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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
  1. Jennifer M Kreslake1,2,
  2. Megan C Diaz1,
  3. Muftau Shinaba1,3,
  4. Donna M Vallone1,2,4,
  5. Elizabeth C Hair1,2,4
  1. 1Schroeder Institute, Truth Initiative, Washington, DC, USA
  2. 2Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland, USA
  4. 4School of Global Public Health, New York University, New York, New York, USA
  1. Correspondence to Dr Jennifer M Kreslake, Schroeder Institute, Truth Initiative, Washington, DC 20001-5332, USA; jkreslake{at}


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

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  • Twitter @MeganCDiaz, @ehairphd

  • Contributors JMK conceptualised the study. JMK designed and led the analysis of the survey data and MCD designed and led the analysis of the e-cigarette sales data. MS prepared e-cigarette sales data for analysis. ECH and DV provided oversight of data collection and guidance on analysis and interpretation. JMK drafted the manuscript with written contributions by MCD and DV and edits by MS and ECH.

  • 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.

  • Ethics approval The study received approval from the Advarra Institutional Review Board.

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

  • 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.

  • Author note The conclusions drawn from the Nielsen data are those of the researcher(s) and do not reflect the views of Nielsen. Nielsen is not responsible for, had no role in, and was not involved in analyzing and preparing the results reported.

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