E-cigarette use and other risk factors associated with tobacco smoking susceptibility among Australian adolescents

Abstract

E-cigarette use and other risk factors associated with tobacco smoking susceptibility among Australian adolescents Maree Scully,1, * Elizabeth Greenhalgh,2 Emily Bain,1 Melanie Wakefield,1,3 Sarah Durkin,1,3 Victoria White4 1 Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia 2 Quit, Cancer Council Victoria, Melbourne, Australia 3 Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia 4 School of Psychology, Deakin University, Burwood, Australia Submitted: 6 March 2023; Revision requested: 6 July 2023; Accepted: 12 July 2023 Abstract Objective: To explore risk factors for smoking susceptibility among Australian adolescents to inform prevention policies and programs. Methods: Cross-sectional survey of students aged 12–17 years who reported having never smoked (n=4,171). Bivariate associations between smoking susceptibility and a range of factors previously linked to youth smoking and smoking susceptibility were initially examined, with significant factors (p<0.05) included in a final multivariable logistic regression model. Results: Eleven percent of adolescents who had never smoked were susceptible to smoking. Smoking susceptibility was independently associated with ever use of e-cigarettes (adjusted odds ratio [AOR]=3.26, 95% confidence interval [CI]: 1.83-5.81), perceiving those who smoke to be more popular (AOR=2.87, 95% CI: 1.62-5.10), having a close friend/s who smokes (AOR=2.66, 95% CI: 1.61-4.40), not perceiving smoking one or two cigarettes occasionally as personally dangerous (AOR=2.56, 95% CI: 1.61-4.09), and having symptoms of depression (AOR=1.59, 95% CI: 1.06-2.38). Conclusions: The strongest smoking-initiation risk factor identified was ever use of e-cigarettes, with social norms, harm misperceptions around low-rate tobacco use and mental health also linked to smoking susceptibility. Implications for Public Health: Stronger e-cigarette regulations that reduce promotion to and access by youth, as well as interventions addressing the other identified risk factors, may help prevent future smoking uptake among Australian adolescents. Key words: adolescent health, smoking susceptibility, e-cigarettes, prevention, cross-sectional survey