Protective Factors

Several protective factors may decrease an adolescent’s risk of initiating e-cigarette use, such as the belief that using an e-cigarette could lead to addiction, parental antismoking norms, college aspirations, and higher parental educational attainment. 

Factors with the greatest impact on a high school student’s odds of vaping, smoking, or doing both were the following: if a student feels that a parent thinks it is not wrong or slightly wrong for them to smoke, if a student reported having housing instability, if a student reported depressive symptoms in the past year, and if a student usually received grades of C or below. These findings are consistent with the findings of several other studies. The National Youth Tobacco Survey found a strong relationship between depression and smoking among adolescents, and students doing poorly in school were more likely than those not doing poorly to use a tobacco product (3). The 2016 Surgeon General’s Report also noted that students with lower academic achievement are more likely than those with higher academic achievement to begin tobacco use (14). A study that examined tobacco use among Somali middle and high school students in Minnesota found that parental antismoking norms protected against the use of all tobacco products (12). Our findings were similar: we found increased odds of vaping, smoking, or doing both when students felt their parents did not think it would be wrong for them to smoke. Our results were also similar to those of a study of college students in Texas, which found that depressive symptoms increased the likelihood of a vaping (9). Our finding of a relationship between poor school performance and use of tobacco products was similar to the findings of another study, which found an association between poor school performance and e-cigarette susceptibility among eighth graders (11). By understanding these factors, public health interventions can be appropriately tailored to reach the groups at risk of these behaviors. We have several recommendations for developing effective programs to decrease vaping and smoking rates among adolescents. We recommend that interventions include educating parents about smoking and vaping products, how these products work, nicotine addiction and its effect on the adolescent brain, and the factors that may increase or decrease the likelihood of their adolescent vaping, smoking, or doing both. Another recommendation is to increase services for adolescents to help with depression, bullying, and housing insecurity. Increasing availability and access to services, such as counseling, could help decrease the prevalence of some of these factors and potentially decrease the likelihood of an adolescent vaping or smoking. In addition, tobacco education should continue to be provided to adolescents in Maine and across the country. Finally, we recommend that research examine the association of risk and protective factors with different levels of use of e-cigarettes and cigarettes; for example, using the numbers of days of use during the past 30 days in analysis rather than just any use versus no use.