A Theory of Reasoned Action Analysis of Youth Electronic Vapor Product Use

Background and Purpose: The prevalence of electronic vapor products (EVPs), including e-cigarettes and e-cannabis, remains a considerable public health challenge among youth. National data from 2022 show that 14.1% of high school students and 3.3% of middle school students reported EVP use in the past 30 days (Park-Lee et al., 2022). Guided by the Theory of Reasoned Action (TRA), this study examines how individual attitudes, perceived social norms (e.g., peer EVP use), and behavioral intentions contribute to EVP use during early adolescence. The current study conceptualizes individual attitudes via unstructured socializing (e.g., delinquency), which reflects favorable dispositions toward risk-taking and substance use. Perceived social norms are captured through peer EVP use, representing youth perceptions of what is typical or acceptable among peers. Behavioral intention is operationalized through past-month EVP use. Additionally, we examine parental monitoring as a contextual moderator that may influence individual attitudes and social norms' salience. We consider accessibility a reinforcing factor that may increase the scope and feasibility of EVP use, thereby shaping perceptions of social norms. This study extends prior research by applying TRA to middle school youth and modeling the co-occurrence of interpersonal, behavioral, and contextual risk factors during early adolescence.

Methods: Participants included 1,375 middle school students. The current study used past 30-day use of e-cigarettes and e-cannabis via EVPs as the dependent variable. Key predictors were levels of parental monitoring, peer EVP use, and engagement in health-risk behaviors (e.g., delinquency). Bivariate analyses, including independent samples t-tests and Fisher’s exact tests, were conducted to examine associations between predictors and outcomes. Multivariate logistic regression models were then used to estimate adjusted associations, controlling for baseline substance use.

Results: Bivariate analyses indicated that youth who reported past-month use of e-cigarettes or e-cannabis also reported significantly lower parental monitoring, higher peer e-cigarette use, and greater engagement in health-risk behaviors. In multivariate models, peer vaping behavior and health-risk behaviors remained significant predictors of both e-cigarette and cannabis EVP use. Parental monitoring was protective against e-cigarette use but not significantly associated with e-cannabis use.

Conclusions and Implications: Current findings support the TRA framework, emphasizing the role of peer norms and behavioral modeling in youth EVP use. Peer behavior and involvement in health-risk activities emerged as salient risk factors for EVP use and were associated with an increased likelihood of use, highlighting the influence of social context. Indeed, adolescents spend a great deal of time with their friends and often emulate peer behavior. Parental monitoring emerged as a protective factor, but its effect appeared substance-specific, associated with reduced e-cigarette use but not e-cannabis use. This suggests that youth may perceive and respond to different substances in distinct ways, potentially due to differences in social acceptability and access. School-based programs such as LifeSkills Training are well-positioned to address these dynamics by targeting peer influence, enhancing behavioral self-regulation, and fostering adult engagement. Future research should examine how peer dynamics, supervision, and substance-specific norms interact over time to inform context-sensitive interventions that effectively support healthy youth development.