Purpose
There is a dearth of research into whether ENDS promote acceptance of cigarette smoking. Therefore, we aimed to assess the association between ENDS exposure, acceptance of cigarette smoking, and susceptibility to cigarette smoking.
Methods
Data from the 2014 Florida Youth Tobacco Survey with a state-representative sample of middle and high school students (n=68928) were analyzed. Own ENDS use, exposure to ENDS advertising, and living with ENDS users, acceptance of adult cigarette smoking, demographics and known predictors of cigarette smoking were assessed. Susceptibility to cigarette smoking was assessed among never smokers. Weighted multiple logistic regression models and mediation analyses were conducted, stratifying by middle/high school and never/ever smoking. Analyses were conducted in 2016.
Results
Own ENDS use, exposure to ENDS advertising, and living with ENDS users were associated with acceptance of adult cigarette smoking even among never smokers, after accounting for covariates (p<0.05). In a mediation analysis, own ENDS use, exposure to ENDS advertising, and living with ENDS users were indirectly associated with susceptibility to cigarette smoking among never smokers through acceptance of adult cigarette smoking (p<0.05).
Conclusions
Youth ENDS exposure may contribute to normalizing adult smoking, and may in turn heighten susceptibility to cigarette smoking. If confirmed by longitudinal studies, these findings suggest that ENDS policy interventions may help prevent youth cigarette smoking.