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Querying about Specific E-cigarette Product use may Enhance Accurate Measurement of Adolescent E-cigarette Prevalence Rates

Fri, March 22, 7:45 to 9:15am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Introduction. E-cigarettes are the most popular tobacco product among youth, but current prevalence estimates may underestimate actual rates of use. Most studies assess e-cigarette use with a variant of the question: “Have you ever used an e-cigarette, even once or twice?” Typically, only participants who indicate lifetime use are asked subsequent questions about e-cigarette use, meaning that all additional information collected about e-cigarette use hinges on an affirmative answer to the initial question. However, it is possible that there is confusion about what exactly constitutes e-cigarette use and that some participants who actually use e-cigarettes incorrectly indicate non-use. Confusion may result from the fact that a multitude of products fall under the umbrella term “e-cigarettes,” different names are used to refer to e-cigarettes (e.g., vapes, electronic vaping devices), and different terminology is used to refer to e-cigarette use (e.g., “vaping,” “JUULing”). In this study, we compared rates of endorsing e-cigarette use when adolescents were asked about lifetime e-cigarette use in two different ways to examine the impact of terminology on prevalence estimates.
Methods. In May-June 2018, 1960 students from 2 Connecticut high schools completed a computerized, school-based survey on tablets provided by the study staff. Participants first reported on lifetime use of an e-cigarette via the question: “Have you ever tried an e-cigarette, even one or two puffs?” (accompanied by a picture of exemplar e-cigarette devices). Participants then reported on lifetime use of five specific types of e-cigarette devices: Disposables, Cig-a-Likes, or E-hookahs; Vape pens or Egos; JUULs; pod systems other than JUULs like PHIX or Suorin; and Advanced Personal Vaporizers/Mods. Adolescents were asked about lifetime use of each product separately (no/yes) and were provided with example pictures of each device type and a brief description. Descriptive statistics were run for lifetime e-cigarette use (based on the question “Have you ever tried an e-cigarette?”), lifetime use of each product, and lifetime e-cigarette use calculated based on the endorsement of lifetime use of one or more of the specific e-cigarette products.
Results. 35.8% of students endorsed lifetime “e-cigarette” use, while 51.3% endorsed lifetime use of 1 specific e-cigarette product. When rates of individual product use were assessed, JUULs were the most commonly used product (44.0%), followed by Vape-pens/Egos (28.5%), pod systems other than JUULs (26.5%), Mods or APVs (25.2%), and Disposables, Cig-a-likes, or E-hookahs (12.4%). Importantly, 31.5% of adolescents who endorsed lifetime product use did not endorse lifetime “e-cigarette” use.
Conclusions. The study findings suggest that asking about e-cigarette use, broadly defined, leads to an underestimation of actual use compared to assessing lifetime use of a range of different products that are classified as e-cigarettes. Conversely, the findings indicate that assessing the use of specific e-cigarette products may yield more accurate, albeit higher, rates of use. If these findings are replicated in a nationally representative sample, regulatory efforts requiring all e-cigarette products to be clearly labeled as “e-cigarettes” may help to reduce confusion.

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