Adolescents' attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation

Prev Med. 2017 Jan;94:65-71. doi: 10.1016/j.ypmed.2016.10.019. Epub 2016 Oct 20.


E-cigarette use has dramatically increased. While studies have examined adolescents' attitudes towards smoking, few have extended this research to adolescents' attitudes towards e-cigarettes. The goal of this study was to examine adolescents' attitudes regarding e-cigarette ingredients, safety, addictive properties, social norms, accessibility, price, and regulation; and determine whether attitudes differ by past cigarette/e-cigarette use. Participants were 786 9th and 12th graders from California (63.21% females; mean age=16.10years [SD=1.6]; 26.61% White, 21.98% Asian/Pacific Islander, 29.82% Hispanic, and 21.59% other). Results indicated that 19.05% of participants believed smoke from e-cigarettes is water; 23.03% believed e-cigarettes aren't a tobacco product; 40.36% considered e-cigarettes to be for cessation, and 43.13% felt they were safer than cigarettes. Participants felt it was more acceptable to use e-cigarettes indoors and outdoors compared to cigarettes (p<0.0001), 23.13% felt raising e-cigarette taxes is a bad idea, 63.95% thought e-cigarettes were easier to get than cigarettes, 54.42% felt e-cigarettes cost too much, 64.33% felt the age for buying e-cigarettes should be raised, and 64.37% favored e-cigarette regulation. Adolescents who used e-cigarettes and/or cigarettes had significantly more favorable e-cigarette attitudes than non-users. This study indicates that adolescents are aware of some of the risks of e-cigarettes, although many harbor misperceptions and hold more favorable attitudes towards e-cigarettes than cigarettes. Of concern is the relationship between favorable e-cigarette attitudes and use. Findings suggest the need to provide adolescents with correct information about e-cigarette ingredients, risks, and the insufficient evidence of their role in cigarette cessation.

Keywords: Adolescent health; Adolescent perceptions; Adolescent substance use; E-cigarettes; Public health.

MeSH terms

  • Adolescent
  • Adolescent Health
  • Behavior, Addictive / psychology*
  • California
  • Electronic Nicotine Delivery Systems / economics
  • Electronic Nicotine Delivery Systems / psychology*
  • Electronic Nicotine Delivery Systems / statistics & numerical data
  • Female
  • Government Regulation*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Nicotine / adverse effects
  • Risk Factors
  • Safety
  • Social Norms*
  • Surveys and Questionnaires


  • Nicotine