Understanding the association between susceptibility to smoke e-cigarettes and the actual use of e-cigarette among school-going youths in rural appalachia

Background: The Central Appalachian region of the United States is disproportionately burdened with high prevalence of tobacco use and tobacco-induced diseases. Efforts to address tobacco use in the region have become complicated with uptake of Electronic Nicotine Products (ENPs), including e-cigarettes, among adolescents and young adults. The high prevalence of tobacco use, and the history of tobacco production have created a high-risk environment for the use of tobacco and ENP among adolescents in the region. However, research on how susceptibility to use e-cigarettes among school-going adolescents translates to usage is sparse. This study aimed to explore the association between susceptibility to use e-cigarette and e-cigarette use in school-going adolescents in Appalachian Tennessee.

Methods: Data (N=399) was collected from high school students in an Appalachian Regional Commission (ARC)-designated distressed County in Appalachian Tennessee. We ascertain the study’s outcomes (current e-cigarette use), the exposure (susceptibility to use e-cigarette) and co-variates (grade, sex, age at first use of tobacco, perception of the danger of smoking, parental counseling) using validated questions. Descriptive statistics and multi-variable logistics analyses were performed. The Odds Ratios (ORs) along with Confidence Intervals (CI) have been reported.

Results: 15.5% of the population were current e-cigarette users and 25.93% were identified as susceptible to use e-cigarettes. Susceptibility to use e–cigarette was associated with increased odds of the current use of e-cigarette (OR=6.40, CI=4.18–9.77). In addition, age at first use of tobacco (OR = 0.42, 95%CI =0.32 – 0.56) was associated with reduced odds of the current use of e-cigarette, while intention to smoke e-cigarette (OR =6.46, CI =3.63 -11.49) was associated with increased odds of the current use of e-cigarette.

Conclusion: Susceptibility to use e-cigarette was positively associated with the current use of e-cigarette among school going adolescents. Future longitudinal studies with large sample size are warranted to confirm the association.