E-Cigarette, Conventional Cigarette, and Dual Use in Korean Adolescents: A Test of Problem Behavior Theory

Background/Purpose:

Few barriers for selling e-cigarettes and myths about e-cigarettes (e.g., e-cigarettes are safer than conventional cigarettes) contribute to the increasing prevalence of e-cigarette use among Korean youth. Although there is a growing body of research examining adolescent e-cigarette use in Korea, little is known about how various factors are associated with the use of e-cigarettes, conventional cigarettes, and dual use among adolescent tobacco users. Using the framework of Jessor and Jessor’s problem behavior theory (PBT), this study examines the list of PBT factors which affects current e-cigarette and cigarette use, and dual use among adolescent tobacco users.

Methods:

Using data from the 2017 Korea Youth Risk Behavior Web-based Survey, three groups of adolescent tobacco users were created for this study: ever cigarette users (n = 8,150), ever e-cigarette users (n = 4,302), and current cigarette or e-cigarette users (n = 4,022). We measured PBT variables as possible predictors of current e-cigarette use among ever cigarette users (Group 1), current cigarette use among ever e-cigarette users (Group 2), and dual use among current cigarette or e-cigarette users (Group 3): Personality system (reasons for using e-cigarettes, suicidal thoughts, feelings of hopelessness, and stress), perceived environment (exposure to tobacco advertisement, tobacco accessibility, and secondhand smoke exposure at home), and behavior system (sexual intercourse, alcohol use, and participation in school-based tobacco control programs). Logistic regression analyses were used to examine predictors in each group.

Results:

In the personality system domain, use of e-cigarettes as alternative was the only significant predictor of current cigarette users among ever e-cigarette users (Group 2). In the perceived environment system domain, significant predictors include exposure to tobacco advertisement for Group 2, tobacco accessibility for Group 1, 2, and 3, and secondhand smoke exposure at home for Group 1 and 3. In the behavior system domain, significant predictors include sexual intercourse for every group, alcohol use for Group 2, and participation in school-based tobacco control programs for Group 2. In terms of demographics, girls were more likely to turn to current e-cigarette use than boys among ever cigarette users (Group 1). Middle school students (vs. high school students) were more likely to switch from the conventional smoking to e-cigarette smoking in Group 1 and to use both cigarettes and e-cigarettes in Group 3.

Conclusions and Implications:

Largely, more perceived environment system and behavior system factors than personality system variables predicted adolescent tobacco use. This study suggests that tobacco control programs only consider certain subgroups of adolescent tobacco users. While tobacco accessibility and sexual intercourse were common predictors across all three groups, predictors such as use of e-cigarettes as alternative, exposure to tobacco advertisement, and participation in school-based tobacco control programs were unique to Group 2. These factors were associated with the argument indicating that e-cigarette use could be the gateway to the use of conventional cigarette use.