Short communicationSelf-reported reasons for vaping among 8th, 10th, and 12th graders in the US: Nationally-representative results
Introduction
Adolescent use of electronic vaporizers to inhale nicotine and other aerosols is increasing at an alarming rate. From 2011 to 2014, the use of “electronic cigarettes or e-cigarettes”—a specific type of vaporizer—increased nine-fold among US high school students and six-fold among middle school students (Arrazola et al., 2015; Centers for Disease Control and Prevention (CDC), 2015). Among national samples of 8th and 10th graders, at least twice as many students reported using electronic vaporizers (such as e-cigarettes), compared to regular cigarettes (Miech et al., 2015a). The current study reports nationally representative data on adolescent reasons for vaping and differences across sociodemographic and tobacco-use subgroups.
Vaporizers deliver an inhalable aerosol that can contain flavors and/or nicotine, in addition to other chemicals (e.g., Behar et al., 2014, Goniewicz et al., 2014). This study intentionally uses the general term “vaporizers,” which casts a wide net including “e-cigarettes” and other newly available vaping devices. Over 450 e-cigarette brands and 7700 flavors exist today, marketed to youth much as cigarettes were before regulations (CDC, 2015, Zhu et al., 2014), with advertising dollars for vaping increasing almost 20-fold from 2011 to 2014 (CDC, 2016). Packaging labels and device settings do not precisely indicate the ingredients delivered, and “nicotine-free” e-liquids have been found to contain nicotine (Cameron et al., 2014, Goniewicz et al., 2014, Walton et al., 2014).
The rising use of vaporizers is of public health concern because of its potential negative impact on adolescent health. Use of nicotine in vaporizers can harm the developing adolescent brain (Breland et al., 2016), particularly affecting attention and learning. Nicotine also has a high potential for addiction (England et al., 2015, Kandel and Kandel, 2015). Recent studies show that adolescent use of e-cigarettes is associated with intention to use and actual use of regular cigarettes (Bunnell et al., 2015, Dutra and Glantz, 2014, Leventhal et al., 2015) and with progression to regular cigarette smoking (Primack et al., 2015), although additional research is needed. If vaporizer use leads to use of regular cigarettes then vaporizers may reverse the decades-long decline in adolescent smoking prevalence and its associated benefits for population health.
The potential public health impact of vaporizers has generated substantial interest in the reasons that adolescents self-report for using them. Knowing why adolescents use vaporizers is a first step toward identifying strategic approaches and policies to effectively counter and ideally reverse the rise in youth vaporizer use (e.g., Carroll Chapman and Wu, 2014, Kong et al., 2015, Lippert, 2015). In initial findings, quitting smoking does not appear to be a primary reason for vaporizer use among youth. Curiosity, flavors, and peer influences were identified as top reasons for e-cigarette use in seven middle schools, high schools, and colleges in Connecticut (Kong et al., 2015). Enjoyment was the primary reason for using e-cigarettes among undergraduates at four colleges in New York State (Saddleson et al., 2016). In a national study of teen flavored tobacco use, the primary reason for e-cigarette use was flavoring, followed closely by doing less harm than with cigarettes (Ambrose et al., 2015). These studies suggest that reasons for vaporizer use among youth differ substantially and warrant separate study from the reasons given by adults, who are more likely to report use of vaporizers in an attempt to quit smoking and improve personal health (e.g., Berg et al., 2014, Pepper et al., 2014, Soule et al., 2016).
The current study reports nationally representative data on adolescent reasons for vaping. Research aims were to examine: (1) the most common reasons for vaporizer use among US adolescents in 8th, 10th, and 12th grades; and (2) how reasons for use differ by grade, lifetime use of regular cigarettes, frequency of vaporizer use, gender, race/ethnicity, and parent education. Based on research to date, we expect reasons other than quitting smoking to predominate. National data on the reasons why adolescents use vaporizers will inform national policy on vaporizer use, and help build a cumulative scientific literature on the topic.
Section snippets
Sample
The Monitoring the Future (MTF) project conducts annual cross-sectional surveys of 8th, 10th, and 12th graders in the contiguous US (Miech et al., 2015b), administered to each grade in separate schools that participate for two consecutive years. The 2015 samples total 44,892 students in 382 public and private schools (Johnston et al., 2016). Students are randomly assigned to different questionnaires to increase coverage of MTF topics and reduce respondent burden; accordingly, one third of 8th
Results
The percentage of ever-users of vaporizers who reports the various reasons for vaporizer use is provided in Table 1. The most common reason for use was to experiment (53.0%), followed by taste (37.2%), boredom (23.5%), to have a good time (22.4%), and to relax (21.6%). Less common reasons were because it looks cool (13.7%) and to feel good or get high (8.3%). Reasons pertaining to regular cigarette use, including to quit regular cigarettes (7.3%) and because regular cigarette use is not
Discussion
Overall, results suggest that adolescent decisions to vape are based on curiosity, taste, and pleasure, which is somewhat consistent with the existing but limited research on adolescent experimentation with e-cigarettes (Ambrose et al., 2015, Kong et al., 2015). Vaping for taste and pleasure (e.g., boredom, to have a good time with friends, and to relax) may be similar to using e-cigarettes for enjoyment, a primary reason found among college students (Saddleson et al., 2016). Reasons associated
Conflict of interest
The authors declare no conflict of interest.
Role of funding source
This study was funded by the National Institute on Drug Abuse (R01 DA 001411). The content here is solely the responsibility of the authors and does not necessarily represent the official views of the sponsors.
Contributors
All authors are responsible for the reported research. M. Patrick conceptualized and designed the analysis. M. Patrick and C. Carlier drafted the initial manuscript. M. Patrick, R. Miech, P. O'Malley, L. Johnston, and J. Schulenberg were responsible for data collection. All authors critically reviewed the manuscript and approved the final manuscript as submitted.
Acknowledgement
The authors wish to thank Peter Freedman-Doan for conducting the data analyses.
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