Rehab AufFollow

Document Type



Doctor of Philosophy (PhD)


Public Health

First Advisor's Name

Miguel Cano

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Mary Jo Trepka

Second Advisor's Committee Title

Committee Member

Third Advisor's Name

Mario De La Rosa

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Elena Bastida

Fourth Advisor's Committee Title

Committee Member

Date of Defense



E-cigarettes became available in the United States during 2007. Studies using national data have found an increase in e- cigarette use among adolescents as early as 2011. In 2014, e-cigarettes became the most commonly used tobacco product among adolescents; however, little is known about its association with other tobacco products use. Therefore, the present study aimed to: 1) Examine the association between initiating tobacco use via e-cigarettes and subsequent use of other tobacco products; 2) Examine the association between the exposure to e-cigarettes marketing messages and tobacco use; 3) Describe symptoms of nicotine dependence associated with e-cigarette use, compared with cigarette and dual use of e-cigarettes and cigarettes. All aims were carried out among data from the National Youth Tobacco Survey (NYTS) 2014 and 2015. The participants of NYTS were adolescents, and they self-reported their demographic characteristics and tobacco use in an anonymous 81-item pencil-paper questionnaire.

Findings from logistic regression modeling showed that initiating tobacco use via e-cigarettes was significantly associated with subsequent current use of cigarettes (adjusted odds ratio (AOR)=2.7; 95% confidence interval [CI], 1.9-4.0), cigars (AOR= 1.7; 95% CI, 1.2-2.4), smokeless tobacco (AOR= 3.1; 95% CI, 2.2-5.4), or any tobacco products (AOR= 4.4; 95% CI, 3.5-5.6). In addition, living with someone who used e-cigarettes at home significantly increased the likelihood of using tobacco products. Notably, e-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.6), hookah (AOR: 1.3, 95% CI: 1.03-1.7), cigars (AOR: 1.3, 95% CI: 1.1-1.6), and polytobacco (i.e. more than one tobacco product) use (AOR: 1.8, 95% CI: 1.5-2.1). Among adolescent daily tobacco users, 35.6% of e-cigarette users and 85.3% of cigarette users reported one or more dependence symptoms. These proportions increased to 74.3% among e-cigarette and 93.3% of cigarette dual (i.e. combined) users. Strong craving was the most commonly reported symptom with a range of 16.1-58.9% among different types of smokers in the study.

In conclusion, exposure to e-cigarette marketing messages and e-cigarette use were associated with use of other tobacco products. Furthermore, e-cigarette use is addictive. Despite cigarette and dual (i.e. e-cigarette and cigarette) users being more likely to report dependence symptoms than e-cigarette users, the addictiveness of e-cigarettes occurred at appreciable rates. Collectively, the findings suggest that e-cigarettes are associated with dependence symptoms and use of tobacco products and suggest that stricter regulations are needed to prevent adolescent access to and use of e-cigarettes.






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