Co-occurring Change in Electronic Nicotine Delivery System (ENDS) and Cigarette Harm Perceptions and Use in Young Adults

Introduction:
This text presents the results of a longitudinal study examining the relationship between electronic nicotine delivery systems (ENDS) and cigarette use in young adults. The study tests two potential mechanisms by which ENDS use may facilitate cigarette use: desensitization (decreasing tobacco harm perceptions) and renormalization (increasing favorability of tobacco use). The study uses data from a large sample of young adults who reported any ENDS or combustible cigarette use at ages 21, 23, or 26.

Key Points:

* The study uses parallel process latent growth models to test how change in ENDS use and harm perceptions about ENDS use co-occur with change in cigarette use and harm perceptions about cigarette use across a 6-year period from ages 21, 23, and 26.
* The results show that when ENDS harm perceptions decreased and ENDS use increased, cigarette harm perceptions decreased and the favorability of cigarettes increased.
* Decreases in ENDS harm perception were differentially associated with the likelihood of transition to cigarette use (an increase) and frequency of use when it occurred (a decrease).
* The study also finds that changing tobacco harm perceptions and favorability are two processes by which ENDS use may underlie transitions to cigarette use.
* The findings suggest that prevention messaging around tobacco products should emphasize the potential harms of ENDS use, especially among young adults who are not already frequent cigarette smokers.

Main Message:
The study highlights the importance of understanding the relationship between ENDS use and cigarette use in young adults. The findings suggest that prevention messaging around tobacco products should emphasize the potential harms of ENDS use, including the increased likelihood of cigarette use after initiating ENDS. This is particularly important for young adults who are not already frequent cigarette smokers. The study underscores the need for continued research in this area to inform effective tobacco control policies and interventions.

Justin D Caouette, Marina Epstein, Max A Halvorson, Sarah Danzo, Margaret R Kuklinski, Sabrina Oesterle, Co-occurring Change in Electronic Nicotine Delivery System (ENDS) and Cigarette Harm Perceptions and Use in Young Adults, Nicotine & Tobacco Research, Volume 27, Issue 7, July 2025, Pages 1192–1199, https://doi.org/10.1093/ntr/ntaf014