Electronic cigarette use by college students

Abstract

Background

Electronic cigarettes, or e-cigarettes, are battery operated devices that deliver nicotine via inhaled vapor. There is considerable controversy about the disease risk and toxicity of e-cigarettes and empirical evidence on short- and long-term health effects is minimal. Limited data on e-cigarette use and correlates exist, and to our knowledge, no prevalence rates among U.S. college students have been reported. This study aimed to estimate the prevalence of e-cigarette use and identify correlates of use among a large, multi-institution, random sample of college students.

Methods

4444 students from 8 colleges in North Carolina completed a Web-based survey in fall 2009.

Results

Ever use of e-cigarettes was reported by 4.9% of students, with 1.5% reporting past month use. Correlates of ever use included male gender, Hispanic or “Other race” (compared to non-Hispanic Whites), Greek affiliation, conventional cigarette smoking and e-cigarette harm perceptions. Although e-cigarette use was more common among conventional cigarette smokers, 12% of ever e-cigarette users had never smoked a conventional cigarette. Among current cigarette smokers, e-cigarette use was negatively associated with lack of knowledge about e-cigarette harm, but was not associated with intentions to quit.

Conclusions

Although e-cigarette use was more common among conventional cigarette smokers, it was not exclusive to them. E-cigarette use was not associated with intentions to quit smoking among a sub-sample of conventional cigarette smokers. Unlike older, more established cigarette smokers, e-cigarette use by college students does not appear to be motivated by the desire to quit cigarette smoking.

Introduction

Electronic cigarettes, or e-cigarettes, are electronic nicotine delivery devices that were developed to closely approximate the sensory experience of smoking conventional cigarettes. While designs differ slightly between manufacturers, most e-cigarettes consist of the same basic components: a battery, an airflow sensor, a vaporizer, and a nicotine cartridge, all contained within a cigarette-like tube (American Legacy Foundation, 2012). These novel tobacco products appear to be growing in popularity, as evidenced by substantial increases in electronic search queries (Ayers et al., 2011) and increasing product awareness (Regan et al., 2011). Additionally, in spring 2012, Lorillard purchased Blu Ecigs, marking the first entry of a major tobacco company into the electronic cigarette market. Later in 2012, the Winston-Salem Journal reported that R.J. Reynolds is testing their own electronic cigarette known as Vuse (July 29, 2012). It appears that as cigarette smoking has continued to decline (Centers for Disease Control and Prevention, CDC, 2011), major tobacco companies are diversifying through the introduction of electronic cigarettes, among other novel products.

At present, there is considerable controversy about the health effects of e-cigarettes, especially in comparison to conventional cigarettes. However, research assessing health effects is limited, with no research on the long-term health effects of e-cigarette use, in part because it is a relatively recent phenomenon. Research on the short-term effects of smoking an e-cigarette (up to one day of use) suggests that smoking an e-cigarette does not expose the smoker to detectable levels of respiratory carbon monoxide (Bullen et al., 2010, Eissenberg, 2010, Vansickel et al., 2010). In a recent study, Vardavas et al. (2012) found that following a 5 min period of e-cigarette use, participants had increased, albeit small, lung flow resistance. Longer periods of use could be associated with greater deficiencies, but more research is needed. While current evidence, albeit limited, suggests electronic cigarettes pose fewer health risks than conventional cigarettes for the individual user, population-level effects must also be considered.

From a public health perspective, the extent to which e-cigarettes may serve as a starter product for nonusers of tobacco is a concern (Cobb and Abrams, 2011, Yamin et al., 2010, Foulds et al., 2011). To hinder marketing to children, the U.S. Food and Drug Administration (FDA) recently banned characterizing flavors (i.e., a distinguishable taste or aroma other than tobacco or menthol) in cigarettes (Family Smoking Prevention and Tobacco Control Act, 2009). While the FDA is responsible for regulating e-cigarettes under the Family Smoking Prevention and Tobacco Control Act of 2009 (Deyton and Woodcock, 2011), rules for e-cigarettes are not yet in place. Thus, not surprisingly, e-cigarettes are sold in a variety of candy and fruit flavors, including strawberry, mint and chocolate (Wollscheid and Kremzner, 2009). Such flavors, combined with marketing campaigns that extol e-cigarettes as being “green” and “healthy” and a lack of tobacco taxation (O’Connor, 2012), may particularly appeal to adolescents and young adults; however, few studies have assessed prevalence of e-cigarette use and factors associated with use among young adults.

