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E-cigarette health warnings and use among U.S. adolescents: Deterrence and cognitive elaboration in a national
Sunday Azagba1, Todd Ebling1, Galappaththige S R de Silva1
1Penn State College of Nursing, 210 Nursing Sciences Building, University Park, PA, USA.
Objectives:
Limited research has investigated the association between e-cigarette health warnings and e-cigarette use behaviors among adolescents. This study examines the relationships between e-cigarette health warnings (deterrence and cognitive elaboration) and e-cigarette use among U.S. adolescents.
Study Design:
Longitudinal study.
Methods:
Data were drawn from the Population Assessment of Tobacco and Health Study (Waves 5-7), a nationally representative longitudinal cohort of U.S. adolescents aged 12-17 years. Associations between warning-related deterrence (frequency of dissuasion) and cognitive elaboration (extent of thinking about health risks), and past 30-day e-cigarette use (binary) and use frequency (days used in the past 30 days) were estimated using generalized estimating equations with logistic and negative binomial regression models, respectively.
Results:
Among adolescents who had ever used e-cigarettes, 46.1% were current users. Approximately 24.3% reported frequent deterrence from e-cigarette health warnings, while 28.8% reported high levels of cognitive elaboration. Frequent deterrence was associated with substantially lower odds of current e-cigarette use (OR = 0.34, 95% CI: 0.26-0.43) and lower use frequency (IRR = 0.25, 95% CI: 0.19-0.33). Higher cognitive elaboration was also associated with lower odds (OR = 0.34, 95% CI: 0.24-0.47) and frequency (IRR = 0.36, 95% CI: 0.28-0.48) of e-cigarette use, with evidence of graded associations across levels of cognitive elaboration.
Conclusion:
Deterrence and cognitive elaboration in response to e-cigarette health warnings were inversely associated with e-cigarette use and use frequency. These findings suggest that adolescents' perceptions and cognitive responses to health warnings co-occur with patterns of e-cigarette use.
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