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. Author manuscript; available in PMC: 2018 May 23.
Published in final edited form as: Ky J Commun. 2017;36(1):35–51.

Electronic Cigarettes and Communication: An Examination of College Students’ Perceptions of Safety and Use

E Paige Hart 1, Clara G Sears 2, Joy L Hart 3, Kandi L Walker 4
PMCID: PMC5964989  NIHMSID: NIHMS963935  PMID: 29805323

Abstract

Electronic cigarettes (e-cigs) have increased in popularity over the last few years, especially with youth and young adults. However, little is known about the health effects of using these devices. Additionally, relatively few studies have explored college students’ e-cig use and perceptions of safety. In this study, perceptions of e-cig safety were compared among three groups of college students—those who had never tried, had tried, and currently use e-cigs. Study findings suggest interesting differences between the three groups, with participants who had tried as well as those who currently use e-cigs having more positive views of the devices. For example, current users were more likely to view e-cigs as safe and healthy choices and less likely to view them as tobacco products. Further, compared to participants who had not tried e-cigs, individuals who had tried or currently use e-cigs were more likely to believe that vapor was safe to others (i.e., no second- or third-hand effects). Understanding the perceptions and use of e-cigs among college students is important in order to develop communication strategies for anti-tobacco campaigns that effectively relate safety concerns to these audiences.

Keywords: electronic cigarette, e-cig, tobacco, college students, safety, marketing

The past few years have seen great increases in both the marketing and use of electronic cigarettes (e-cigs) (DHHS, 2016). Today, current and potential customers can select from a vast array of product purchase options, tailor experiences through customization, and access information about e-cigs in a number of ways (e.g., via social media and other online sources, traditional marketing communication channels, face-to-face interaction with vape shop employees) (Hart et al., 2017; Sears et al., 2017). Despite substantial increases in e-cig communication and use, little is known about the health effects of using these products or how audiences targeted by manufacturers perceive the products (Duke et al., 2014), especially in terms of health and safety.

Electronic Cigarettes: Products and Popularity

Electronic cigarettes are battery-powered devices that aerosolize a liquid that users then inhale or “vape” (FDA, 2016; Rigotti, 2012). Typically, the liquids used in e-cigs contain nicotine and flavorings, with users having an array of flavor choices. Specific parts of e-cig devices vary greatly based on the generation of the e-cig, brand, and user preference (Cobb, Byron, Abrams, & Shields, 2010).

E-cig liquid contains roughly 10–40 mg/mL of flavoring chemicals (Tierney, Karpinski, Brown, Wentai, & Pankow, 2016). The assortment of flavors used in e-cig liquid is a main marketing point for e-cigs (Tierney et al., 2016), with considerable communication devoted to the array of options. The majority of flavors are not tobacco-related (e.g., menthol), but instead are confectionary and/or fruity in nature (e.g., strawberry, chocolate, grape) (Tierney et al., 2016). The variety of flavor options, and intense marketing of these options, may entice youth to try or experiment with e-cigs. In addition, the ability to purchase e-cigs online can encourage youth to try to procure and use these products.

Many of the flavor additives in e-liquid contain aldehydes, which have been demonstrated to irritate the respiratory tract’s mucosal tissue (Tierney et al., 2016). Further, concentration of some of the flavor additives is higher than recommended intake values; therefore, the flavors themselves could pose biological concerns when inhaled (Tierney et al., 2016). Although dangers of the flavor additives themselves warrant reconsideration of e-cig use, marketing claims frequently emphasize safety. Flavors and communication surrounding flavor choices, especially emphasizing user abilities to create unique combinations, add to e-cig appeal, often encouraging experimentation, in the absence of scientific data on the effects of consumption.

E-cig Awareness and Use

Across all age cohorts, studies reveal that the awareness and use of e-cigs are increasing, with awareness higher among current smokers than never-smokers or former smokers (King, Alam, Promoff, Arrazola, & Dube, 2013). Recent research suggests that demographic characteristics associated with e-cig use include: male gender (Amrock, Zakhan, Zhou, & Weitzman, 2015), current cigarette use (e.g., King et al., 2013; Palazzolo, 2013; Trumbo & Harper, 2013), non-Hispanic White ethnicity, and a college education (King, Patel, Nguyen, & Dube, 2015; Schraufnagel, 2015). Increased awareness and use of e-cigs parallels increased marketing of e-cigs, both through traditional and digital media communication channels. As traditional and digital marketing and promotion of e-cigs have grown, increasing numbers of youth and adults have become familiar with and/or tried these products.

In particular, youth and young adults may be most vulnerable to advertising promoting e-cig use (Duke et al., 2014). Common e-cig advertising tactics incorporate health claims (i.e., either indirect, direct, or both) not supported by medical evidence and designed to imply safety (Amrock et al., 2015). A subset of such claims have cultivated the view that vaping does not affect others (e.g., has no second- or third-hand effects such as those associated with traditional cigarettes) (e.g., Trumbo & Harper, 2013), which may also entice users and suggest harmless effects. Many of the claims employed as well as the communication channels used, often digital media ones, to promote e-cigs may attract youth and young adults.

