Differences in Peer Norm Perceptions Before and After E-Cigarette Initiation Among Youth and Young Adults

We aim to elucidate differences in peer norm perceptions before and after e-cigarette initiation among young people over time.

We used data from initially e-cigarette naïve participants in the Truth Longitudinal Survey (TLC), a nationally representative longitudinal dataset of youth and young adults spanning Fall/Winter 2020 and Fall/Winter 2022. We used repeated measures mixed effects models to examine changes in reported perceived peer norm and susceptibility measures of e-cigarette use (acceptance for social e-cigarette use, likelihood of accepting an e-cigarette from a friend, perceived friend disapproval of e-cigarette use, perceived number of close friends using e-cigarettes, and estimated proportion of peer e-cigarette use).

We find that participants who initiated e-cigarette use by the second wave were already more likely to report perceptions of higher peer e-cigarette acceptance for most of the measures at baseline, compared to participants who did not initiate. However, the increase in these perceived peer acceptance measures from the baseline wave to the second wave is significantly greater for initiators. Notably, the estimated proportion of the perceived peer e-cigarette use measure did not differ between groups at baseline, and non-initiators had decreased in their peer use estimates by the second wave relative to initiators.

We find that young people who would go on to initiate e-cigarette use already had elevated perceptions of peer acceptance of e-cigarettes at baseline, but these effects are amplified after initiation.