Tobacco & Nicotine Products
DOES FLAVORED E-CIGARETTE USE INFLUENCE TEENS’ SUSCEPTIBILITY TO CIGARETTE SMOKING?
(School of Public Health (UMD) Behavioral and Community Health Doctoral Student)
Introduction The prevalence of flavored e-cigarette use among U.S. adolescents has increased tremendously. Concerns exist about whether flavored e-cigarette use influences perceptions and initiation of conventional cigarette use. This study aims to examine the association of flavored e-cigarette use with cigarette smoking susceptibility among adolescent nonsmokers. Methods Using data from the 2014 National Youth Tobacco Survey, this study considered among adolescent nonsmokers’ (ages 11-18 years) demographics, risk factors for cigarette smoking (e.g., tobacco ads exposure), and current e-cigarette use status (nonuse, plain and flavored e-cigarette use). Multivariate logistic regression was used to examine the relationship between current e-cigarette use and cigarette smoking susceptibility, adjusting for confounders and interactions were added to identify potential moderators. Results Among adolescent nonsmokers (n=18,392), 2.1% and 2.2% reported current use of plain and flavored e-cigarettes. Compared to 30.0% of nonusers, 61.1% and 74.1% of plain and flavored e-cigarette users reported smoking susceptibility (p< 0.0001). Flavored e- cigarette users were almost two times as likely to report smoking susceptibility than plain e-cigarette users (AOR=1.7, p< 0.0001), and almost four times as likely as nonusers (AOR=3.8, p< 0.0001). Among assessed risk factors for smoking, the association of flavored e-cigarette use with smoking susceptibility was the strongest, followed by cigarette experimentation and then plain e-cigarette use. Significant interactions between e-cigarette use and five risk factors indicated that while plain e-cigarette use only influences youth with low risk, flavored e-cigarette use affects those with both low and high risks of using cigarettes. Conclusions Adolescents’ flavored e-cigarette use is strongly associated with smoking susceptibility, a validated predictor of subsequent smoking behavior. Additionally, flavored e-cigarette use has a pervasive influence on smoking susceptibility among adolescents with various risk levels. Possible explanations for the association between e-cigarette use and smoking susceptibility include sensation seeking, duration of use, and perceived social norms towards smoking. Legislation efforts to restrict the number of youth-friendly flavors and limit Internet purchasing access should be enhanced.