title: The Use of E-cigarettes Among School-Going Adolescents in a Predominantly Rural Environment of Central Appalachia.
abstract: E-cigarette use among youth in the United States (U.S.) continues to increase. In the rural Northeast Tennessee, where prevalence of tobacco use is higher than national and state averages, there is no literature on e-cigarette use to inform policies and programs. This study aimed to estimate the prevalence of e-cigarette use and examine association of e-cigarette use with two tobacco products among school-going adolescents. Data from 894 participants of a school-based survey conducted in 2016 in Northeast Tennessee were analyzed. Descriptive statistics and logistic regression analyses were conducted to estimate the prevalence and delineate the associations between e-cigarette use and other tobacco products. Approximately 11% of the participants currently used e-cigarettes, and 35% had ever used e-cigarettes. About 6% of the participants were current users of both e-cigarettes and cigarettes; 4% were current users of e-cigarettes and smokeless tobacco; 3% were current users of all three products, and 15% had ever tried all three products. More than one-half of current e-cigarette users (52%) also smoked cigarettes. Adjusting for covariates, current e-cigarette use was positively associated with cigarette smoking [Odds Ratio (OR) 27.32, 95% confidence interval (CI) 14.4-51.7] and smokeless tobacco use [OR 7.92, 95% CI 3.8-16.5]. E-cigarette use was more common among the high school students than cigarette and smokeless tobacco use, and a significant proportion of users either smoked cigarettes, used smokeless tobacco, or both. Thus, there is a critical need for preventive policies and programs to address dual and poly-use of these products.
authors.affiliation: Georgia State University Tobacco Center of Regulatory Science (GSU TCORS), Atlanta, GA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Owusu
authors.affiliation: , Johnson City, USA.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Aibangbee
authors.affiliation: Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Candice
authors.initials: C
authors.lastname: Collins
authors.affiliation: Louisiana Department of Health, Office of Public Health, Baton Rouge, LA, USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Robertson
authors.affiliation: Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Littleton
authors.affiliation: , Blountville, USA.
authors.forename: Rafie
authors.initials: R
authors.lastname: Boghozian
authors.affiliation: Sullivan County Health Department, Blountville, TN, USA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Casenburg
authors.affiliation: Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN, USA. mamudu@mail.etsu.edu.
authors.forename: Hadii M
authors.initials: HM
authors.lastname: Mamudu
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012424:Rural Population / Q000706:statistics & numerical data*; D013334:Students / Q000706:statistics & numerical data*; D013714:Tennessee / Q000453:epidemiology; D064424:Tobacco Use / Q000453:epidemiology*; D055815:Young Adult
keywords: Dual use; E-cigarette; High school students; Northeast Tennessee; Poly-use