descriptive e-cigarette norms on tobacco attitudes and smoking behavior: The importance of close friends and peers Michael Coleman & William D. Crano william.crano@cgu.edu

Overview Background E-cigs vs. Tobacco Current Study Methodology Results Discussion

Background E-cigs: Handheld battery-operated nicotine delivery devices Presented as the solution to traditional cigarettes Manufacturers claim they are harmless (Water vapor) & help smokers quit Recent research suggests that E-cigs may attract young smokers (Bullen et al., 2010; Eissenberg, 2010; Vansickel et al., 2010)

E-cigs Vs. Traditional Cigs: Examining the Link Current E-cig use Among Middle and High school Students from 2011-2015 Ever-use rates in School Children: Middle 4.5% - 12.5 High: 5% - 38% Decline in Cigarette Use Middle: 4.3% - 2.2% High: 15.8% - 8% Latest Research Suggests that E-cigs May Serve to Attract Young Smokers to Tobacco Use Exposure to Nicotine and Normalization of Smoking Behavior May be Contributing Factors to Later Cigarette and Marijuana Use Adolescents May be Especially Susceptible to Nicotine Addiction Due to Developmental Period Preliminary Evidence Suggests Drop in Cigarette Use, but NOT Overall Tobacco Use However Previous Research has not Examined the Importance of Normative Influence and has Relied on Cross-Sectional Data (Kandel, Yamagucho, & Chen, 1992; Camenga et al., 2014; Bunnel et al., 2015)

The Current Study Longitudinal Data Collected from Alternative High-School Students in Southern California Hypotheses: H1- Non-tobacco smoking participants with peers or parents reporting e-cig use will report higher willingness to try regular cigarettes. H2- Non-tobacco smoking participants who consider e-cigs normative (>50% peer use) will report higher willingness to try regular cigarettes. H3- Peer and Family use of E-cigs will be associated with more positive expectancies towards regular cigarettes. H4- Non-tobacco smoking participants with Peers and Family reporting E-cig use will report higher rates of traditional tobacco use one year post. H5- Non-smoking (Tob/MJ) participants with Peers and Family reporting E-cig use will report higher rates of traditional tobacco and marijuana use one year post.

Method Secondary Data Analysis Data Obtained from CGU School of Community and Global Health Longitudinal Study Focused on E-cigarettes, Traditional Tobacco Use and Marijuana Use Total Dataset Included 2,727 Alternative High-School (AHS) students Present Study Focused on Adolescents (Ages 15-18) N = 788 (Mean Age: 17, SD = 1.09)

Measures Tobacco Use Willingness (Gerrard et al., 2008) Family & Peer Smoking (Youth Tobacco Survey, 2014) Peer & Family Ever Use E-cigs Four Closest Friends E-cig Use Tobacco Use Willingness (Gerrard et al., 2008) “If it were offered by one of your friends, how willing would you be to try…?” E-cig/Tobacco/Marijuana Use Use (Youth Tobacco Survey, 2014) “Have you ever used…?” Positive Tobacco Expectancies (Youth Tobacco Survey, 2014) “Smoking is enjoyable” “Smoking leaves a pleasant tingle on the tongue”

Results H1: “Non-tobacco smoking participants with peers or parents reporting e-cig use will report higher willingness to try regular cigarettes.” Independent Samples T-Tests: Participants reporting close friend e-cig use reported higher willingness to accept cigarettes. t(397) = 3.36, p < .001. Binary Logistic Regression: No Significant Relationship of Gender or Age Hispanic Youth: 3.46 greater odds At least 1 Peer using E-cigs: 4.46 greater odds Parent Use: 1.47 greater odds

Results Cont. H2: “Non-tobacco smoking participants that consider e-cigs normative (>50% peer use) will report higher willingness to try regular cigarettes.” Independent Samples T-Tests: Participants reporting e-cig use as normative reported higher willingness to accept cigarettes. t(403) = 2.89, p < .001. Binary Logistic Regression: No Significant Relationship of Gender or Age Hispanic Youth: 2.12 greater odds Normative E-cig Use: 3.11 greater odds

Results Cont. H3: “Peer and Family use of E-cigs will be associated with more positive expectancies towards regular cigarettes.” Two One-way ANCOVAs were conducted to examine if adolescents reporting close friend or parent e-cig use would report more positive expectancies towards regular cigarettes Results Indicated Significant Effect of Peer E-cig Use on Positive Expectancies after controlling for sample characteristics F(1,495) = 16.24, p < .001 Significant Effect of Family Member E-cig use on Positive Expectancies F(1, 440) = 5.73, p < .01

Results H4: “Non-tobacco smoking participants with Peers and Family reporting E-cig use will report higher rates of traditional tobacco use one year post.” Path analysis based on structural equation modeling (Crano, Brewer, & Lac, 2015) Model: χ2 (2) = 2.36 p = .31 CFI = .99 TLI = .99 RMSEA = .02 90%CI = (.01-.08) R2 = .58

Results H5: “Non-smoking (Tob/MJ) participants with Peers and Family reporting E-cig use will report higher rates of traditional tobacco and marijuana use one year past.” Path analysis based on structural equation modeling Model: χ2 (2) = 2.16 p = .27 CFI = .98 TLI = .97 RMSEA = .03 90%CI = (.01-.07) R2 = .55

Discussion Present data supports the link between E-cig use and normative beliefs about e-cigs to traditional cigarette and marijuana use. 1 Peer norms and prior use have the strongest impact on tobacco expectations, willingness to try, and future tobacco and marijuana use. 2 Path model analysis provides new longitudinal evidence for the relationship of e-cigs to the onset of tobacco and marijuana use. 3

Limitations & Future Directions Study Sample: Limited, but Important Secondary Analysis Choice of measures limited, but good Other? There always are other issues

Conclusion Tobacco/Marijuana Norms E-Cig Use Set out to Examine the Relationship of E-cig Norms and Traditional Tobacco/Marijuana Use. Present Study Found Support for all Hypotheses. Future Research Should Examine the Potential Pathways of Multiple Norms Measures on E- cig and Traditional Cigarette/Marijuana Use .