Tobacco/nicotine use in adolescents and young adults: A focus on electronic cigarettes and measurement of non-daily tobacco cigarette use
Saddleson, Megan L.
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This dissertation describes a program of research examining the use of nicotine/tobacco products among adolescents and young adults. There were two goals of this research; the first goal was to develop a better understanding of electronic cigarette (e-cigarette/e-cig) use among a sample of college students in upstate New York. Using this sample of college students, we developed an understanding of which college students are more likely to use e-cigs and the association of other risky health behaviors with e-cig use. Study number 2 investigated a sub-group of college students who had ever tried e-cigs in order to study reasons why young adults might use e-cigs. In Study number 2, the majority of current e-cig users were non-daily users. In addition, affective reasons for using e-cigs were found to be related to frequency of e-cig use, with current users more frequently reporting use for enjoyment compared with discontinued users; using e-cigs for reasons such as enjoyment may be connected to the popularity of these products. The second goal of this dissertation work was directly related to the discovery of a large portion of light and non-daily cigarette smokers among the current cigarette smokers in the college sample. This finding raised methodological questions about how to better represent those who smoke cigarettes on a non-daily basis. Study number 3 lead to the development of a tool to classify non-daily cigarette smokers using a National longitudinal sample of adolescent smokers who were followed over a period of 14 years. The findings among our college sample offer important insight in regard to the association of e-cig use and involvement in other risky health behaviors. E-cig use appears to be one of multiple products that college students/young adults will likely experiment with and enjoyment of this product could lead to continued use. Notably, Study number 3 provides a method to classify current smokers beyond use of past 30-day use measures to define "current" cigarette smoking (a measure often used in tobacco surveillance). Study number 3 demonstrated that a more precise classification of non-daily cigarette smokers indicates distinct similarities between high-level non-daily smokers and daily smokers. Although non-daily and daily smokers are often classified separately, these two groups should be treated in a similar manner in terms of smoking cessation and prevention efforts. Relatedly, individuals who have smoked a whole cigarette at some point in their lives but had not smoked in the past 30-days were very similar to low-level non-daily smokers who smoked 1-5 cigarettes per month, when predicting future cigarette smoking. Together, with the representation of a method to better classify non-daily cigarette smokers and a rise in the use of novel products, such as e-cigs, especially on a non-daily basis, the need for a method to better classify non-daily users of all tobacco products remains a direction for future research.