Anti-Vape attitudes are associated with lower rates of ENDS use and intentions among youth and young adults.

Theoretical Background and research questions/hypothesis:

Many public-health mass-media campaigns utilize theories of behavior change by changing the attitudes that are causally related to a e behavior. Before we can address the growing use of E-cigarettes and Vapes (Electronic Nicotine Delivery Systems: ENDS) among youth and young adults we first must determine which attitudes and beliefs are associated with ENDS use and intentions to use. Our primary research question is: Are anti-vape attitudes associated with ENDS and tobacco use and intentions?

Methods:

We conducted a cross-sectional, national survey of youth and young adults, ages 15-24 (n=3,039) between May and December 2018.

We assessed the degree to which respondents agreed or disagreed with a series of knowledge, attitude and belief statements about ENDS. These statements had been identified as important metrics based on the strength of the attitude-intention correlation, the proportion of the target population not yet endorsing this attitude, and the degree to which these items form reliable and intuitive factors (Hornick and Woolf, 1999). Statements were presented with the stems: “Vapes / E-cigarettes including JUUL…” or “Vaping / Using E-cigarettes including JUUL …”. Responses to 63 attitude statements were subjected to EFA which narrowed them down to 11 statements comprising 3 factors: Harms Knowledge (e.g. “… contain dangerous chemicals “), Un-Appeal (e.g. “… look silly or childish“), and Social Unacceptability of ENDS (e.g. “…is not OK for people my age“). Together these subscales form an “Anti-Vape Scale”, such that greater scores represent greater knowledge about and more negative attitudes toward ENDS.

Separate logistic-regression models examined relationships between each subscale and tobacco use (current/noncurrent) and intentions (some intention/no intention) adjusted for age, gender, race/ethnicity, and perceived financial situation.

Results:

The Anti-Vape Scale consists of 11 items (a=0.82), the Harms Knowledge subscale consists of 4 items (a=0.58), the un-Appeal subscale consists of 3 items (a=0.62), and the Social Unacceptability subscale consists of 4 items (a=0.67).

Scores on the Anti-Vape Scale as well as each subscale independently, significantly predicted current use of ENDS (all aOR<0.50, p<.001). Scores on the Anti-Vape-Scale and each subscale also predicted current use of cigarettes (all aOR<0.50, all p<.001) and cigars (all aOR< 0.57, all p<.001).

Similarly, scores on the Anti-Vape scale, and each subscale, significantly predicted intention to use ENDS in the next year (all aOR<0.38, all p<.001). Anti-Vape scale and each subscale scores also predicted intentions to use cigarettes (all aOR<0.53, all p<.001) and cigars (all aOR< 0.49, all p<.001).

Conclusions:

Greater anti-vape attitudes are associated with significantly lower rates of current use of ENDS and significantly less intention to use ENDS in the next year.

Implications for research and/or practice:

We expect that mass-media campaigns that focus on increasing knowledge about the harms, increasing the perceptions of social unacceptability, and decreasing the appeal of ENDS will shift young people’s intentions to use ENDS and, with time, will decrease the rate of current ENDS use among young people. Future, longitudinal research is necessary to validate causal impact of public health messaging on ENDS use by young people.