Melissa H. Abadi, Ph.D., mabadi@pire.org
Stephen R. Shamblen, Ph.D., sshamblen@PIRE.org
Kirsten Thompson, M.A., kthompson@PIRE.org
Joel W. Grube, Ph.D., grube@prev.org
Sharon Lipperman-Kreda, Ph.D., skreda@prev.org
Camila Aramburu, M.P.H., caramburu@PIRE.org
Background: Adolescents’ e-cigarette use increases risk of tobacco cigarette use. Dual use is particularly concerning given increased risk of addiction. An environment favorable to e-cigarettes creates use normalization, which may cultivate a re-normalization of tobacco use.
Methods: We conducted an initial survey and daily EMA surveys over two weeks to examine patterns of use and between- and within-persons contextual predictors of exclusive and dual-use among 50 adolescent (ages 14-17) e-cigarette users.
Results: Participants reported non-use on 38% of days, exclusive e-cigarette use on 44%, exclusive tobacco use on 8%, and dual use on 9%. Analyses comprised mixed effects random intercept regressions and random intercept generalized linear models. Vaping-only days were predicted by exposure to peers vaping, higher prior day vaping intentions, and lower prior day tobacco smoking intentions. Tobacco-use-only days were predicted by no exposure to peers vaping. Dual-use days were predicted by lower negative e-cigarette expectancies, parental norms favorable to e-cigarette use, exposure to adults and peers vaping, exposure to e-cigarette advertising, and greater prior day tobacco intentions. Next day intentions-to-vape were predicted by parental and peer norms favorable to e-cigarette use, higher perceived peer e-cigarette use, high nicotine strength (≥18 mg), vaping own device, vaping alone, vaping at home, vaping because “it feels good”, exposure to adults and peers vaping, exposure to e-cigarette warnings, and exposure to e-cigarette advertising. Next day intentions-to-use-tobacco were predicted by parental and peer norms favorable to e-cigarette use and exposure to less e-cigarette advertising.
Conclusions: Results suggest that preventive efforts should focus on countering the influence of normative approval of e-cigarettes, exposure to vaping by parents and peers, exposure to e-cigarette marketing, and effective e-cigarette warnings.
Statement of Relevance to CTP Regulatory Authorities: Through innovative methods and measures, the results of this study inform CTP’s understanding of contexts, beliefs, and behaviors that best predict adolescents’ exclusive and dual use of e-cigarettes and tobacco.
Funding: This research is supported by grant 1R03DA041899-01A1 from the National Institute on Drug Abuse Research (NIDA), grant 25IR-0029 from the California Tobacco-Related Disease Research Program (TRDRP) and grant P60-AA006282 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIDA, TRDRP, NIAAA or NIH.
Topic: Public Health
Key Words: adolescents; youth; e-cigarette; tobacco; dual use; EMA; public health
