Electronic Nicotine Delivery Systems and Acceptability of Adult Cigarette Smoking Among Florida Youth: Renormalization of Smoking?

Introduction:
This text is a summary of a research study examining the relationship between exposure to electronic nicotine delivery systems (ENDS) and acceptance of cigarette smoking among Florida youth. The study also explores whether these associations differ between middle and high school students and by smoking status (never and ever smokers). Additionally, the study investigates whether the associations between own ENDS use, exposure to ENDS advertising, living with ENDS users, and susceptibility to cigarette smoking among never smokers are mediated by acceptability of adult cigarette smoking using structural equation models.

Key Points:

* The study used data from the 2014 Florida Youth Tobacco Survey (FYTS) with a sample size of 68,928 middle and high school students.
* Exposure to ENDS (use, advertising, and living with ENDS users) was positively associated with perceived peer and community acceptance of adult cigarette smoking.
* These associations were significant for never smokers but not for ever smokers.
* Mediation analysis showed significant indirect effects of lifetime ENDS use and exposure to ENDS advertising on susceptibility to cigarette smoking through peer acceptance of adult cigarette smoking among both middle and high school students who never smoked cigarettes.
* Living with ENDS users had a significant indirect effect on susceptibility to cigarette smoking through community acceptance of adult cigarette smoking among never smoking students.
* Among high school students who smoked cigarettes in their lifetime, ENDS use was positively associated with community acceptance of adult cigarette smoking.
* The study suggests that ENDS exposure may contribute to normalizing cigarette smoking among nonsmoking youth by promoting a normative perception of cigarette smoking.

Main Message:
The main message of this study is that ENDS exposure, including use, advertising, and living with ENDS users, may contribute to the renormalization of cigarette smoking among nonsmoking youth. This normalization, if confirmed in longitudinal studies, could complicate public health efforts to denormalize cigarette smoking and prevent smoking initiation. Therefore, interventions to reduce youth ENDS use, regulations to reduce youth exposure to ENDS marketing, and policies to reduce youth exposure to ENDS use at home may be necessary to uphold successful public health efforts to denormalize cigarette smoking and prevent smoking initiation due to electronic cigarettes.

Choi, Kelvin, Rachel Grana, and Debra Bernat. “Electronic Nicotine Delivery Systems and Acceptability of Adult Cigarette Smoking Among Florida Youth: Renormalization of Smoking?” Journal of Adolescent Health 60, no. 5 (May 2017): 592–98. https://doi.org/10.1016/j.jadohealth.2016.12.001.