Youth use

Increases in the use of alternative forms of tobacco, notably e-cigs, among youth have paralleled declines in conventional cigarette use (Camenga et al., 2014; CDC, 2011, 2012, 2013; Larson & Pearlman, 2016). For example, Larson and Pearlman (2016) found that over one-fourth of high school youth (25.3%) were current tobacco product users, with e-cigs identified as the most common product (16.0%). In other words, while youth use of conventional cigarettes has declined in recent years in the U.S., more than a quarter of high school aged youth continue to use tobacco and the most preferred product these days is e-cigs. Further, youth who perceive e-cigs as a less harmful alternative to traditional cigarettes are more likely to use e-cigs (Amrock et al., 2015). Given the current use rates and general perceptions of safety, it is likely that youth who transition to college will have more exposure to e-cigs at a time when they also experience greater freedom from adult supervision.

College student use

Despite increases in e-cig use, limited research has examined college student perceptions and use of these devices. Some studies have found that over 30% of college students have tried an e-cig (Saddleson et al., 2015) and nearly 4% have used an e-cig in the last month (American College Health Association, 2016).

Recent research suggests that the individuals most likely to try or use e-cigs in college are: males, past or present traditional cigarette smokers, and Greek affiliated (Sutfin, McCoy, Morrell, Hoeppner, & Wolfson, 2013). However, little is known about other characteristics of college students that may be associated with e-cig use (e.g., work status, perceptions of individual health). Further, findings suggest that college e-cig use is not motivated by the desire to quit smoking (Palazzolo, 2013; Saddleson et al., 2016; Sutfin et al., 2013). Instead, initial findings suggest that college students’ primary reason for e-cig use may be enjoyment (Saddleson et al., 2016), which is frequently emphasized by marketers to recruit customers. Potentially linked to views of enjoyment, it is possible that some college students are drawn to e-cigs to try something new—for a novel experience. For example, individuals higher in sensation-seeking interests are more likely to pursue new, different, and exhilarating or stimulating experiences (Zuckerman, 1994); thus, they are more likely to sample new products and to be excited by new, uncertain experiences (Noar, Zimmerman, Palmgreen, Lustria, & Horosewski, 2006; Stephenson & Southwell, 2006; Zuckerman 1979, 1994). One such experience might be sampling an e-cig. Further, previous research has found links between smoking and college students high in sensation-seeking interests (e.g., Zuckerman, Ball, & Black, 1990), and such links, though yet unexplored, may exist with e-cigs as well. Although past research indicates that college students are less likely to use traditional cigarettes and smokeless tobacco than peers who are not in college (Jamal et al., 2016), little is known about college students’ overall propensity to use e-cigs, especially as considerable marketing efforts work to secure their attention.

Promotion and Perception

Growing e-cig interest and use has resulted in vape shops, specialty stores catering to e-cig users and potential users by selling products, providing information on use, and helping customers craft e-liquids and devices designed to meet their preferences (FDA, 2016; Hart et al., 2017). Fueling popularity, marketing of these devices has burgeoned (Berry, Burton, & Howlett, 2017; Wagoner et al., 2014). For example, between 2011–2012, advertising expenses for e-cigs increased from $6.4 million to $18.3 million (King et al., 2015). Beyond employing traditional communication channels, marketers have successfully used digital media to promote e-cigs (e.g., Lee et al., 2017; Sears et al., 2017; Willis, Haught, & Morris, 2017), with Twitter an especially popular social media platform for e-cig companies (Jidong, Kornfield, Szczypka, & Emery, 2014).

Marketing efforts often insinuate or directly state that e-cigs emit only water vapor, despite evidence that toxins and carcinogens are present in e-cigs (e.g., acetaldehyde, acrolein, toluene, nitrosamines) (Drummond & Upson, 2014). In the absence of evidence-based public health messaging, such marketing promotes beliefs and behaviors that can lead to increases in both use of e-cigs (Duke et al., 2014) and public confusion (Ratzan, 2014; Sangalang, 2015; Tan, Lee, & Chae, 2015). For example, e-cigs are frequently promoted as a smoking cessation tool, despite unanswered questions regarding their effectiveness. Although people may report fewer urges to smoke a traditional cigarette (Palazzolo, 2013), studies suggest that individuals tend to become dual users (i.e., using both traditional cigarettes and e-cigs), rather than quitting traditional cigarette use. Further, as dual users they may increase their overall consumption of nicotine (Rigotti, 2012). Additionally, findings suggest that viewing e-cig advertisements increases current smokers’ urges to consume a traditional cigarette and lowers former smokers’ intentions to refrain from consuming traditional cigarettes (Maloney & Cappella, 2016).

