Changes in ENDS Harm Perceptions Predict Intentions to Initiate ENDS Use in Tobacco-Naive Adolescents

Youth who use electronic nicotine delivery system (ENDS) products have lower perceptions of the health harms of ENDS products compared to youth not using ENDS. However, it remains unclear whether lower harm perceptions precipitate youths' intention to use, consistent with theories of health behavior. We examined whether changes in ENDS harm perceptions were associated with intentions to start using ENDS in the next year, among tobacco-naïve youth.

Using six annual waves of data from the Population Assessment of Tobacco and Health (PATH) Study Wave 4 Youth Cohort (2016/18 to 2022/23; ages 12-17 at baseline), we examined within-person associations between change in ENDS harm perceptions and intention to use ENDS within the next year among youth who had not used any tobacco or nicotine (N=14,319). Fixed effect logistic regression models were estimated for the overall sample and by sex, and tests for coefficient equality were used to identify sex differences.

When youth reported decreases in ENDS harm perceptions, they had an increased likelihood of intent to start using ENDS (aOR=1.77; 95% CI=[1.41, 2.23]). In contrast, waves in which youth reported increases in ENDS harm perceptions were associated with a decreased likelihood of intent to initiate ENDS use (aOR=0.43; 95% CI=[0.38, 0.48]). These within-person associations were similar for girls and boys.

Changes in harm perceptions among tobacco-naïve adolescents may precipitate a decision to start using ENDS and should be a target for future prevention efforts to reduce ENDS initiation among youth.