Cognitive risk factors of electronic and combustible cigarette use in adolescents

Cognitive susceptibility to cigarette smoking has been demonstrated to predict future cigarette initiation in adolescents. Examining this construct prior to tobacco product initiation may provide useful information on the differential risk of individuals initiating cigarette vs. e-cigarette products. Additionally, examining how susceptibility and tobacco product use relate to perceived harm cognitions will increase understanding of risk predisposition among adolescents.

Data were taken from a longitudinal study of middle school students (n = 1023; age = 12.1, 52.2% female, 72.1% white) in the Northeastern U.S. Likelihood of e-cigarette and cigarette ever-use in high school was examined as a function of a validated index of cigarette smoking susceptibility among tobacco naïve students in middle school. Prospective associations between cognitive susceptibility to smoking and subsequent perceived harm of e-cigarettes (assessed in high school), and cross-sectional associations between concurrent tobacco product ever-use status and perceived harm of e-cigarettes were examined.

Adolescents classified as susceptible to cigarette smoking in middle school were more likely to initiate use of cigarettes (OR = 2.53) and e-cigarettes (OR = 1.95) as compared to adolescents classified as non-susceptible; cigarette smoking susceptibility did not differentially predict use of one product over the other. Adolescents endorsing e-cigarette use, reported significantly less perceived harm associated with e-cigarettes vs. cigarettes, while those who endorsed cigarette only or dual use did not.

Our data indicate that cognitive susceptibility to cigarette smoking may index a broad risk factor for using either cigarettes or e-cigarettes in the future, and is prospectively associated with perceived harm of e-cigarette use. Overall, those who used any tobacco product perceived e-cigarettes as less harmful when compared to abstainers. Individual facets of perceived harm (addiction potential and harm vs. cigarettes) differ between cigarette only users and e-cigarette users and may help to explain the choice to use one product vs. the other.

This is the first study to examine prospective associations between cognitive susceptibility to cigarette smoking, predating tobacco use, and subsequent likelihood of cigarette vs. e-cigarette initiation. This study demonstrates that initiation of either product is elevated among youth who are susceptible to smoking; thus susceptibility to smoking may serve as a useful marker of vulnerability to tobacco product use. Furthermore, this study provides novel information on the relationship between tobacco product onset and specific harm perceptions associated with e-cigarettes versus cigarettes among adolescents.