E-Cigarette risk perception in adolescents: The role of flavors and friends

Background: Examining the way adolescents perceive and trade-off the risks of e-cigarettes is critical for designing effective tobacco cessation policies and informing ongoing FDA regulations. This study evaluates the perceived risks of e-cigarettes in adolescents, and analyzes the impact that flavors and peers have on e-cigarette risk perception.

Methods: We conducted surveys in primarily urban, minority high schools in Connecticut to assess 1) e-cigarette and tobacco usage, 2) the perception of the healthfulness of different e-cigarette flavors, and 3) the impact of peer “closeness” on the perceived risks of e-cigarette products.

Results:  Participants (n=576) reported high levels of awareness of e-cigarettes (80%) yet far lower levels of usage (17%).  Students perceived fruit flavors to be both healthy and addictive, and believed tobacco flavors were more likely to cause lung cancer, irritate the throat, and give bad breath.  When asked how difficult they thought it would be to stop using e-cigarettes, students were more likely to think that it would be easier to quit themselves than for a close friend, for a peer at the same school, and for average US teenagers - in that order (optimism bias).

Conclusion: High Schools students perceive fruit flavors as both appealing and healthy, and demonstrate an optimism bias by increasing degrees of peer “closeness.”