (OR=1.03), positive E-cigarette expectations (OR=1.08), depressive symptoms (OR=1.02), and sensation seeking (OR=1.03).

CONCLUSIONS

From middle to late adolescence, vaping of nicotine and cannabis develop in close parallel. Regulatory policy and prevention interventions should consider the interplay between these 2 substances during this period of adolescence.

More support needed: Evaluating the impact of school e-cigarette prevention and cessation programs on e-cigarette initiation among a sample of Canadian secondary school students

Given the recent increase in e-cigarette use among adolescents, there is a need to further explore how school programs are associated with e-cigarette initiation. The objective of this quasi-experimental study was to evaluate the impact of multiple school-based e-cigarette prevention and cessation programs on e-cigarette initiation among Canadian adolescents. This study used data from Year 6 (2017/18) and Year 7 (2018/19) of the COMPASS study in British Columbia, Alberta, Ontario, and Quebec, Canada. Students in grades 9 to 11 who had never tried e-cigarettes at baseline were included (n = 13,269). Schools (n = 88) reported whether they added programming that addressed e-cigarette or tobacco prevention or cessation. Generalized estimating equations were used to identify how added programs were associated with e-cigarette initiation at follow-up. At one-year follow-up (2018/19), 23% of schools added programs. Our evaluation results suggest that none of the activities taken by schools to prevent or reduce vaping among students significantly prevented vaping onset. In fact, female students at schools that reported adding a theme week had higher odds of e-cigarette initiation (OR 1.68 [95% CI 1.31-2.16]) and male students at schools that reported a cessation program had higher odds of e-cigarette initiation (OR 1.20 [95% CI 1.01-1.44]). These results suggest that schools may not know how to address e-cigarette use and that there can be risks to students if programs are not carefully implemented. Results point to the need for additional support to ensure that schools are taking evidence-based approaches that support all students.

The Indirect Effect of Cigarette Smoking on e-Cigarette Progression via Substitution Beliefs

PURPOSE

This study sought to evaluate whether associations between adolescent combustible cigarette smoking and e-cigarette progression were explained by beliefs that e-cigarettes substitute for cigarettes in nonsmoking situations.

METHODS

Adolescents (N = 1,799) from public high schools outside of Philadelphia, PA, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 36 months (fall 2019, beginning of 12th grade).

RESULTS

A parallel process latent growth curve model revealed that the pathway from baseline smoking to e-cigarette use trend through baseline e-cigarette substitution beliefs was significant (B = .02, z = 2.16, p = .03), indicating that the positive effect of greater baseline cigarette smoking on the rate of e-cigarette progression was channeled through e-cigarette substitution beliefs. The indirect effect from baseline smoking to e-cigarette use trend via e-cigarette substitution beliefs trend was also significant, albeit negative (B = -.05, z = -2.61, p = .009). The negative indirect effect suggested that the strong positive effect of baseline cigarette smoking on baseline substitution beliefs was followed by a slowing of the overall rate of change from baseline. Given that the total effect from baseline smoking to e-cigarette trend was not significant (p = .91), the results suggested complete mediation.

CONCLUSIONS

Among adolescents with greater use of combustible cigarettes, beliefs regarding the substitutability of e-cigarettes in nonsmoking situations appear to foster progression in e-cigarette use. Addressing these beliefs in the school setting and through media campaign messaging early in adolescence may help to prevent the use of e-cigarettes and combustible cigarettes.

Conjoint Developmental Trajectories of Adolescent E-cigarette and Combustible Cigarette Use

OBJECTIVES

In this study, we sought to identify which adolescents progress to regular electronic cigarette (e-cigarette) use (without cigarette smoking), which adolescents become dual users of both types of cigarettes, and how dual use develops across time.

METHODS

Adolescents (N = 1808) from public high schools outside Philadelphia, Pennsylvania, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-month intervals for the following 36 months (fall 2019, beginning of 12th grade).

RESULTS

A sequential processes growth mixture model identified 4 conjoint latent classes: later, rapid e-cigarette uptake (class 1: n = 230); no use of e-cigarettes or combustible cigarettes (class 2: n = 1141); earlier, steady e-cigarette uptake (class 3: n = 265); and dual use of e-cigarettes and combustible cigarettes (class 4: n = 204). Using a rich set of potential risk factors, multinomial logistic regression assessed the likelihood of belonging to each conjoint class compared with the comparison class (dual use). Adolescents in the dual use class were characterized by a greater number and severity of e-cigarette and combustible cigarette risk factors. Adolescents in the 2 e-cigarettes-only classes were characterized by either e-cigarette-specific risk factors (earlier onset) or no risk factors (later onset). The no use class had an absence of risk factors for e-cigarette and cigarette use.

CONCLUSIONS

This study provides new prospective evidence for distinct patterns and profiles of adolescents who progress to current e-cigarette use, including adolescents who were initially cigarette smokers. The findings have implications for prevention intervention timing, tobacco product focus, content, and the adolescent subgroups to target.

Adolescent depression symptoms and e-cigarette progression

BACKGROUND

Depression symptoms are associated with the initiation of cigarette smoking and progression to regular use. Whether similar relationships exist between depression symptoms and adolescent e-cigarette progression has not been firmly established.

METHODS

This prospective longitudinal survey study measured the relationship between depression symptoms and e-cigarette use among 1822 adolescents from four public high schools outside of Philadelphia, PA. Adolescents completed in-classroom surveys at wave 1 (fall 2016, 9th grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). E-cigarette use, depression symptoms, and potential covariates were measured at each wave. A latent growth curve model was used to assess the longitudinal relationship between e-cigarette use and depression symptoms.

RESULTS

Baseline depressive symptoms had a significant effect on e-cigarette use trend (b = 0.01, z = 4.29, p < 0.0001) while holding other variables constant. A standard deviation increase in depressive symptoms at baseline was associated with a 0.25 standard deviation increase in the rate of e-cigarette progression across the following 36 months. By contrast, the path from baseline e-cigarette use to depressive symptoms trend was not significant (p = 0.74).

CONCLUSIONS

The present study provides new evidence for the effects of depression symptoms on adolescent e-cigarette progression. Greater depressive symptoms at age 14 years old were associated with a faster rate of e-cigarette escalation. However, e-cigarette use was not related to the development of depression symptoms over time. It will be important to examine whether adolescents with elevated depression symptoms respond similarly to e-cigarette prevention campaigns as adolescents in general.