Adolescents have unfavorable opinions of adolescents who use e-cigarettes

While evidence suggests positive opinions of smokers are associated with tobacco use, research exploring adolescents' opinions of e-cigarette users is nascent. We hypothesized that adolescents harbor positive opinions of e-cigarette users, and that these opinions will be more positive among adolescents willing to try or who have used e-cigarettes.

Participants were 578 U.S. adolescents (ages 14 to 20) recruited from ten California schools. An online survey assessed their attitudes toward and opinions of adolescents who use e-cigarettes in 2015-2016. Analyses examined whether these variables were associated with willingness to try and use (ever vs. never) of e-cigarettes.

The majority (61%) of participants had negative overall opinions toward adolescent e-cigarette users. Few participants ascribed positive traits (i.e., sexy, cool, clean, smart, and healthy) to e-cigarette users. Participants who were willing to try or had used e-cigarettes endorsed positive traits more than those unwilling to try and never-users (all p < .01). Participants sometimes endorsed negative traits (i.e., unattractive, trashy, immature, disgusting, and inconsiderate) to describe e-cigarette users. Unwilling and never-users viewed negative traits as more descriptive of e-cigarette users than willing or ever-users (all p < .01).

Adolescents generally had somewhat negative opinions of other adolescents who use e-cigarettes. Building on adolescents' negativity toward adolescent e-cigarette users may be a productive direction for prevention efforts, and clinicians can play an important role by keeping apprised of the products their adolescent patients are using and providing information on health effects to support negative opinions or dissuade formation of more positive ones.