Based on marketing claims and in the absence of agreed upon scientific evidence, many perceive e-cigs as healthy and safe products. Perhaps not surprisingly, users are more likely to perceive e-cigs as less dangerous than traditional cigarettes, with males rating e-cigs as less harmful than females do (Amrock et al., 2015). However, the perception that e-cigs are harmless is not supported by research (Yu et al., 2016); instead, emerging research has suggested that e-cig cartridges, solutions, and aerosol contain potentially harmful products (e.g., nitrosamines, diethylene glycol; Westenberger, 2009). For example, nicotine is known to be highly addictive, and its dangers are well documented (e.g., it can negatively affect brain development in youth and young adults, Schraufnagel, 2015), with e-cigs users consuming varied nicotine amounts based on device brand and parts as well as e-liquid choices and potentially greater levels via dual use. Thus, despite the perception that e-cigs are harmless or are reducing harmful effects when compared to traditional cigarettes, scientific evidence is inconclusive at present (Palazzolo, 2013), and several studies point to potential harm in using e-cigs.

Given the potential harm associated with e-cig use and emerging research findings documenting the dangers, additional regulation of e-cig marketing and sales seems warranted. Originally, e-cigs could be purchased online with little verifying information. Now, however, with oversight from the FDA, retailers selling e-cigs must restrict sales to persons over the age of 18, with a photo ID required to confirm age for anyone under 27 (FDA, 2016). Additionally, distribution of free e-cig samples and sales by vending machine are restricted to adult-only facilities (FDA, 2016).

Study purpose

With increased use, sustained product marketing, and limited regulation, it is important to understand the perspectives of demographic groups, such as college students, most likely to use e-cigs. Examining the perspectives of college students is especially important because young adults tend to experiment with and be frequent users of e-cigs (Camenga et al., 2014; CDC, 2011, 2012, 2013; Larson & Pearlman, 2016) and this age group is targeted by tobacco company marketing in an attempt to secure new lifetime product purchasers (Ling & Glantz, 2002). The objective of this analysis is to examine perceptions of safety and e-cig use among college students. More specifically, perceptions of e-cig safety were compared among three groups of college students—those who had never tried, had tried, and currently use e-cigs. Understanding the perceptions and use of e-cigs among young adults is important in order to develop communication strategies for anti-tobacco campaigns that effectively relate safety concerns to these users.

Methods

Participants

After approval for this study was obtained from the Institutional Review Board, data were collected from participants (N=652) currently enrolled at a large midwestern metropolitan university, in the spring semester of 2017. To participate in the study, individuals had to meet the following inclusion criteria: be an undergraduate or graduate student and be at least 18 years old. Participants were instructed that participation was voluntary and were given time to ask questions. Participants agreed to participate in the survey by completing and submitting the questionnaire electronically in REDCap, and no incentive was provided for participation.

Procedures

College students were recruited to participate in the survey using several different methods. The questionnaire was administered in required and elective communication courses, many of which were general education ones that enrolled students from across diverse majors. Additionally, participants were recruited through flyers, distributed in several on-campus locations, with the URL link to the questionnaire. Participants, recruited both in courses and via flyers, were invited to share the link with other students.

E-Cig Survey

Participants completed a 96-item questionnaire about their demographics as well as knowledge, usage, attitudes, and perceptions of e-cigs. The questionnaire took approximately 15–20 minutes to complete. The demographic questions included gender, income, involvement in school, major, length of time in college, grade point average, and work status. The questionnaire also assessed participants’ perceptions of the safety of traditional cigarettes and e-cigs, temptation to use e-cigs, and knowledge of ingredients in traditional cigarettes and e-cigs. In addition, current e-cig users were asked about use behaviors and communication sources for e-cig information.

Sensation seeking behavior was assessed using a series of questions (e.g., Hoyle, Stephenson, Palmgreen, Lorch, & Donohew, 2002): “I would like to explore strange places,” “I prefer to be around people who are excitingly unpredictable,” “I like to do things that scare me,” “I like attending wild parties,” “I would love to try new things, even if they are illegal,” and “I would go sky diving.” Response options were strongly disagree to strongly agree. The average score for all of the responses was calculated and categorized into tertiles (i.e., low, medium, high).

E-Cig Use

Three different e-cig use groups were created: current users, tried, and never tried. “Current users” was defined as participants who reported using an e-cig in the past 30 days (n=42). “Tried” was defined as participants who answered “Yes” to the question “Have you ever tried an electronic cigarette, even if it was just one puff?” and reported no e-cig use in the past 30 days (n=174). People who chose “Yes” to the question “Have you ever tried an electronic cigarette, even if it was just one puff?” but did not answer the question about e-cig use in the past 30 days were classified as “tried.” “Never tried” was defined as participants who responded “No” to the question “Have you ever tried an electronic cigarette, even if it was just one puff?” and reported no e-cig use in the past 30 days (n=299). Participants who chose not to answer (n=52) were considered “never tried” because this classification was the most parsimonious and it avoided any inflation of the number of e-cig users.

