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Youth and young adult risk perceptions and behaviours in response to an outbreak of e-cigarette/vaping-associated lung injury (EVALI) in the USA

Abstract

Objective To determine whether awareness of emerging vaping-attributable health conditions influences vaping-related risk perceptions and behaviours among young people.

Design Respondents aged 15–24 years (n=3536) were drawn from a repeated cross-sectional online panel survey (222 participants/week) during an e-cigarette/vaping-associated lung injury (EVALI) outbreak in the USA (September 2019–January 2020). Logistic regression models tested for associations between EVALI awareness and perceived lung injury risk and product harm, stratified by e-cigarette/vape use and controlling for awareness of other e-cigarette/vaping news stories, demographic characteristics and outbreak week. Other models measured the association between perceived risk of lung injury and intentions to use (non-users) or intentions to quit (current users) e-cigarettes/vape products. Changes in national retail e-cigarette sales data were examined during national EVALI outbreak reporting.

Results EVALI awareness was associated with: perceived risk of lung injury (current users OR 1.59, p=0.004; non-users OR 2.11, p<0.001); belief that e-cigarettes/vapes contain dangerous chemicals (current users OR 1.47, p=0.017; non-users OR 1.88, p<0.001) and belief that e-cigarettes/vapes are harmful (current users OR 1.66, p=0.002; non-users OR 1.67, p<0.001). Perceived risk of lung injury from e-cigarette/vape use was associated with intentions to own e-cigarette/vape products (ever-users OR 0.25, p<0.001; never-users OR 0.61, p=0.004) and intentions to quit among current users (OR 2.02, p=0.002). Declines in e-cigarette sales were observed following news of the EVALI outbreak.

Conclusions News of vaping-attributable health conditions may prevent e-cigarette/vape use and encourage cessation among young people. Tobacco control campaigns should address uncertain health effects of e-cigarettes or vape products and align with risk communication by public health agencies during outbreaks.

  • electronic nicotine delivery devices
  • priority/special populations
  • media

Data availability statement

Data are available on reasonable request. A data sharing agreement is required for use of all data. Investigators seeking access to data used in the study should make a written request to Truth Initiative authors and submit a detailed research plan including the purpose of the proposed research, required variables, duration of the analysis phase, IRB approval with FWA information, and investigator training in human subjects. Approved investigators may access datasets via an analytical Portal owned and administered by Truth Initiative.

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