Youth Vaping Habits: An Analysis

Abstract

This study aimed to examine the relationship between e-cigarette use and knowledge of their adverse health effects in young adults aged 18-26. The study involved 129 participants who completed an anonymous Google survey. Participants were asked about their e-cigarette use and knowledge of the associated health risks. The survey distinguished participants into three groups: “never users,” “ever users,” and “current users.” It was hypothesized that never users would be the most educated on the negative health effects of vaping, while ever users would be less educated, and current users would be the least educated of all three groups. The results revealed that never users were overall the least knowledgeable about the harmful effects of e-cigarettes than current or ever users. Ever users were found to have the most knowledge on the subject, potentially due to their experience with e-cigarette use in the past. The findings suggest that education and awareness campaigns targeting young adults may be necessary to inform them of the potential risks of e-cigarette use.

Introduction

Following the release of the Surgeon General’s report on tobacco control in 1964, smoking rates in the United States witnessed a considerable decline. Prior to this report, tobacco companies marketed combustible cigarettes as a means of maintaining happiness and good health, particularly targeting impressionable youth who were unaware of the harmful effects of tobacco use. As scientific research emerged in the 1960s linking smoking to lung cancer and other diseases, the use of combustible cigarettes fell from 43% in 1965 to approximately 14% in 2017 (Wei et al., 2020, National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health, 2014).

Just as cigarettes were becoming less popular, a new nicotine delivery system took over the market: the electronic cigarette. Electronic cigarettes are battery-powered handheld devices that deliver nicotine through an aerosolized flavored liquid using an electric pulse. Electronic cigarettes are battery-operated handheld devices that deliver nicotine, an addictive chemical, through an aerosolized flavored liquid using an electric pulse. They were initially invented in China in 2000 as a tool to help adults quit smoking combustible cigarettes. In 2007, they were introduced to the U.S. and quickly became a popular product among teenagers, most of whom have never used combustible cigarettes (Trinidad et al., 2018). Over the past decade, e-cigarette products have significantly advanced, including disposable e-cigarettes as well as rechargeable and refillable devices with adjustable power settings. Pod-style devices also became popular, such as JUUL, first launched in 2015, becoming the most popular e-cigarette brand in the United States (O'Connor et al., 2022).

Unfortunately, the widespread use of e-cigarettes among adolescents has led to significant negative consequences. From 2017 to 2018, there was a 10% surge in e-cigarette use among teenagers, which translates to an additional 1.3 million adolescents who picked up the habit of vaping withing a single year (Farzal, 2019). As of 2020, approximately 20% of young adults in the United States have reported current use of e-cigarettes. By December 2018, youth e-cigarette use was declared a national epidemmic by the US Surgeon General, as the use of vaping devices among teens continues to rise dramatically. Today, adolescents and young adults constitute the largest group of e-cigarette consumers.

To make matters worse, big tobacco companies know their audience and deliberately advertise their products to teenagers (Jones & Salzman, 2020). For tobacco companies to stay in business, it is important that they maintain current smokers, as well as recruit new smokers to replace ones who either quit or die due to tobacco-related health issues. The industry depends on creating new and appealing products to maintain nicotine addictions and promote experimentation (Wayne et al., 2008). They use fun packaging and a wide variety of flavors as a marketing strategy to target adolescents and get them hooked on nicotine to profit from them. In doing this, big tobacco companies are able to secure a new generation of lifelong customers.

This targeted marketing of e-cigarettes is particularly harmful to teenagers, given that they are especially susceptible to addiction. The teenage brain is still developing, and nicotine can affect the way the brain processes reward, making it more difficult to quit. Research has shown that the use of nicotine and e-cigarettes during this critical period of brain development when habits and behaviors are formed can have lifelong health consequences. Nicotine addictions typically start in adolescence, and studies show that close to 90% of adult smokers picked up the habit before the age of 18 (Jones & Salzman, 2020). With the recent popularity of e-cigarettes, more teenagers are getting their hands on nicotine devices, and are developing addictions that persist into adulthood.

E-cigarettes are still relatively new and we still do not know the full extent of the potential health implications they can cause, but recent research has provided substantial evidence supporting the fact that e-cigarettes pose significant health risks to adolescents (Jones & Salzman, 2020, Chadi et al., 2019). Studies show that nicotine has been proven to have adverse effects on the developing brain such as cognitive deficits, impairment in memory and executive functioning, and increased impulsivity and hyperactivity when compared to non-users (Jones & Salzman, 2020). Despite the growing body of research on the harmful effects of vaping, the number of young adults using e-cigarettes continues to rise.

