Young adults use electronic nicotine delivery systems (ENDS) like vapes at higher rates than any other age group. Reasons for this may range from general factors, including curiosity and the availability of different flavors, to more individual-specific factors such as having tried to quit smoking or the belief that ENDS are safer than traditional cigarettes. This week, ASHES reviews a study by Max A. Halvorson and colleagues that examined the relationship between young adults’ reasoning for using ENDS and subsequent ENDS and cigarette use over time.
What was the research question?
Among young adults, how do reasons for trying ENDS relate to smoking history and ENDS/cigarette use over time?
What did the researchers do?
The researchers looked at data from the longitudinal Community Youth Development Study. The survey assessed cigarette use history between the ages of 12 and 23, reasons for trying ENDS at age 23 (i.e., curiosity, variety of flavors, to quit cigarettes, and perceived safety compared to cigarettes), and past-year ENDS/cigarette use at age 26. Drawing on data from 977 individuals who reported past-year ENDS use at age 23, the researchers used logistic regression analysis to determine whether reasons for ENDS use at age 23 was associated with ENDS/cigarette use at age 26.
What did they find?
Participants’ reasons for trying ENDS were associated with smoking history and subsequent ENDS/cigarette use. More specifically, participants who tried ENDS for cigarette cessation and their perceived safety were more likely to be current or former smokers at age 23 and be cigarette and ENDS smokers by age 26. Trying ENDS for their variety of flavors was not associated with past smoking status or cigarette use at age 26 but was associated with ENDS use at age 26. Conversely, participants who tried ENDS out of curiosity were less likely to have smoked in the past and were also less likely to be ENDS or cigarette smokers by age 26. (see Figure).
Figure. Odds ratios for reasons for initiating ENDS use and subsequent ENDS and cigarette use at age 26. Click image to enlarge. All findings were statistically significant except the effect of variety of flavors on cigarette use at age 26.
Why do the findings matter?
There is discourse among the research community as to whether ENDS is a safer alternative to cigarettes and can aid in smoking cessation. This study’s findings suggest that using ENDS for these reasons might increase one’s addiction severity, as those who used ENDS in their youth were at higher risk for future ENDS/cigarette smoking. This reinforces the notion that using ENDS to quit smoking might not be effective, but it could be more successful if it is coupled with behavioral treatment or pharmacotherapy. Whereas, individuals who tried ENDS out of curiosity or for their flavors might benefit more from psychoeducation on their beliefs about ENDS and the harms of nicotine use.
Every study has limitations. What are the limitations in this study?
The observational design of the study impacts our ability to determine causality between reasons for ENDS use and future ENDS/cigarette use. Additionally, the study was limited to four reasons for ENDS use. It is likely that ENDS products and policies will evolve over time, eliciting new reasons for ENDS initiation and continued use. Future research should consider additional reasons in their study design.
For more information:
SmokeFree offers tools and tips for quitting and maintaining abstinence from smoking tobacco. The Centers for Disease Control and Prevention also provides research and tips about cigarettes and how to quit. For additional self-help tools, please visit the BASIS Addiction Resources page.
— Nakita Sconsoni, MSW
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