Brief Report
Beliefs and Experimentation with Electronic Cigarettes: A Prospective Analysis Among Young Adults

https://doi.org/10.1016/j.amepre.2013.10.007Get rights and content

Background

Previous cross-sectional studies found that positive beliefs about electronic nicotine delivery systems (commonly known as electronic cigarettes or e-cigarettes) were associated with use of these products. However, the prospective association between these beliefs and subsequent use of e-cigarettes is unclear.

Purpose

To identify the beliefs predicting subsequent use of e-cigarettes.

Methods

A total of 1379 young adults (mean age=24.1 years) from the Minnesota Adolescent Community Cohort who reported never using e-cigarettes at baseline (collected Oct 2010–Mar 2011) and completed follow-up data collection (during Oct 2011–Mar 2012) were included in this analysis. Participants’ beliefs about e-cigarettes (potential as quit aids, harmfulness and addictiveness relative to cigarettes) were asked at baseline (yes/no). At follow-up, participants were asked if they had ever used e-cigarettes. Logistic regression models were used to assess the associations between beliefs about e-cigarettes and subsequent experimentation. Analysis was conducted in 2012.

Results

At follow-up, 7.4% of the sample reported ever using e-cigarettes (21.6% among baseline current smokers, 11.9% among baseline former smokers, and 2.9% among baseline nonsmokers). Participants who believed e-cigarettes can help people quit smoking and perceived e-cigarettes to be less harmful than cigarettes at baseline were more likely to report experimenting with e-cigarettes at follow-up (p<0.05). These associations did not differ by smoking status.

Conclusions

Given that young adults are still developing their tobacco use behaviors, informing them about the lack of evidence to support e-cigarettes as quit aids and the unknown health risk of e-cigarettes may deter young adults from trying these products.

Introduction

Tobacco use remains a prominent public health issue in the U.S.; 25.2% of all adults (aged ≥18 years) and 35.6% of young adults (aged 18–24 years) reported current tobacco use in 2010.1 Although the public health community is continuously working on reducing the prevalence of tobacco use in the nation, recent introduction of electronic cigarettes (e-cigarettes, also known as electronic nicotine delivery systems) in the U.S. may hamper this effort,2 with about 3% of U.S. adults (aged ≥18 years) and 7% of U.S. Midwest young adults (aged 20–28) ever using e-cigarettes.3, 4, 5 This is problematic because young adults are still developing their tobacco use behaviors,6, 7 and e-cigarettes may introduce young adults to tobacco use or promote dual use of cigarettes and smokeless tobacco products.

Although some studies found that smokers who used e-cigarettes reported that e-cigarettes were helpful in smoking cessation and had used e-cigarettes to quit smoking,8, 9, 10 other studies showed that ever using e-cigarette is not associated with intention to quit, quit attempt, and smoking cessation.3, 4, 10, 11, 12 Addictiveness and long-term harmfulness of e-cigarettes are also unknown. Nonetheless, some young adults already hold positive beliefs about the products. A study in a U.S. regional sample of young adults found that 44.5% of the participants who were aware of e-cigarettes believed e-cigarettes can help people quit smoking, 52.8% believed that e-cigarettes are less harmful than cigarettes, and 26.3% believed that e-cigarettes are less addictive than cigarettes.5 Young adults who held these beliefs were more likely than those who did not to have tried e-cigarettes.5 However, given the cross-sectional design of previous analysis, it s unclear whether these beliefs and perceptions precede or follow the experimentation with the products. The objective of the current analysis is therefore to assess the longitudinal associations between these beliefs and subsequent experimentation with e-cigarettes.

Section snippets

Study Population

Data are from the Minnesota Adolescent Community Cohort (MACC). The design of the study has been detailed elsewhere.13, 14 Briefly, participants in the MACC study were selected in 2000–2001 through cluster random sampling of household phone numbers. Sixty geopolitical units (GPUs) in Minnesota (out of 126) were randomly selected. Five GPUs from four comparison states (North and South Dakota, Michigan, and Kansas) were chosen because of their similarity to Minnesota. Modified random-digit

Results

Among all participants included in the analysis (n=1379), the average age was 24.1 years (SD=1.7); 48.4% of the sample was male, 90.3% was non-Hispanic white, 63.7% enrolled in or graduated from a 4-year college. Regarding smoking status at baseline, 17.8 were current smokers, 12.8% were former smokers, and 69.4% were nonsmokers. At 1-year follow-up, 7.4% (n=102) of the sample (who had never used e-cigarettes at baseline) reported ever using e-cigarettes: 21.6% (n=53) among baseline current

Discussion

E-cigarettes have received attention from the U.S. population since their introduction in 2007. The study showed that, among baseline nonsmokers, 2.9% of baseline nonsmokers in this U.S. regional sample of young adults reported ever using e-cigarettes at follow-up, suggesting an interest in e-cigarettes among nonsmoking young adults, a group that is still experimenting with tobacco.6 This study also suggested that about 12% of former young adult smokers at baseline were re-introduced to

Acknowledgments

This work was supported by the National Cancer Institute at the National Institutes of Health (R01 CA86191: Jean Forster, principal investigator).

No financial disclosures were reported by the authors of this paper.

References (18)

  • S.E. Adkison et al.

    Electronic nicotine delivery systems: international tobacco control four-country survey

    Am J Prev Med

    (2013)
  • B.A. King et al.

    Current tobacco use among adults in the U.S.: findings from the national adult tobacco survey

    Am J Public Health

    (2012)
  • N.K. Cobb et al.

    E-cigarette or drug-delivery device? Regulating novel nicotine products

    N Engl J Med

    (2011)
  • A.K. Regan et al.

    Electronic nicotine delivery systems: adult use and awareness of the “e-cigarette” in the USA

    Tob Control

    (2013)
  • J.L. Pearson et al.

    E-cigarette awareness, use, and harm perceptions in U.S. adults

    Am J Public Health

    (2012)
  • K. Choi et al.

    Characteristics associated with awareness, perceptions, and use of electronic nicotine delivery systems among young U.S. Midwestern adults

    Am J Public Health

    (2013)
  • Preventing tobacco use among youth and young adults: a report of the Surgeon General

    (2012)
  • P.M. Ling et al.

    Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents

    Am J Public Health

    (2002)
  • J.F. Etter

    Electronic cigarettes: a survey of users

    BMC Public Health

    (2010)
There are more references available in the full text version of this article.

Cited by (186)

  • Electronic cigarettes and fertility: True or false friends?

    2023, Gynecologie Obstetrique Fertilite et Senologie
View all citing articles on Scopus
View full text