Perceptions of E-Cigs and Safety

Perceptions of e-cigs and safety were assessed by a series of statements with response options formatted as Likert-like scales (i.e., strongly agree, agree, neutral, disagree, or strongly disagree). Participants were asked to respond to the following statements: “Electronic cigarettes are tobacco products; Vape from electronic cigarettes is safe to others; Electronic cigarettes are safe; I consider electronic cigarettes a healthy option; Electronic cigarettes are safer than traditional cigarettes because they do not produce any particulate matter; and There is no conclusive evidence showing e-cigarettes are not safe, therefore electronic cigarettes are safer than traditional cigarettes.” For statistical analysis, responses were categorized as yes (strongly agree, agree, neutral) and no (disagree and strongly disagree).

Statistical Analysis

Statistical analysis was conducted in SAS 9.4. Descriptive analysis was used to compare perceptions of e-cig safety among never tried, tried, and current users. The Chi-square test was used to compare categorical variables and Wilcoxon Rank-Sum Test was used to compare continuous variables. P-values are reported and differences were determined to be significant at p < 0.05.

Results

Of the total sample, 567 participants had heard of e-cigs, and their responses were used in the analyses. Of these participants, 61.9% (n=351) had never tried the devices, 30.7% (n=174) had tried an e-cig(s), and 7.4% (n=42) were current users. Table 1 shows the demographic characteristics of the study participants.

Table 1.

Demographics of E-cigarette Use

Total Never Tried Tried Current Users P-value
100% (N=567) 61.9% (n=351) 30.7% (n=174) 7.4% (n=42)
Age 0.62
Mean (SD) 20.5 (2.3) 20.4 (2.2) 20. (2.6) 20.5 (2.4)
Median (Range) 20 (18–37) 20 (18–37) 20 (18–36) 20 (18–31)
P25 19 19 19 19
P75 21 21 21 21
Gender <0.0001
Females 65.7% (371) 71.4% (250) 60.2% (104) 40.5% (17) 0.03a
Males 34.0% (192) 28.3% (99) 39.3% (68) 59.5% (25) 0.0002b
0.06c
Overall Health 0.02
Excellent 15.3% (87) 18.2% (64) 11.5% (20) 7.1% (3) 0.72a
Very Good/Good 79.4% (450) 78.4% (275) 79.9% (139) 85.7% (36) <0.0001b
Fair/Poor 5.3% (30) 3.4% (12) 8.6% (15) 7.1% (3) 0.0006c
Sensation Seeking <0.0001
Low 27.8% (158) 34.1% (120) 19.4% (34) 9.5% (4) <0.0001a
Medium 49.2% (280) 50.6% (178) 46.3% (81) 50.0% (21) <0.0001b
High 23.0% (131) 15.3% (54) 34.3% (60) 40.5% (17) 0.3c
Open in a new tab
a

Chi-square p-value comparing Never Tried to Tried

b

Chi-square p-value comparing Never Tried to Current User

c

Chi-square p-value comparing Current User to Tried

There was no significant difference in the average age of participants who had never tried, had tried, or were current users p=0.62 (average age-never users = 20.5 +/− 2.3 years, tried = 20.4 +/− 2.2 years, current users = 20.5 +/− 2.4 years). Compared to never tried, the majority of current users were males (p=0.0002). More current users considered their overall health (i.e., responses to the question, “How would you rate your overall health?” on a 5-point scale from poor to excellent) to be Very Good/Good rather than Excellent or Fair/Poor compared to participants who had tried or never tried (p<0.0001 and p=0.0006, respectively). Students who had tried and current users reported significantly greater sensation seeking behaviors compared to students who had never tried e-cigs (p<0.0001 and p<0.0001).

Overall the majority of participants (75.8%) considered e-cigs to be tobacco products (See Table 2). However, significantly more current users did not regard e-cigs as tobacco products compared to participants who had never tried e-cigs (p=0.005). Although the majority of participants (57.1%) considered vape as unsafe to others, more participants who had tried or currently use e-cigs believed vape was safe to others compared to participants who had never tried e-cigs (p=0.0003 and p=0.0003, respectively). In addition, compared to students who had never tried or tried e-cigs, more students who currently use e-cigs considered this use to be safe overall (p<0.0001 and p=0.003, respectively) and a healthy option (p<0.0001 and p=0.003, respectively).

Table 2.

Perception of E-cigarette Safety and Use- % (n)

Total Never Tried Tried Current Users P-value
100% (N=567) 61.9% (n=351) 30.7% (n=174) 7.4% (n=42)
Electronic cigarettes are tobacco products. 0.01
Yes 75.8% (430) 78.9% (277) 73.6% (128) 59.5% (25) 0.17a
No 24.2% (137) 21.1% (74) 26.4% (46) 40.5% (17) 0.005b
0.07c
Vape from electronic cigarettes is safe to others. <0.0001
Yes 42.9% (243) 35.6% (125) 52.3% (91) 64.3% (27) 0.0003a
No 57.1% (324) 64.4% (226) 47.7% (83) 35.7% (15) 0.0003b
0.16c
Electronic cigarettes are safe. 0.0005
Yes 31.4% (178) 27.6%(97) 32.8%(57) 57.1%(24) 0.22a
No 68.6%(389) 72.4%(254) 67.2%(117) 42.9%(18) <0.0001b
0.003c
I consider electronic cigarettes a healthy option. <0.0001
Yes 28.0% (159) 24.8% (87) 27.6% (48) 57.1% (24) 0.49a
No 72.0% (408) 75.2% (264) 72.4% (126) 42.9% (18) <0.0001b
0.0003c
There is no conclusive evidence showing e-cigarettes are not safe, therefore electronic cigarettes are safer than traditional cigarettes. 0.02
Yes 50.8% (288) 48.2% (169) 51.2% (89) 71.4% (30) 0.52a
No 49.2% (279) 51.9% (182) 48.9% (85) 28.6% (12) 0.004b
0.02c
Open in a new tab
a

Chi-square p-value comparing Never Tried to Tried

b

Chi-square p-value comparing Never Tried to Current User

c

Chi-square p-value comparing Current User to Tried

The majority of participants (50.8%) indicated that the lack of evidence communicated suggesting that e-cigs are not safe supports the assumption that e-cigs are safer than traditional tobacco products. Compared to participants who had never tried or tried e-cigs, more participants currently using e-cigs supported this assumption (p=0.004 and p=0.02, respectively).

Discussion

Not surprisingly, most students (87%) participating in the study had heard of e-cigs. Based on frequent marketing of e-cigs, the popularity of these devices on some campuses, as well as the number of vape shops near our campus (with large signs and other attention-grabbing communicative features), it was somewhat surprising that 13% of the student participants were not aware of e-cigs. Although the vast majority of participants were aware of e-cigs, other recent studies have reported even higher levels of college student e-cig awareness (e.g., Saddleson et al., 2015, at 95.5%).

Further, several recent studies have indicated growing use of e-cigs by youth and young adults (DHHS, 2016), and our findings provide some evidence to support this trend. For example, in 2013, Sutfin et al. found that 4.9% of their college sample had tried an e-cig(s), with 1.5% of these individuals reporting use in the past 30 days. In our study, nearly one-third (30.7%) of participants had tried e-cigs and an additional 7.4% were current users of these products. Although it is heartening that nearly two-thirds of our participants had never tried an e-cig, the increases reported in trying and currently using e-cigs between Sutfin et al.’s (2013) study and ours are cause for concern.

Age did not significantly predict e-cig use behaviors; however, despite some variance in age (18–37), the mean age in our sample was 20, suggesting a fairly standard college age sample. The potential influence of age may be easier to tease out in approaches that look at a wider array of age groups.

Similar to findings from earlier research (e.g., Amrock et al., 2015), current e-cig users in our study tended to be male. Given that several studies have found males more likely to use e-cigs than females, health communication campaign designers should consider this demographic in planning campaigns. Additionally, student health offices on college campuses often communicate with students to raise their awareness of health issues and promote healthy behavior. Such offices could especially target male students in their communicative efforts, and an array of communication options exists for such message targeting. For example, partnerships with campus fraternities or men’s sports teams could be established. Some campuses have other student organizations or ongoing initiatives that are primarily populated by male students (e.g., African American Male Initiative, Men in Nursing), and these existing systems could be useful in creating tailored programming.

Also, of our current user participants, most (85.7%) rated themselves as in very good or good health. The data reveal that both students who had tried e-cigs as well as students who had not tried them rated themselves similarly (i.e., very good/good health); however, current e-cig users were less likely than other groups to see themselves as in excellent health. The reason for these health assessments warrants investigation in future studies, and findings could form the basis of future health communication efforts to better educate college students on links between e-cig and other tobacco product use and health outcomes.

Additionally, participants who had tried e-cigs or were current users scored higher in sensation seeking interests. Their propensity to seek out exciting and novel experiences (Zuckerman, 1994) increases the likelihood that they will try new products and be attracted to new and risky experiences (Noar et al., 2006; Stephenson & Southwell, 2006; Zuckerman 1979, 1994), such as sampling an e-cig. Previous studies have linked smoking and high sensation-seekers, including specific smoking-related behaviors (e.g., inhalation levels; Zuckerman et al., 1990), in college students. Given the previous findings on smoking as well as emerging ones on e-cigs, additional investigation of sensation-seeking interests, especially in college populations, could prove useful in identifying groups most likely to use e-cigs and experiment with other novel tobacco products and for whom tailored communication messaging might be most heavily targeted.

Our findings suggest other interesting differences between the three groups. First, compared to participants who had not tried e-cigs, individuals who had tried or currently use these products were more likely to believe that vapor was safe to others (i.e., no second- or third-hand effects). Second, current users were less likely to view e-cigs as tobacco products and more likely to view them safe and healthy choices. Third, although more than half (50.8%) of participants indicated that e-cigs are safer than traditional tobacco products because there is not evidence to the contrary, current users more frequently held this viewpoint. In other words, current users of these products more often believed that, without evidence to the contrary, e-cigs are safer than traditional tobacco products. In a recent analysis, Copeland, Peltier, and Waldo (2017) found that college students who smoked traditional cigarettes or used e-cigs regarded vaping as beneficial, an assessment that our findings support.

