The Use of E-cigarettes Among School-Going Adolescents in a Predominantly Rural Environment of Central Appalachia
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E-cigarette use among youth in the United States (U.S.) continues to increase. In the rural Northeast Tennessee, where prevalence of tobacco use is higher than national and state averages, there is no literature on e-cigarette use to inform policies and programs. This study aimed to estimate the prevalence of e-cigarette use and examine association of e-cigarette use with two tobacco products among school-going adolescents. Data from 894 participants of a school-based survey conducted in 2016 in Northeast Tennessee were analyzed. Descriptive statistics and logistic regression analyses were conducted to estimate the prevalence and delineate the associations between e-cigarette use and other tobacco products. Approximately 11% of the participants currently used e-cigarettes, and 35% had ever used e-cigarettes. About 6% of the participants were current users of both e-cigarettes and cigarettes; 4% were current users of e-cigarettes and smokeless tobacco; 3% were current users of all three products, and 15% had ever tried all three products. More than one-half of current e-cigarette users (52%) also smoked cigarettes. Adjusting for covariates, current e-cigarette use was positively associated with cigarette smoking [Odds Ratio (OR) 27.32, 95% confidence interval (CI) 14.4–51.7] and smokeless tobacco use [OR 7.92, 95% CI 3.8–16.5]. E-cigarette use was more common among the high school students than cigarette and smokeless tobacco use, and a significant proportion of users either smoked cigarettes, used smokeless tobacco, or both. Thus, there is a critical need for preventive policies and programs to address dual and poly-use of these products.
KeywordsE-cigarette Dual use Poly-use Northeast Tennessee High school students
The Sullivan County Department of Health in Northeast Tennessee conducted the survey and we would like to thank them for sharing the data with us and giving us the permission to publish. Additionally, although the agreement with the participating schools restricts us from publicizing their names, we would like to thank them for the voluntary participation. Further, we would like to thank the Department of Health Services Management and Policy and the College of Public Health at East Tennessee State University for their logistical support. Finally, we would like to thank all the students, particularly Olivia Luzzi, Ashley Dowrick, and Guy Holdon for helping us with the edition of the manuscript.
Compliance with Ethical Standards
Conflict of interest
None to declare.
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