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Positive attitudes toward e-cigarettes from friends and family were associated with their use among teens, according a small survey of Southern California high school students.
In the survey of more than 2,000 students, there was a greater risk of vaping by teens associated with a greater number of their friends using e-cigarettes, and a more favorable reaction to e-cigarettes by their best friends (P<0.05), reported Jessica L. Barrington-Trimis, PhD, of the University of Southern California in Los Angeles, and colleagues.
Almost all (91%) of current e-cigarette users said they would receive a positive ("friendly") response to their e-cigarette use from their best friends compared to less than a third (31%) of never-users (adjusted OR 18.6, 95% CI 10.9-31.6), the researchers reported in Pediatrics.
These attitudes extended to the teenager's home life, as e-cigarette users were more than six times more likely to also have an e-cigarette user at home than never-users (34% versus 7.3%, OR 6.80, 95% CI 4.71-9.83).
Researchers surveyed 2,084 11th and 12th graders in the Southern California Children's Health study during spring 2014. Of the participants, 24% (n=499) had used an e-cigarette, including 9.6% (n=200) current e-cigarette users (last 30 days). There were 18.7% (n=390) who had smoked a standard cigarette, with 5.7% (n=119) describing themselves as current users.
Demographically, the sample was comprised of a large portion of Hispanic adolescents (51.7% Hispanic, 35.1% non-Hispanic white, and 13.2% other). Notably, psychosocial factors were more strongly associated with non-Hispanic youth than among Hispanic youth, the authors wrote.
Social acceptance appeared to be more important for e-cigarette users compared with cigarette users.
Although nearly half (49.5%) of e-cigarette users said they had three or four best friends who also used e-cigarettes, only a little over a quarter (27.7%) of cigarette users said they had the same number of friends who also used cigarettes (P<0.001 difference). A "very friendly" response from friends was associated with 37 times the odds of current e-cigarette use (95% CI 20.9-65.5) compared with nine times the odds of current cigarette use (CI 5.29-16.7).
New User Group
Among current e-cigarette users, 40.5% said they had never smoked a cigarette. Barrington-Trimis said she was surprised by this result. She told MedPage Today via e-mail that part of the motivation for the research was to better understand whether kids using e-cigarettes were the same ones who were smoking or who had previously used cigarettes, as well as whether social environment was a determining factor in the use of the product.
"There is concern by the public health community that e-cigarettes may be recruiting a whole new group of users, independent of those who were smoking cigarettes, and our data support this," said Barrington-Trimis. "Ongoing research is needed to better understand the implications of high rates of e-cigarette use; such research can also be used to develop public health messages."
A vast majority of participants agreed that cigarettes and e-cigarettes are bad for health (98.6% and 86.0%, respectively). Friedman said these results were "promising" because although e-cigarettes are less damaging to the cardiorespiratory system than cigarettes, that does not mean they are safe.
"There have been studies that demonstrated that inhaling particles from e-cigarettes results in inflammation in the lungs and impairment in immune system function," she said.
Not surprisingly, nearly half of e-cigarette users were likely to disagree vaping is bad for health, compared with 7.5% of never users (OR 23.5, 95% CI 15.3-36.1).
Limitations to the study include the cross-sectional nature of the data and the fact that cigarette and e-cigarette psychosocial variables were strongly correlated. The authors noted e-cigarette and cigarette social environment variables showed considerable multicollinearity. They also cited the lack of information on different types of e-cigarettes or nicotine dose of the e-cigarette used.
Barrington-Trimis said that she would like to see more long-term studies done on any potential health risks associated with e-cigarettes.
"In addition, continued research into factors that lead to e-cigarette use, as well as studies examining the individual and population-level implications of high rates of e-cigarette use in adolescent populations are needed," she concluded.
Joy Friedman, MD, section head of adolescent pediatrics at Beaumont Health System in Royal Oak, Mich., said these results suggest e-cigarettes may be more socially acceptable to teenagers compared with the response she has received from her patients about traditional cigarettes.
"When I discuss cigarette smoking with teens, they often report that they think cigarettes are 'disgusting' due to the immediate effects: foul smell, stained teeth, bad breath," she told MedPage Today in an e-mail.
Friedman, who was not involved in the study, added that "health educators need to continue to promote the message that e-cigarettes are not entirely safe, and smoking these can lead to nicotine dependence, especially in teenagers as their brains are still developing."
This study was supported by the National Cancer Institute, the FDA's Center for Tobacco Products, and the NIH.
Barrington-Trimis and co-authors disclosed no relevant relationships with industry.
- Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner