E-cigarette use and other risk factors associated with tobacco smoking susceptibility among Australian adolescents

Aust N Z J Public Health. 2023 Oct;47(5):100076. doi: 10.1016/j.anzjph.2023.100076. Epub 2023 Aug 22.


Objective: To explore risk factors for smoking susceptibility among Australian adolescents to inform prevention policies and programs.

Methods: Cross-sectional survey of students aged 12-17 years who reported having never smoked (n=4,171). Bivariate associations between smoking susceptibility and a range of factors previously linked to youth smoking and smoking susceptibility were initially examined, with significant factors (p<0.05) included in a final multivariable logistic regression model.

Results: Eleven percent of adolescents who had never smoked were susceptible to smoking. Smoking susceptibility was independently associated with ever use of e-cigarettes (adjusted odds ratio [AOR]=3.26, 95% confidence interval [CI]: 1.83-5.81), perceiving those who smoke to be more popular (AOR=2.87, 95% CI: 1.62-5.10), having a close friend/s who smokes (AOR=2.66, 95% CI: 1.61-4.40), not perceiving smoking one or two cigarettes occasionally as personally dangerous (AOR=2.56, 95% CI: 1.61-4.09), and having symptoms of depression (AOR=1.59, 95% CI: 1.06-2.38).

Conclusions: The strongest smoking-initiation risk factor identified was ever use of e-cigarettes, with social norms, harm misperceptions around low-rate tobacco use and mental health also linked to smoking susceptibility.

Implications for public health: Stronger e-cigarette regulations that reduce promotion to and access by youth, as well as interventions addressing the other identified risk factors, may help prevent future smoking uptake among Australian adolescents.

Keywords: adolescent health; cross-sectional survey; e-cigarettes; prevention; smoking susceptibility.