Overall, these findings suggest that participants who have tried or currently use e-cigs have a more positive view of these devices; thus, making continued use more acceptable in their minds and perhaps more likely. As noted earlier, flavors and other constituents pose potential negative health consequences for e-cig users (e.g., Sherwood & Boitano, 2016; Tierney et al., 2016). As health communication professionals consider campaign messages, key points could center in these and related areas (e.g., product constituents, emerging findings on health effects). In a similar vein, additional communication work is needed to help college student and other target audiences understand the scientific uncertainty surrounding the health effects of e-cig and novel tobacco product use and weigh this uncertainty and the emerging findings as they make decisions about their own health choices.

Despite interesting findings that contribute to the emerging body of literature on e-cigs, especially in a young adult population likely to use such products, this study has several limitations. First, our study investigated perceptions and use on one college campus. The views and use patterns on one campus may not necessarily represent those of college students across the nation or of young adults who did not attend college. Second, this cross-sectional survey did not track participant views or use across time. Such work in future studies could address how opinions and actions may change based on public communication, in traditional media channels as well as digital media ones, and more fully address the overall views and behavior of college students related to e-cigs.

The results of this study reveal intriguing information about awareness levels, perceptions, and use of e-cigs by college students and set the groundwork for future inquiry. Given the relative newness of these products and scientific uncertainty regarding the health effects of their use, much work remains to be done in assessing public perception, investigating use patterns, and communicating accurate information to the public to support healthy decision making. Timely and accurate communication with college students is especially important because young adults tend to be frequent users of e-cigs (Camenga et al., 2014; CDC, 2011, 2012, 2013; Larson & Pearlman, 2016) and other tobacco products and targeted by tobacco companies because as potential customers they have a lifetime of purchasing opportunities (Ling & Glantz, 2002).

Acknowledgments

This work was supported, in part, by the National Heart, Lung, and Blood Institute (NHLBI) and FDA Center for Tobacco Products (CTP) (grant number 5P50HL120163). The project also received support from the Department of Communication and the University Honors Program at the University of Louisville. FDA funding pertained only to aspects of the project that were under CTP-FDA regulatory authority at the time of the data collection. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

Footnotes

This work originated from the Senior Honors Thesis research of the first author, Paige Hart (undergraduate student). The project mentors were Clara Sears (doctoral candidate at the time of the project; now PhD), Joy Hart (faculty member), and Kandi Walker (faculty member).

Contributor Information

E. Paige Hart, School of Medicine, University of Louisville.

Clara G. Sears, Superfund Research Program, Brown University.

Joy L. Hart, Department of Communication, University of Louisville.

Kandi L. Walker, Department of Communication, University of Louisville.