In addition to the fact that adolescents are highly impressionable, one of the main reasons behind the higher prevalence of smoking among young people is that they are not afraid of the consequences, yet. A study done by McLeish et al. (2022) found that young people underestimate the potential long-term health consequences of tobacco use, or feel invincible to such consequences, due to their youth and inexperience with medical issues. They see tobacco-related health problems as something they will not have to worry about until they are much older, or something they may not even have to worry about at all due to the rapid development of modern medicine. Additionally, they found that young adults are more optimistic about their ability to quit smoking before experiencing any adverse health effects. Unfortunately, this is rarely the case, as 99% of adult smokers first try smoking by age 26.

Although the research behind perceptions of e-cigarettes in young adults is still expanding, multiple themes have appeared, including the belief that e-cigarettes are harmless or even beneficial compared to combustible cigarettes, and that they can be equated with substances like caffeine. A study done by Cooper et al. (2016) found that a common idea amongst young adults was that e-cigarettes are a healthier alternative to combustible cigarettes, and that vaping is no worse than drinking coffee. While e-cigarettes do not contain the harmful tar and chemicals found in combustible cigarettes, they do contain nicotine, which is a highly dangerous and addictive chemical. It is important to note that e-cigarettes have not been shown to be a safe alternative to combustible cigarettes, and only appear to confer more significant health risks than initially understood, as well as contribute to increased rates of nicotine addiction. Comparing e-cigarettes to caffeine is also misleading, as caffeine does not have the same addictive properties as nicotine, and is not associated with the same range of health problems.

Given the lack of knowledge, common misconceptions, and mixed opinions of the adverse health effects of vaping, it is important to understand how young adults view e-cigarettes. Previous studies have investigated harm perceptions and reasons for use among e-cigarette users versus non-users, but have not examined differences in perception among current users and ever users. The current study aims to analyze people’s education on the effects of vaping and how it correlates to their current vaping habits. This is done by splitting up participants based on if they are current users, ever users, or never users of e-cigarettes, and asking questions about their e-cigarette use and knowledge of the health risks using a survey.

I hypothesize that young adults who are current users of e-cigarettes have a more positive view of e-cigarettes and are less likely to be educated on the health risks, young adults who have used e-cigarettes in the past but have now quit are more likely to be educated on health risks, and young adults who have never vaped are most likely to be educated on the health risks of e-cigarettes.

Methods

A total of 129 young adults between the ages of 18 and 26 were randomly selected to take part in the study. The participant’s mean age was 20.5 and the group consisted of 85 females (65.9%), 39 males (30.2%), and 5 nonbinary people (3.9%). The survey was taken on Google Surveys and was completely anonymous. The participants were only asked for their age and sex. The survey was only given to college-aged students because they are the age group that uses e-cigarettes the most, and are older than 18.

The survey was created on Google Surveys, and participants were recruited through an Instagram post, as well as several online survey sites. In the survey, participants were informed that their answers were confidential, and their anonymity was assured. It also confirmed that the participant’s decision to partake in the study was entirely voluntary, and they had the right to withdraw at any time. First, the survey asked for the participant’s age and sex, and second asked if they have ever used an e-cigarette.

The main section of the survey split into three separate questionnaires based on if the participant answered that they were “never users,” “ever users,” or “current users” of e-cigarettes. The “never users” group was asked why they have never used an e-cigarette, and if they are curious about using e-cigarettes. “Ever users” were asked how old they were when they first started vaping, and which nicotine products they have used. Additionally, they were asked to describe their past e-cigarette usage, why they used them, and what factors led them to quit. The “current users” group was asked how old they were when they started using e-cigarettes, and which nicotine products they have used. They were also asked about their current vaping habits, and why they use e-cigarettes.

All three groups were asked what they know about the consequences of e-cigarette use. The questions included Likert scales that asked how harmful the participant believes both e-cigarettes and combustible cigarettes are on a scale of 1 to 5. Next, the survey asked several yes/no questions asking about their knowledge about the negative side effects of vaping, such as lung cancer, cardiovascular disease, memory impairment, hyperactivity, and asthma.

Placing current and ever users into two separate categories allowed us to examine perceptions of e-cigarettes from people who had once used, but have since quit. It is likely that this group is more educated on the negative effects of vaping compared to current users, and is potentially linked to their reason for quitting. Studying peoples’ reasons for quitting e-cigarettes can also give valuable insight as to which factors and influences make people more likely to terminate their use.

