Psychosocial Factors Associated with E-Cigarette Use among Young Adults in a 4-Year University in Appalachia

Young adults (ages 18-25) have the highest rate of e-cigarette use, or vaping, among any other age group. College students make up a large portion of young adults and are on the forefront of cultural substance use patterns. Objectives In order to determine methods to reduce vaping prevalence, motivations for use and co-occurring health behaviors and disorders need to be determined. This study investigated vaping characteristics and associated health behaviors in a young adult Appalachian college population. Methods Students attending an Appalachian university were invited to participate in an online survey measuring their use of e-cigarettes, motivations for use, mental health, and Adverse Childhood Experiences (ACEs). Analysis included prevalence of e-cigarette use and associations between e-cigarette use and Appalachian identity, mental health, and ACEs. Results Participants (N = 3398) stated that the most common motivator for using e-cigarettes was to decrease stress, followed by the good taste, friends' usage, and wanting to quit cigarettes. E-cigarette use was associated with alcohol use, anxiety, depression, stress, and Adverse Childhood Experiences (ACEs) and these variables were placed into a full logistic regression model, in which anxiety and stress were no longer significant, and alcohol use was the strongest association (OR 1.36 95% CI 1.35-1.42, p<.0001). Conclusions/importance: Findings demonstrate a need for efforts to reduce e-cigarette use to focus on the co-use of alcohol, co-occurring mental health disorders, and the social and enjoyment motivations for use.