Risk and Protective Factors Associated With Susceptibility to Electronic Nicotine Delivery Systems Initiation in...

Among nicotine-naïve youth, cognitive susceptibility (ie, intentions/willingness to use) is a powerful predictor of initiating the use of electronic nicotine delivery systems (ENDS). Our research objective is to examine the time-varying adolescent and family risk and protective factors that may be associated with youth susceptibility to ENDS initiation.

We used hybrid panel models on longitudinal data from parents and youth aged 12-17 in the Population Assessment of Tobacco and Health Study, followed over 7 survey waves between 2015 and 2023. Analyses included 16 142 nicotine-naïve youth whose ENDS susceptibility was assessed over 43 427 longitudinal observations.

Youth were susceptible to ENDS initiation in 25.9% of longitudinal observations. Youth were more susceptible when they believed using ENDS was safer and less addictive than smoking, when they had high weekly earnings, and when they believed ENDS were easy to buy. Youth problem behaviors and both parents' and friends' ENDS use also predicted greater odds of ENDS susceptibility. The odds of susceptibility were lower when youth resided in homes with vaping bans, when they believed their parents would be upset if they started vaping nicotine, and when they were earning good grades. Girls were more susceptible to ENDS initiation than boys.

Parents may be interested in potentially malleable factors associated with greater susceptibility, including youth drinking alcohol, believing ENDS are safer and less addictive than smoking, and having friends who use ENDS. Conversely, maintaining household vaping bans and parental disapproval of ENDS were linked with lower susceptibility.

Research consistently identifies cognitive susceptibility-defined as intentions and willingness to use ENDS-as a powerful predictor of ENDS initiation in adolescence. Less is known about specific risk factors that heighten nicotine-naïve adolescents' willingness to vape nicotine or protective factors that may deter their intentions to initiate ENDS use. To address this gap, the present study leveraged longitudinal data to identify key adolescent and family risk factors that are associated with youth susceptibility to ENDS initiation.