References

  1. American College Health Association. American College Health Association National College Health Assessment NCHA II, Spring 2016 Reference Group Data Report. Hanover, MD: Author; 2016. [Google Scholar]
  2. Amrock SM, Zakhar J, Zhou S, Weitzman M. Perception of e-cigarette harm and its correlation with use among U.S. adolescents. Nicotine & Tobacco Research. 2015;17(3):330–336. doi: 10.1093/ntr/ntu156. https://doi.org/10.1093/ntr/ntu156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Berry C, Burton S, Howlett E. The impact of e-cigarette addiction warnings and health-related claims on consumers’ risk beliefs and use intentions. Journal of Public Policy & Marketing. 2017;36:54–69. doi: 10.1509/jppm.15.024. [DOI] [Google Scholar]
  4. Camenga DR, Delmerico J, Kong G, Cavallo D, Hyland A, Cummings KM, Krishnan-Sarin S. Trends in use of electronic nicotine delivery systems by adolescents. Addictive Behaviors. 2014;39:338–340. doi: 10.1016/j.addbeh.2013.09.014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Centers for Disease Control and Prevention (CDC) Vital signs: Current cigarette smoking among adults aged ≥ 18 years—United States, 2005–2010. 2011 Retrieved from: http://www.cdc.gov.echo.louisville.edu/mmwr/preview/mmwrhtml/mm6035a5.htm. [PubMed]
  6. Centers for Disease Control and Prevention (CDC) Youth risk behavior surveillance—United States, 2011. 2012 Retrieved from: https://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf.
  7. Centers of Disease Control and Prevention (CDC) Notes from the field: Electronic cigarette use among middle and high school students — United States, 2011–2012. 2013 Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm. [PMC free article] [PubMed]
  8. Cobb NK, Byron MJ, Abrams DB, Shields PG. Novel nicotine delivery systems and public health: The rise of the “e-cigarette. American Journal of Public Health. 2010;100(12):2340–2342. doi: 10.2105/AJPH.2010.199281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Copeland AL, Peltier MR, Waldo K. Perceived risk and benefits of e-cigarette use among college students. Addictive Behaviors. 2017;71:31–37. doi: 10.1016/j.addbeh.2017.02.005. [DOI] [PubMed] [Google Scholar]
  10. Drummond MB, Upson D. Electronic cigarettes. Potential harms and benefits. Annals of the American Thoracic Society. 2014;11(2):236–242. doi: 10.1513/AnnalsATS.201311-391FR. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Duke JC, Lee YO, Kim AE, Watson KA, Arnold KY, Nonnemaker JM, Porter L. Exposure to electronic cigarette television advertisements among youth and young adults. Pediatrics. 2014;134(1):e 29–36. doi: 10.1542/peds.2014-0269. [DOI] [PubMed] [Google Scholar]
  12. Hart JL, Walker KL, Sears CG, Lee AS, Smith C, Siu A, Keith R, Ridner SL. Vape shop employees: Public health advocates? Tobacco Prevention and Cessation. 2017;2(Suppl) doi: 10.18332/tpc/67800. doi: https://doi.org/10.18332/tpc/67800. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hoyle RH, Stephenson MT, Palmgreen P, Lorch EP, Donohew RL. Reliability and validity of a brief measure of sensation seeking. Personality and Individual Differences. 2002;32:401–141. [Google Scholar]
  14. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults—United States, 2005–2015. Morbidity and Mortality Weekly Report (MMWR) 2016;65:1205–1211. doi: 10.15585/mmwr.mm6544a2. doi: http://dx.doi.org/10.15585/mmwr.mm6544a2. [DOI] [PubMed] [Google Scholar]
  15. Jidong H, Kornfield R, Szczypka G, Emery SL. A cross-sectional examination of marketing of electronic cigarettes on Twitter. Tobacco Control. 2014;23(S3):iii26–iii30. doi: 10.1136/tobaccocontrol-2014-051551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. King BA, Alam S, Promoff G, Arrazola R, Dube S. Awareness and ever use of electronic cigarettes among U.S. adults, 2010–2011. Nicotine & Tobacco Research. 2013;15(9):1623–1627. doi: 10.1093/ntr/ntt013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. King BA, Patel R, Nguyen KH, Dube SR. Trends in awareness and use of electronic cigarettes among U.S. adults, 2010–2013. Nicotine & Tobacco Research. 2015;17(2):219–227. doi: 10.1093/ntr/ntu191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Larson E, Pearlman DN. Use of emerging tobacco products among adolescents who do not smoke conventional cigarettes. Rhode Island Medical Journal. 2016;99(6):45–47. [PubMed] [Google Scholar]
  19. Lee AS, Hart JL, Sears CG, Walker KL, Siu A, Smith C. A picture is worth a thousand words: Electronic cigarette content on Instagram and Pinterest. Tobacco Prevention and Cessation. 2017:3. doi: 10.18332/tpc/74709. http://doi.org/10.18332/tpc/74709. [DOI] [PMC free article] [PubMed]
  20. Ling PM, Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: Evidence from industry documents. American Journal of Public Health. 2002;96:908–916. doi: 10.2105/AJPH.92.6.908. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Maloney EK, Cappella JN. Does vaping in e-cigarette advertisements affect tobacco smoking urge, intentions, and perceptions in daily, intermittent, and former smokers? Health Communication. 2016;31:129–138. doi: 10.1080/10410236.2014.993496. [DOI] [PubMed] [Google Scholar]
  22. Noar SM, Zimmerman RS, Palmgreen P, Lustria M, Horosewski ML. Integrating personality and psychosocial theoretical approaches to understanding safer sexual behavior: Implications for message design. Health Communication. 2006;19(2):165–174. doi: 10.1207/s15327027hc1902_8. doi: http://dx.doi.org/10.1207/s15327027hc1902_8. [DOI] [PubMed] [Google Scholar]