The survey was designed to measure students’ knowledge on the adverse health effects of vaping to see if it correlates with their vaping habits. Data was analyzed to find differences between “never users,” “ever users,” and “current users'' in regard to e-cigarette use and education on e-cigarettes.

Results

Previous studies have looked at motives for e-cigarette use among adolescents, and have also analyzed youth perceptions of vaping health risks. The current study is interested in the potential relationship between vaping education and vaping status of adults. The following data represents the Google Survey responses of 129 young adults who were asked about their vaping habits and their knowledge of the health risks of vaping.

Graph 1 (below) depicts the danger perceptions of both e-cigarettes and combustible cigarettes among current, ever users, and never users. Ever users and never users ranked combustible cigarettes equally harmful, while current users found combustible cigarettes less harmful. Ever users and never users also found e-cigarettes equally harmful, though only slightly less harmful than combustible cigarettes. Current users, on the other hand, found e-cigarettes relatively less dangerous.

Graph 1

Table 1 (below) shows the percentage of current, ever, and never users who answered “yes” when asked if they were taught about the specific health risks of vaping. The data shows that, on average, current users and ever users have been taught more about the health risks of vaping when compared to never users. When asked if they were taught that e-cigarette use can cause illnesses such as lung cancer and cardiovascular disease, 68% of both current users and ever users answered “yes,” while only 55% of never users answered “yes.” The data indicates that people who have never used e-cigarettes are the least familiar with the health risks.

Table 1: Percentage of Participants Who Answered “Yes” When Asked if They Were Taught about the Specific Health Risks of E-cigarette Use

Table 2 (below) shows the percentage of current, ever, and never users who answered “yes” when asked if they believe in the specific health risks of e-cigarette use. It was found that 79% of ever users, and 68% of never users answered “yes” when asked if they believe that vaping can cause health complications such as lung cancer and cardiovascular disease. As for current users, 75% answered “yes” to believing in the negative health effects of e-cigarette use.

Table 2: Percentage of Participants Who Answered “Yes” When Asked if They Believe in the Specific Health Risks of E-cigarette Use

Table 3 (below) shows discrepancies between participants’ education and beliefs on the negative health effects of e-cigarette use. The numbers represent the average difference between the percentage of people who answered “yes” to being taught about the health risks and the percentage of people who answered “yes” to believing in the health risks. This discrepancy is overall positive, meaning that across all groups, people report having more belief in the health risks of vaping than they report being taught about them. People who have never used an e-cigarette on average tend to have the highest discrepancy between their teaching and beliefs, while current users have the lowest discrepancy.

Table 3: Discrepancies Between Participants’ Education and Beliefs about the Health Risks of Vaping

Table 3

Additional data was gathered on never and ever users. When asked why they have never used an e-cigarette, 88.1% of never users answered that they were “worried about health risks,” and “don’t want to develop an addiction/dependency.” When asked why they quit using e-cigarettes, 87.3% of ever users answered that they were “worried about future health risks,” while 12.7% answered that they were “already facing health risks.”

Discussion

This study uncovered many interesting finds, some that support and some that do not support the original hypothesis. The first finding supported the hypothesis that current users perceive nicotine products as less harmful than ever and never users. However, contrary to the hypothesis, it was found that ever and never users perceive nicotine products as equally harmful. For current users, e-cigarettes are seen as relatively less harmful than combustible cigarettes. Ever and never users find e-cigarettes only slightly less harmful than combustible cigarettes, as both groups gave equal rankings. These findings suggest that current users’ lower perceived danger of nicotine products is likely what motivates their use because they do not see as many potential health risks as the other two groups. This data was overall consistent with a study done by Cooper et al. (2016), indicating that combustible cigarettes are perceived as worse than e-cigarettes across all three groups.

The second find was related to people’s education on the health risks of vaping. It was found that never users did not receive as much education on vaping as current and ever users. When asked if they were taught that e-cigarette use can cause issues such as lung cancer, cardiovascular disease, memory impairment, hyperactivity, and asthma, 55% of never users said “yes.” On the other hand, 68% of both current and ever users answered “yes” to being taught about how vaping can lead to these health complications. This find was inconsistent with the initial hypothesis, which states that never users would be the most educated on the health risks of vaping, while current users would be the least educated. It is likely that never users have the least education because they do not use e-cigarettes, so they have little interest in learning about the health risks. Current and ever users have experience with vaping and thus are more likely to have heard about the health risks because it is something that does, or did, directly affect them.