To date, two large, nationally representative studies have assessed e-cigarette use among adults, including young adults (Pearson et al., 2012, Regan et al., 2011). In both of these samples, prevalence of ever using electronic cigarettes was highest among young adults and age was inversely associated with use (Pearson et al., 2012, Regan et al., 2011). In a third study, Choi and Forster (2013) assessed awareness, use, harm perceptions and beliefs about use as a cessation aid among a cohort of young adults in the Midwest. They found that 7% had ever used an e-cigarette and use was associated with younger age (20–24 vs. 25–28), male gender, conventional cigarette smoking, agreement that e-cigarettes can help people quit, and agreement that e-cigarettes are less harmful than conventional cigarettes. However, to date, no studies have assessed use among college students.

College students, in particular, are an important population to examine. Young adults are the tobacco industry's youngest legal targets, and marketing strategies targeting college students are widespread (Rigotti et al., 2004). Additionally, substance use is high in this population (Arnett, 2005), with concomitant risk to develop harmful alcohol and other drug use and substance use disorders (Substance Abuse and Mental Health Services Administration, 2009). In terms of tobacco use, young adulthood is a critical period for smoking, often marked by escalation (Orlando et al., 2004) or late-initiation (Chassin et al., 2000). From an epidemiological standpoint it is noteworthy that college students are often drawn to novel products and have historically been at the forefront of societal changes in substance use that later materialize within the general population (Johnston et al., 2008). Therefore, college students may be drawn to e-cigarettes due, at least in part, to their novelty. Sensation seeking is a personality trait resulting in the need for stimulation, novel experiences and risk taking (Stephenson et al., 2003, Zuckerman, 1994, Zuckerman and Neeb, 1979). Research has shown that sensation seeking is related to conventional cigarette smoking (Zuckerman et al., 1990); however, its association with e-cigarettes has not been studied.

Little is known about the correlates of e-cigarette use among young adults. In two of the three studies to date that included young adults, few variables other than demographics and tobacco use were included (Pearson et al., 2012, Regan et al., 2011, Choi and Forster, 2013). Research on tobacco use among college students has shown associations with several contextual and behavioral factors. For example, affiliation with Greek organizations is associated with tobacco use among college students, particularly social smoking (Sutfin et al., 2009, Sutfin et al., 2012, Morrell et al., 2005). Additionally, type of institution is related to cigarette smoking. Although daily smoking is more common on public versus private campuses, nondaily smoking is equally likely at public and private campuses (Sutfin et al., 2009). Residence location also appears to be associated with cigarette smoking. Students who report smoking only a few puffs in the past month are more likely to live on-campus than heavy, moderate or social smokers (Sutfin et al., 2009). Finally, a large body of research has documented the association of tobacco use and other substance use, including alcohol and illicit drugs (Ridner et al., 2005; Morrell et al., 2005, Harrison et al., 2008). For example, data from the 2001 College Alcohol Study (N = 10,924 students; 120 colleges) show that over 98% of current smokers also drink alcohol (Weitzman and Chen, 2005).

This study aims to (1) estimate the prevalence of e-cigarette use among college students in North Carolina (NC); (2) identify correlates of e-cigarette use among a large, multi-institution, random sample of college students in NC; and (3) assess correlates of e-cigarette use among current smokers, including associations with cigarette smoking quit intentions, sensation seeking, and other substance use. To our knowledge, this is the first study to report on e-cigarette use based on a random sample of U.S. college students.