A Multilevel Analysis of School-level Influences on Adolescent e-Cigarette Beliefs, Intentions, and Use Behaviors, 2011-2014

• In Event: 368 - Section on Alcohol, Drugs, and Tobacco Refereed Roundtable Session and Business Meeting
  In Refereed Roundtable 60min: Table 06. Adolescent Alcohol Use

Abstract

The percent of US high school students reporting use of electronic cigarettes (i.e., e-cigarettes) tripled in recent years. Little is known about the temporal shifts in school-level e-cigarette prevalence or the multilevel correlates of teen e-cigarette use. Using multilevel regression techniques and data from the 2011 and 2013 US National Youth Tobacco Surveys, I investigate how the school-level clustering of e-cigarette use has shifted between 2011 and 2013, whether school-level e-cigarette use is associated with individual-level use, and whether this association is explained by individual perceptions of harm attributed to e-cigarettes. I also examine whether these patterns were consistent with results from 2014, and how the school context relates to other dimensions of e-cigarettes, including harm perceptions, use intentions, and—among active users—their age at initiation and frequency of use. Results indicate that school-level clustering of past-month e-cigarette use increased between 2011 and 2013. Multivariate multilevel models show that school-level e-cigarette use is positively associated with individual use, with a small proportion of this relationship explained by perceived harm of e-cigarettes. Results from 2014 indicate that attending high-use schools is associated with (1) greater odds of intending to use in the near future among abstainers, (2) more frequent use among active users, and (3) lower perceived addictivity of electronic vs. combustible cigarettes, irrespective of one’s own use of electronic or combustible cigarettes. These results point to an important and strengthening role played by school environments in shaping adolescent e-cigarette attitudes, intentions and use behaviors.

Authors

• Shannon Fanning

• Adam Matthew Lippert, University of Colorado Denver