Adolescents' attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation

Abstract

E-cigarette use has dramatically increased. While studies have examined adolescents’ attitudes towards smoking, few have extended this research to adolescents’ attitudes towards e-cigarettes. The goal of this study was to examine adolescents' attitudes regarding e-cigarette ingredients, safety, addictive properties, social norms, accessibility, price, and regulation; and determine whether attitudes differ by past cigarette/e-cigarette use. Participants were 786 9th and 12th graders from California (63.21% females; mean age = 16.10 years [SD = 1.6]; 26.61% White, 21.98% Asian/Pacific Islander, 29.82% Hispanic, and 21.59% other). Results indicated that 19.05% of participants believed smoke from e-cigarettes is water; 23.03% believed e-cigarettes aren't a tobacco product; 40.36% considered e-cigarettes to be for cessation, and 43.13% felt they were safer than cigarettes. Participants felt it was more acceptable to use e-cigarettes indoors and outdoors compared to cigarettes (p < .0001), 23.13% felt raising e-cigarette taxes is a bad idea, 63.95% thought e-cigarettes were easier to get than cigarettes, 54.42% felt e-cigarettes cost too much, 64.33% felt the age for buying e-cigarettes should be raised, and 64.37% favored e-cigarette regulation. Adolescents who used e-cigarettes and/or cigarettes had significantly more favorable e-cigarette attitudes than non-users. This study indicates that adolescents are aware of some of the risks of e-cigarettes, although many harbor misperceptions and hold more favorable attitudes towards e-cigarettes than cigarettes. Of concern is the relationship between favorable e-cigarette attitudes and use. Findings suggest the need to provide adolescents with correct information about e-cigarette ingredients, risks, and the insufficient evidence of their role in cigarette cessation.

Bidirectional associations of e-cigarette, conventional cigarette and waterpipe experimentation among adolescents: A cross-lagged model

“…Evidence-based interventions to prevent youth tobacco smoking should pay more attention to waterpipe use prevention and start incorporating e-cigarette and vaporizer use prevention (Lopez et al, 2017; U.S.DHHS, 2016). School-based tobacco interventions should be expanded with messages targeting e-cigarette and waterpipe prevention, specifically educating youth about the adverse health effects of vaping substances from e-cigarettes including nicotine as an addictive substance, flavoring chemicals and other toxicants (Gorukanti et al, 2017; Miech et al, 2017; Pepper et al, 2016). …”

Measuring perceptions related to e-cigarettes: Important principles and next steps to enhance study validity

“…Consumers have different reasons for using, and varied expectations regarding the perceived benefits and risks of e-cigarettes in general, by product type, and in comparison to conventional cigarettes (Ambrose et al, 2014; Brose et al, 2015; Chaffee et al, 2015; Cooper et al, 2016; Gorukanti et al, 2016; Roditis, Delucchi, et al, 2016). Therefore, researchers should not simply substitute “e-cigarette” or “vaping” into existing cigarette perception measures.…”

“…As with all measurements of social norms, contextualizing the question is important for ensuring valid answers. For example, users may not disapprove of using e-cigarettes outdoors but may be less accepting of using them indoors (Gorukanti et al, 2016), in part because of widespread smoke- free policies and some evidence that secondhand aerosol from e-cigarettes exposes non-users to nicotine and other toxicants (Glasser et al, 2016; HHS, 2016). As with all e-cigarette perception measurements, responses may vary by product type, whether or not the product contains nicotine or flavors, and how frequently people are using it.…”

“…Cross-sectional studies of youth find that favorable e-cigarette perceptions (e.g., they are “not addictive” or users “look cool”) are associated with youth e-cigarette use (Ambrose et al, 2014; Chaffee et al, 2015; Cooper et al, 2016; Gorukanti, Delucchi, Ling, Fisher-Travis, & Halpern-Felsher, 2016) and intentions (Chaffee et al, 2015). Among youth, favorable perceptions of e-cigarettes are particularly concerning because nicotine may affect adolescent brain development (Dwyer et al, 2009; England et al, 2015; U.S.…”

A call to end the epidemic of adolescent E-cigarette use

“…Moreover, adolescents perceive e-cigarettes to have the lowest harm relative to all other tobacco products (Roditis et al, 2016). Adolescents also hold many misperceptions about e-cigarettes, such as believing e-cigarette vapor is water and that e-cigarettes are not a tobacco product (Gorukanti et al, 2017). Thus, the general perception that e-cigarettes are safe may also promote use among adolescents.…”