The third find was related to people’s beliefs about the health complications of e-cigarette use. The data show that 72% of current users answered “yes” when asked if they believe that vaping can cause problems such as lung cancer, cardiovascular disease, memory impairment, hyperactivity, and asthma. As for never users, 68% of participants answered “yes” to belief in health risks. Ever users held the most beliefs, with 79% of participants answering “yes.” This finding did not support the original hypothesis, which stated that never users would have the most beliefs about the negative effects of vaping, while current users would have the least. These results were also inconsistent with a study done by McLeish et al. (2022), which found that current users have more positive beliefs about e-cigarettes, which is likely what promotes their use. Again, it is likely that the never users group has the lowest amount of beliefs because of the fact that they do not use e-cigarettes, so they would not have reason to form many beliefs on the health risks. Current users likely hold more beliefs than never users simply because of their experience with e-cigarettes. The reason why ever users have the most beliefs is likely because of their past experience with vapes, as well as the fact that they have since quit, and are therefore more receptive to the health risks that come with it.

Additionally, discrepancies were found between participants’ education and beliefs on the consequences of vaping. Across all groups, participants reported that they believe in more health risks of vaping than they were originally taught. Never users saw the largest difference of 13%, meaning that on average they are more likely to believe in the health risks of vaping, despite being taught less about them. Ever users only had a slightly smaller difference of 10%. Current users saw the smallest difference between belief and education, being only 4%. Examining current and ever users’ discrepancies side by side is especially significant, given that they reported an equal amount of education. It is clear that current users are the least inclined to believe that e-cigarettes can lead to health issues, which is likey because they are actively using them. Despite having the same amount of education, it is likely that ever users hold more beliefs because of the fact that they no longer use e-cigarettes, and are more open to the idea that they can cause health complications.

Additional data gathered on never and ever users can point to significant reasons for not using e-cigarettes as well as reasons for quitting among adolescents. For never users, it was found that the two most common reasons for never having used an e-cigarette are because participants are “worried about health risks,” and they “don’t want to develop an addiction/dependency.” Among ever users, the most common reason for terminating use was because they were “worried about future health risks.” Another potential option in this question was because they were “already facing health risks,” which was far less popular. These findings are related to claims that were made in a study by McLeish et al. (2022), stating that young adults are more expected to use e-cigarettes because of the fact that they are young and healthy, and will likely not experience the consequences of vaping until they are much older. The study claims that young people are instead more concerned about the short-term effects of vaping, such as shortness of breath. In the current study, however, it seems that young adults who currently use or have ever used e-cigarettes are well aware of both the short and long term health complications that may come with vaping, and that suffering from long-term effects may be the biggest motive to quit. Future research would likely benefit from looking at the effect of smoking interventions on current users over a longitudinal study.

Conclusion

The current study found some interesting results, but none significant enough to make any substantial claims. This was mainly due to an overly comprehensive research instrument design and an under representative sample. Further, the sample had an uneven amount of males and females, and the three vaping groups were not evenly distributed. This was counteracted with the use of percentages to represent the data as accurately as possible.

The survey used in the study was probably the biggest issue because it contained more questions than necessary, which made the data difficult to organize and interpret. The wording and repetitiveness of some of the questions also may have made it difficult for participants to answer the questions to the best of their ability. Overall, the data gathered from these questions provided value to the study once properly analyzed. If this study were to be revisited in the future, a more condensed survey would be beneficial for the data collection process as well as the data analysis process.

Additionally, a convenience sample was used in the study, which consisted of mostly UCSB students. This could potentially cause the results to be skewed due to the fact that UCSB has a reputation for being a “party school.” UCSB students are more likely to be e-cigarette users because where there is a party there is likely alcohol, and where there is alcohol there is likely nicotine. The participants of the current study are therefore not an accurate representation of the population, and the data should not be interpreted as such. If replicated, a more diverse sample of young adults, at other colleges as well as not enrolled in college, would yield more accurate data.

The results of the current study draw even more attention to the fact that further research is necessary in order to fully understand youth e-cigarette use. It is unclear whether current and ever users have received more education on the health risks of vaping because they were curious themselves, or if they were told by a friend or family member out of worry. Although the survey asked where participants learned what they know about vaping, the answers were varied, yet consistent across all groups, so no conclusions were able to be drawn. Among ever users, it is also unclear as to whether stronger beliefs in the negative effects of vaping result in termination of use, or if termination of use results in stronger beliefs. Regardless of correlation or causation, this suggests that education on the health risks of vaping can play a crucial role in preventing e-cigarette use among young adults, especially those who have never used them. These findings have important implications for public health campaigns and policy makers to develop effective strategies to educate and prevent young adults from using e-cigarettes.

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