A supportive youth cigarette social environment, e.g. friends’ approval of use, leads to cigarette use initiation, and cigarette users develop a more supportive social environment. Whether there is a bidirectional relationship of e-cigarette social environment with e-cigarette use has not been studied.
Prospective data were collected from 1441 Children’s Health Study participants in 2014 (median age=17.3 years) and at follow-up 1.5 years later. Associations were examined of (1) supportive e-cigarette social environment with subsequent e-cigarette use initiation and (2) of baseline e-cigarette use with supportive e-cigarette social environment at follow-up (among those with a non-supportive baseline social environment).
Participants with 3-4 friends using e-cigarettes at baseline (vs. no friends) had an odds ratio (OR) of 4.08 of subsequent initiation (95% confidence interval (CI): 1.96,8.49); those with best friends who would have a very friendly (vs. unfriendly) reaction to e-cigarette use had OR 2.54 of initiation (95%CI: 1.57,4.10); and those with someone in the home using e-cigarettes had OR 1.94 of initiation (95%CI: 1.19,3.15). Participants who had ever used e-cigarettes at baseline developed a supportive social environment at follow-up (OR 2.06 of having any friends who used e-cigarettes (95%CI: 1.29, 3.30) and OR 2.33 of having friends who were friendly toward use (95%CI: 1.32, 4.11). Similar bidirectional associations were observed between ever cigarette use and a supportive cigarette social environment.
The bidirectional relationship between a supportive e-cigarette social environment and ever use of e-cigarettes was similar to that previously observed between cigarette social environment and cigarette use.
Disrupting the social acceptability of youth e-cigarette use merits consideration as a strategy for preventing initiation of e-cigarette use, just as the social de-normalization of cigarette use has proven to be effective in preventing cigarette initiation.