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Associations between public e-cigarette use and tobacco-related social norms among youth
  1. Israel Terungwa Agaku1,
  2. Siobhan N Perks2,3,
  3. Satomi Odani1,
  4. Rebecca Glover-Kudon1
  1. 1 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2 Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
  3. 3 Rollins School of Public Health, Emory University, Atlanta, GA, United States
  1. Correspondence to Dr Israel Terungwa Agaku, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; iagaku{at}


Importance E-cigarette use in public places may renormalise tobacco use.

Objective To measure associations between e-cigarette use in public places and social norms among youth.

Design Cross-sectional survey.

Setting School-based.

Participants 24 353 never tobacco users in US 6th–12th grades who completed the 2016–2017 National Youth Tobacco Surveys.

Exposure Individuals were classified as exposed in public places within the past 30 days to: (1) neither e-cigarette secondhand aerosol (SHA) nor combustible tobacco secondhand smoke (SHS); (2) SHA only; (3) SHS only; and (4) both SHA and SHS.

Outcomes Outcomes were overestimation of peer e-cigarette use (a measure of descriptive norms), harm perception and susceptibility. Data were analysed using descriptive statistics and logistic regression (p<0.05).

Results Overall prevalence of SHS and SHA exposure in public places was 46.6% and 18.3%, respectively. SHA exposure in public places was associated with increased odds of overestimating peer e-cigarette use (adjusted OR (AOR): 1.83; 95% CI 1.29 to 2.58) and decreased odds of perceiving e-cigarettes as harmful (AOR: 0.63; 95% CI 0.51 to 0.79), compared with those exposed to neither emission. SHA exposure in public places was also associated with increased susceptibility to using e-cigarettes (AOR: 2.26; 95% CI 1.82 to 2.81) and cigarettes (AOR: 1.51; 95% CI 1.20 to 1.90). E-cigarette harm perception was lower among students in jurisdictions with no comprehensive clean indoor air laws (AOR: 0.79; 95% CI 0.71 to 0.88) or cigarette-only laws (AOR: 0.88; 95% CI 0.78 to 0.99) than in those prohibiting both cigarette and e-cigarette use in public places.

Conclusions Prohibiting both e-cigarette and cigarette use in public places could benefit public health.

  • e-cigarettes
  • social norms
  • youth
  • smoke-free policies
  • tobacco control

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  • Contributors ITA conceptualised and designed the study and drafted the initial manuscript. SO and SNP helped conceptualise the study, assisted in the statistical analyses and critically reviewed and revised the manuscript. RGK helped conceptualise the study and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open-access repository.