  23. Palazzolo DL. Electronic cigarettes and vaping: A new challenge in clinical medicine and public health. Frontiers in Public Health. 2013;1:56. doi: 10.3389/fpubh.2013.00056. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Ratzan SC. The next 50 years—Reducing the continued harm from tobacco use. Journal of Health Communication. 2014;19:389–391. doi: 10.1080/10810730.2014.904196. [DOI] [PubMed] [Google Scholar]
  25. Rigotti NA. Strategies to help a smoker who is struggling to quit. Journal of the American Medical Association. 2012;308(15):1573–1580. doi: 10.1001/jama.2012.13043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Saddleson ML, Kozlowski LT, Giovino GA, Goniewicz ML, Mahoney MC, Homish GG, Arora A. Enjoyment and other reasons for electronic cigarette use: Results from college students in New York. Addictive Behaviors. 2016;54:33–39. doi: 10.1016/j.addbeh.2015.11.012. [DOI] [PubMed] [Google Scholar]
  27. Saddleson ML, Kozlowski LT, Giovino GA, Hawk LW, Murphy JM, MacLean MG, Mahoney MC. Risky behaviors, e-cigarette use and susceptibility of use among college students. Drug and Alcohol Dependence. 2015;149:25–30. doi: 10.1016/j.drugalcdep.2015.01.001. [DOI] [PubMed] [Google Scholar]
  28. Sangalang A. The need for communication research in regulatory science: Electronic cigarettes as a case study. International Journal of Communication. 2015;9:3485–3493. [Google Scholar]
  29. Schraufnagel DE. Electronic cigarettes: Vulnerability of youth. Pediatric Allergy, Immunology, and Pulmonology. 2015;28(1):2–6. doi: 10.1089/ped.2015.0490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Sears CG, Walker KL, Hart JL, Lee AS, Siu A, Smith C. Clean, cheap, convenient: Promotion of electronic cigarettes on YouTube. Tobacco Prevention and Cessation. 2017:3. doi: 10.18332/tpc/69393. doi: https://doi.org/10.18332/tpc/69393. [DOI] [PMC free article] [PubMed]
  31. Sherwood CL, Boitano S. Airway epithelial cell exposure to distinct e-cigarette liquid flavorings reveals toxicity thresholds and activation of CFTR by the chocolate flavoring 2,5-dimethypyrazineara. Respiratory Research. 2016;17:57. doi: 10.1186/s12931-016-0369-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Stephenson MT, Southwell BG. Sensation seeking, the activation model, and mass media health campaigns: Current findings and future directions for cancer communication. Journal of Communication. 2006;56:S38–S56. doi: 10.1111/j.1460-2466.2006.00282.x. [DOI] [Google Scholar]
  33. Sutfin EL, McCoy TP, Morrell HER, Hoeppner BB, Wolfson M. Electronic cigarette use by college students. Drug and Alcohol Dependence. 2013;131(3):214–221. doi: 10.1016/j.drugalcdep.2013.05.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Tan ASL, Lee CJ, Chae J. Exposure to health (mis)information: Lagged effects on young adults’ health behaviors and potential pathways. Journal of Communication. 2015;65:674–698. doi: 10.1111/jcom.12163. [DOI] [Google Scholar]
  35. Tierney PA, Karpinski CD, Brown JE, Wentai L, Pankow JF. Flavour chemicals in electronic cigarette fluids. Tobacco Control. 2016;25(e1):e10–e15. doi: 10.1136/tobaccocontrol-2014-052175. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Trumbo CW, Harper R. Use and perception of electronic cigarettes among college students. Journal of American College Health. 2013;61(3):149–155. doi: 10.1080/07448481.2013.776052. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. U.S. Department of Health and Human Services. E-cigarette use among youth and young adults: A report of the Surgeon General—executive summary. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016. Retrieved from: https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf. [Google Scholar]
  38. U.S. Food and Drug Administration. Vaporizers, e-cigarettes, and other electronic nicotine delivery systems (ENDS) 2016 Retrieved June 14, 2016, from http://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm456610.htm.
  39. Wagoner KG, Song EY, Egan KL, Sutfin EL, Reboussin BA, Spangler J, Wolfson M. E-cigarette availability and promotion among retail outlets near college campuses in two southeastern states. Nicotine & Tobacco Research. 2014;16(8):1150–1155. doi: 10.1093/ntr/ntu081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Westenberger BJ. Evaluation of e-cigarettes. St. Louis, MO: Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Division of Pharmaceutical Analysis; 2009. Available from: http://www.fda.gov/downloads/drugs/Scienceresearch/UCM173250.pdf. [Google Scholar]
  41. Willis E, Haught MJ, Morris DL., II Up in vapor: Exploring the health messages of e-cigarette advertisements. Health Communication. 2017;32:372–380. doi: 10.1080/10410236.2016.1138388. [DOI] [PubMed] [Google Scholar]
  42. Yu V, Rahimy M, Korrapati A, Xuan Y, Zou AE, Krishnan AR, Tsui T, Aguilera JA, Advani S, Crotty Alexander L, Brumund K, Wang-Rodriguez J, Ongkeko WM. Electronic cigarettes induce DNA strand breaks and cell death independently of nicotine in cell lines. Oral Oncology. 2016;52:58–65. doi: 10.1016/j.oraloncology.2015.10.018. doi:10.1016/j. oraloncology.2015.10.018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Zuckerman M. Sensation seeking: Beyond the optimal level of arousal. Hillsdale, NJ: Erlbaum; 1979. [Google Scholar]
  44. Zuckerman M. Behavioral expressions and biosocial bases of sensation seeking. New York: Cambridge University Press; 1994. [Google Scholar]
  45. Zuckerman M, Ball S, Black J. Influences of sensation seeking, gender risk, appraisal and situational motivation on smoking. Addictive Behaviors. 1990;15:209–220. doi: 10.1016/0306-4603(90)90064-5. doi: https://doi.org/10.1016/0306-4603(90)90064-5. [DOI] [PubMed] [Google Scholar]

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