Melissa Abadi, Ph.D., firstname.lastname@example.org
Sharon Lipperman-Kreda, Ph.D., email@example.com
Joel W. Grube, Ph.D., firstname.lastname@example.org
Kirsten Thompson, M.A., kthompson@PIRE.org
Background: A Social Ecological perspective posits that substance use is a result of the interaction among risk factors at the individual, interpersonal, community, and societal levels. We examined associations between socio-ecological factors and single use and dual use of e-cigarettes and tobacco cigarettes among rural youth.
Methods: A cross-sectional survey was administered to 941 middle- and high-school students ages 11-18 in south central rural Tennessee. Students were asked about demographics, tobacco and nicotine marketing exposure, perceived access of e-cigarettes and tobacco, perceived risk of e-cigarettes and tobacco, perceived parent and peer disapproval of e-cigarettes and tobacco, and perceived past year e-cigarette and tobacco use by parents and peers.
Key Results: Past month prevalence was 8.4% for e-cigarettes only use, 2.9% for tobacco cigarettes only use, and 8% for dual use. Perceived access to e-cigarettes was significantly associated with past-month e-cigarette use only and dual use, as well as intentions for e-cigarette only use and dual use. Peer e-cigarette use was significantly associated with past-month tobacco cigarette use and intentions to use tobacco cigarettes. Peer tobacco cigarette use was significantly associated with past-month tobacco cigarette use and dual use, as well as intentions for tobacco cigarette use and dual use. Exposure to tobacco and nicotine ads was associated with all three use categories, as well as intentions for e-cigarette only use and dual use.
Conclusions: Socio-ecological factors may be uniquely associated with single and dual use of tobacco and nicotine. Notably, however, exposure to nicotine or tobacco advertising was positively associated with all three use categories. Results enhance our understanding of the knowledge, attitudes, and behaviors related to tobacco use, and the influence of marketing on single use and dual use of tobacco products. Policy efforts should uniquely address risk factors for each behavior, but target tobacco advertising in general.
Funding: National Institute on Drug Abuse Research (NIDA), grant number 1R03DA041899-01A1. The content provided here is solely the responsibility of the authors and does not necessarily reflect the opinions of NIDA.
Topic: Public Health
Our understanding of the risk factors associated with e-cig use and dual use of e-cigs and tobacco is limited. This study contributes to public health and tobacco control policy by identifying specific contextual factors to be targeted in prevention and policy efforts.
Key Words: rural; youth; e-cigarette; tobacco; dual use; public health; survey research