The Use of E-cigarettes Among School-Going Adolescents in a Predominantly Rural Environment of Central Appalachia
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E-cigarette use among youth in the United States (U.S.) continues to increase. In the rural Northeast Tennessee, where prevalence of tobacco use is higher than national and state averages, there is no literature on e-cigarette use to inform policies and programs. This study aimed to estimate the prevalence of e-cigarette use and examine association of e-cigarette use with two tobacco products among school-going adolescents. Data from 894 participants of a school-based survey conducted in 2016 in Northeast Tennessee were analyzed. Descriptive statistics and logistic regression analyses were conducted to estimate the prevalence and delineate the associations between e-cigarette use and other tobacco products. Approximately 11% of the participants currently used e-cigarettes, and 35% had ever used e-cigarettes. About 6% of the participants were current users of both e-cigarettes and cigarettes; 4% were current users of e-cigarettes and smokeless tobacco; 3% were current users of all three products, and 15% had ever tried all three products. More than one-half of current e-cigarette users (52%) also smoked cigarettes. Adjusting for covariates, current e-cigarette use was positively associated with cigarette smoking [Odds Ratio (OR) 27.32, 95% confidence interval (CI) 14.4–51.7] and smokeless tobacco use [OR 7.92, 95% CI 3.8–16.5]. E-cigarette use was more common among the high school students than cigarette and smokeless tobacco use, and a significant proportion of users either smoked cigarettes, used smokeless tobacco, or both. Thus, there is a critical need for preventive policies and programs to address dual and poly-use of these products.
KeywordsE-cigarette Dual use Poly-use Northeast Tennessee High school students
The Sullivan County Department of Health in Northeast Tennessee conducted the survey and we would like to thank them for sharing the data with us and giving us the permission to publish. Additionally, although the agreement with the participating schools restricts us from publicizing their names, we would like to thank them for the voluntary participation. Further, we would like to thank the Department of Health Services Management and Policy and the College of Public Health at East Tennessee State University for their logistical support. Finally, we would like to thank all the students, particularly Olivia Luzzi, Ashley Dowrick, and Guy Holdon for helping us with the edition of the manuscript.
Compliance with Ethical Standards
Conflict of interest
None to declare.
- 1.U.S. Department of Health and Human Services. (2014). The Health consequences of smoking—50 years of progress: A report of the surgeon general, 2014, 1–978.Google Scholar
- 2.Mamudu, M. H., Littleton, A. M., & Wang, L. (2015). Regional population health improvement plan: Tobacco Cessation in Northeast Tennessee. Johnson City, Tennessee.Google Scholar
- 3.CDC. (2015). National center for health statistics: Healthy people 2020. Retrieved October 5, 2016, from http://www.cdc.gov/nchs/healthy_people/hp2020.htm.
- 4.World Health Organization. (2014). Electronic nicotine delivery systems: Report by WHO. Geneva: WHO Framework Convention on Tobacco Control.Google Scholar
- 6.Centers for Disease Control and Prevention (CDC) (2013). Notes from the field: electronic cigarette use among middle and high school students—United States, 2011–2012. MMWR. Morbidity and Mortality Weekly Report, 62(35), 729–730.Google Scholar
- 8.CDC Office on Smoking and Health. (2015). Electronic nicotine delivery systems: Key facts. Retrieved October 5, 2016, from https://www.cdc.gov/tobacco/stateandcommunity/pdfs/ends-key-facts2015-508tagged.pdf.
- 11.Overbey, M. (2015). State of Tennessee. Public chapter no. 353: Senate bill no. 411. Substituted for: House bill no. 309. State of Tennessee. Retrieved from http://www.tn.gov/sos/acts/109/pub/pc0353.pdf.
- 14.CDC. (2014). Best practices for comprehensive tobacco control. Atlanta: US department of health and human services, centers for disease control and prevention, national center for chronic disease prevention and health promotion, office on smoking and health.Google Scholar
- 17.Zhong, J., Cao, S., Gong, W., Fei, F., & Wang, M. (2016). Electronic cigarettes use and intention to cigarette smoking among never-smoking adolescents and young adults: A meta-analysis. International Journal of Environmental Research and Public Health, 13(5), 465. doi: 10.3390/ijerph13050465.CrossRefPubMedCentralGoogle Scholar
- 18.Loomis, B. R., Rogers, T., King, B. A., Dench, D. L., Gammon, D. G., Fulmer, E. B., & Agaku, I. T. (2016). National and state-specific sales and prices for electronic cigarettes-U.S., 2012–2013. American Journal of Preventive Medicine, 50(1), 18–29. doi: 10.1016/j.amepre.2015.05.003.CrossRefPubMedGoogle Scholar
- 28.de Andrade, M., Hastings, G., & Angus, K. (2013). Promotion of electronic cigarettes: tobacco marketing reinvented? BMJ (Clinical Research Ed.), 347, f7473.Google Scholar
- 32.Primack, B. A., Soneji, S., Stoolmiller, M., Fine, M. J., & Sargent, J. D. (2015). Progression to Traditional cigarette smoking after electronic cigarette use among us adolescents and young adults. JAMA Pediatrics, 1–7. doi: 10.1001/jamapediatrics.2015.1742.
- 33.Leventhal, A. M., Strong, D. R., Kirkpatrick, M. G., et al. (2015). Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence. JAMA: The Journal of the American Medical Association, 314(7), 700–707. doi: 10.1001/jama.2015.8950.CrossRefPubMedGoogle Scholar
- 35.CDC. (2012). Smoking and tobacco use. State highlights—Tennessee. Retrieved September 16, 2016, from http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2012/states/tennessee/index.htm.
- 36.Lee, Y. O., Hebert, C. J., Nonnemaker, J. M., & Kim, A. E. (2014). Multiple tobacco product use among adults in the United States: Cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus. Preventive Medicine, 62, 14–19. doi: 10.1016/j.ypmed.2014.01.014.CrossRefPubMedGoogle Scholar
- 37.CDC. (2016). Smoking & tobacco use: National Youth Tobacco Survey (NYTS). Retrieved October 5, 2016, from http://www.cdc.gov/tobacco/data_statistics/surveys/nyts/.
- 38.CDC. (n.d.). Adolescent and School Health: Youth Risk Behavior Surveillance System (YRBSS). Retrieved October 5, 2016, from http://www.cdc.gov/healthyyouth/data/yrbs/index.htm.
- 39.USDHHS. (2012). Preventing tobacco use among youth and young adults. A report from the Surgeon General. U.S. Department of Health & Human Services. Retrieved from http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/factsheet.ht.