Kirsten Thompson, M.A., kthompson@PIRE.org
Melissa Abadi, Ph.D., firstname.lastname@example.org
Stephen Shamblen, Ph.D., sshamblen@PIRE.org
Joel Grube, Ph.D., email@example.com
Sharon Lipperman-Kreda, Ph.D., firstname.lastname@example.org
Camila Aramburu, M.P.H., caramburu@PIRE.org
To help inform policy and prevention, we used ecological momentary assessment (EMA) to examine daily context, characteristics, motivations, and patterns of e-cig use among 50 adolescent vapers, ages 14 to 17, in Kentucky. An initial survey assessed demographics and e-cig use and perceptions while daily surveys over two weeks (700 observations) obtained real-time data on e-cig use, motivations, and environmental context.
Overall, 64% vaped nicotine before the age of 15, 90% reported it was easy to obtain nicotine e-liquid, 33% reported past month dual-use with tobacco cigarettes, and 22% reported dual-use with cigars. Over the two-week EMA, adolescents exclusively used e-cigs on 44% of days, dual-used with tobacco cigarettes on 9% of days, and concurrently-used (any tobacco product use within two hours of vaping) on 12% of days. On average, youth vaped nicotine 7 times per day with 6 puffs per occasion. The highest e-cig use occurred on a Saturday with an average of 11.4 occasions (consisting of an average 82 total puffs). The lowest e-cig use occurred on a Monday with an average of 4.4 occasions (consisting of an average 28 total puffs).
Adolescents typically vaped with their own device (55% of occasions); vaped high nicotine content (18mg or higher; 46%); vaped with flavors (86%); vaped socially (70%); and vaped in their home (48%). The most common reasons for vaping included: feels good (83% of occasions), like the flavors (75%), tobacco is prohibited (61%), boredom (59%), and like doing vape tricks (48%).
On 47% of days, adolescents reported intentions to vape the next day. We used multi-level models with daily observations nested within individuals to examine use patterns. Results showed e-cig use had a linear trend, with use highest on weekends. Use then dropped significantly early in the week, rose mid-week, and peaked on Saturdays.
In order to inform FDA policy, it is critical to better understand adolescent risk associated with e-cig use, including the use and uptake of combustible tobacco. A profile of adolescent low- and high- risk vapers would greatly inform prevention, policy, and intervention, but must include daily measures to accurately capture use and contextual and individual risk factors at the individual, interpersonal, and community levels. Results of this study help inform FDA priorities by investigating e-cig use patterns and context among adolescents, a critically important population when considering public health impact and FDA regulation.