Relationship between population characteristics, e-cigarette and tobacco-related perceptions, and likelihood of ever using e-cigarettes
Jack A. Pfeiffer 1, 2
Joy L. Hart 2, 3, 4  
Anshula Kesh 4
Allison Groom 4
Thanh-Huyen T. Vu 4, 5
Jennie Z. Ma 4, 6
Robyn Landry 4
Thomas J. Payne 4, 7
Aida L. Giachello 4, 8
Kandi L. Walker 2, 3, 4
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Department of Epidemiology, University of Louisville, Louisville, United States
Christina Lee Brown Envirome Institute, University of Louisville, Louisville, United States
Department of Communication, University of Louisville, Louisville, United States
American Heart Association, Tobacco Regulation and Addiction Center, Dallas, United States
Department of Preventative Medicine (Epidemiology), Feinberg School of Medicine, Northwestern University, Chicago, United States
Division of Biostatistics, University of Virginia, Charlottesville, United States
Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, United States
Department of Preventative Medicine (Public Health Practice), Feinberg School of Medicine, Northwestern University, Chicago, United States
Joy L. Hart   

Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, United States
Publication date: 2020-03-18
Submission date: 2019-11-10
Final revision date: 2020-01-25
Acceptance date: 2020-01-26
Tob. Prev. Cessation 2020;6(March):20
Electronic nicotine delivery systems (ENDS) are a relatively new type of nicotine-containing product that has risen greatly in use within the past decade, displacing conventional tobacco products as the dominant source of nicotine exposure by many groups. Among those impacted are large sections of US youth. Though health outcomes associated with ENDS use are still being assessed, several potential harms have been noted in the extant literature. The purpose of this study is to examine which US youth subpopulations are at greatest risk for ENDS ever use and how perceptions pertaining to nicotine-containing products relate to this risk.

A nationwide online survey was administered to US youth ENDS users and non-users aged 13–18 years. A total weighted sample of 2501 participants was obtained. Statistical analyses included binomial logistic regression and a likelihood ratio test.

Of these youth, 1346 (53.8%) reported having ever used an ENDS product. Those most likely to have used ENDS were White males in their late teens. Those who reported ever using a conventional tobacco product were much more likely to have reported ever using ENDS (AOR= 19.96; 95% CI: 15.30–26.05). A number of perceptions related to nicotine-containing products, including product safety and health effects, were significantly associated with an increased likelihood of ENDS use.

Certain sections of the US youth population have elevated odds of being ENDS ever users. As increasing evidence supports the need to combat ENDS use by youth, effectively targeted education and prevention campaigns will be necessary.

We extend our thanks to Shesh Rai for assistance with data analysis.
The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. All authors report grants from the National Institutes of Health and the Food and Drug Administration during the conduct of the study.
This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) and the Food and Drug Administration’s Center for Tobacco Products (CTP) under Award Numbers P50HL120163 and U54HL120163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the Food and Drug Administration, or the American Heart Association.
Not commissioned; externally peer reviewed.
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