Risky behaviors, e-cigarette use and susceptibility of use among college students
Introduction
Since 2007, electronic cigarettes (e-cigarettes) have gained popularity in the U.S. In April 2014, the Food and Drug Administration (FDA) proposed regulations restricting e-cigarette sales to minors. One public health concern is that e-cigarettes may be a “gateway,” leading e-cigarette users to begin smoking (Cobb and Abrams, 2011). E-cigarettes are often believed by users to be less harmful than cigarettes (Choi and Forster, 2013, Pearson et al., 2012). A recent review supports beliefs about reduced harmfulness, concluding “Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to e-cigarettes as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use” (Hajek et al., 2014). Perceptions of e-cigarettes as less harmful than cigarettes may be associated with use of e-cigarettes. Perceived harmfulness of marijuana is strongly associated with marijuana use (Bachman et al., 1998, Bailey et al., 1992). Existing studies offer mixed results on associations between e-cigarette harm perceptions and use (Adkison et al., 2013, Choi and Forster, 2013, Sutfin et al., 2013).
Prevalence of e-cigarette ever use is highest among young adults (Adkison et al., 2013, Pearson et al., 2012, Regan et al., 2013). Young adults are more aware and have higher rates of use than older groups (Choi and Forster, 2013, Pearson et al., 2012, Pepper et al., 2013, Sutfin et al., 2013, Trumbo and Harper, 2013). Trumbo et al. surveyed students at a Colorado university in 2011: 13.0% had ever used e-cigarettes (Trumbo and Harper, 2013). Sutfin et al. surveyed undergraduates in North Carolina colleges in 2009 (in early years of e-cigarette marketing), reporting prevalence of 4.9%; those who were smokers, male, Hispanic, “other race,” or in Greek organizations (sorority/fraternity), or with lower harm perceptions of e-cigarettes were likelier to use e-cigarettes (Sutfin et al., 2013). Latimer et al. surveyed urban public universities in Texas during 2011 and reported 3.1% used e-cigarettes during the previous 30-days (Latimer et al., 2013). In 2014, e-cigarette prevalence rates among middle and high school students were 6.5% (ever use) and 2.0% (current use; Dutra and Glantz, 2014).
The present study measured prevalence and correlates of e-cigarette use among college students attending four colleges/universities in Upstate New York in 2013. Given concerns about e-cigarette use in never smokers of cigarettes, analyses explored correlates of e-cigarette use in never smokers. We examined factors that could lead young adults to try e-cigarettes. Among never e-cigarette users, we assessed correlates of “susceptibility” to future e-cigarette use adapting measures Pierce (Pierce et al., 1996, Pierce et al., 2005, Pierce et al., 1995) employed to examine ‘susceptibility to cigarette smoking’ which predicted never smokers who later become cigarette smokers (Pierce et al., 1996, Zhu et al., 2013).
Section snippets
Sample
Undergraduate students in selected classes (e.g., psychology/health behavior-related courses) at four colleges/universities in New York State (NYS; outside of New York City) participated in fall, 2013, providing informed consent for this IRB-approved research.
Survey instrument
Our 111-item, self-administered, web-based survey, used items from published studies on e-cigarettes, assessed awareness, ever and current use (i.e., within the past 30-days). Skip patterns determined items completed. We collected
Results
Respondents included 1437 students (18–23 years) from four colleges/universities. See Table 1. There are differences between colleges/universities for age, gender, race/ethnicity (p < 0.001) and cigarette smoking status (p = 0.001). Overall, 95.5% of respondents report awareness of e-cigarettes; 29.9% are ever users and 14.9% are current users of e-cigarettes, with 6.4% reporting concurrent use of both e-cigarettes and tobacco cigarettes.
Role of funding source
Nothing declared
Contributors
All authors contributed to the completion of this manuscript.
Conflict of interest
Other than Dr. Mahoney, the other co-authors have no financial interest in this study and no conflicts of interests to disclose. Dr. Mahoney has previously served as a consultant to Pfizer regarding Chantix® and the topic of smoking cessation, has received peer-reviewed research funding from Pfizer's Global Research Award for Nicotine Dependence (GRAND), has conducted smoking cessation clinical trials, and has served as a paid expert witness in litigation against the tobacco industry; he also
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