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J Adolesc Health. 2017 May;60(5):592-598. doi: 10.1016/j.jadohealth.2016.12.001. Epub 2017 Jan 31.

Electronic Nicotine Delivery Systems and Acceptability of Adult Cigarette Smoking Among Florida Youth: Renormalization of Smoking?

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Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD. Electronic address:
Tobacco Control Research Branch, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, MD.
Department of Behavioral and Community Health, University of Maryland, College Park, MD.



There is a dearth of research into whether electronic nicotine delivery systems (ENDS) promote acceptance of cigarette smoking. Therefore, we aimed to assess the association between ENDS exposure, acceptance of cigarette smoking, and susceptibility to cigarette smoking.


Data from the 2014 Florida Youth Tobacco Survey with a state representative sample of middle and high school students (n = 68,928) were analyzed. Own ENDS use, exposure to ENDS advertising, living with ENDS users, acceptance of adult cigarette smoking, demographics, and known predictors of cigarette smoking were assessed. Susceptibility to cigarette smoking was assessed among never smokers. Weighted multiple logistic regression models and mediation analyses were conducted, stratified by middle/high school and never/ever smoking. Analyses were conducted in 2016.


Own ENDS use, exposure to ENDS advertising, and living with ENDS users were associated with acceptance of adult cigarette smoking even among never smokers, after accounting for covariates (p < .05). In a mediation analysis, own ENDS use, exposure to ENDS advertising, and living with ENDS users were indirectly associated with susceptibility to cigarette smoking among never smokers through acceptance of adult cigarette smoking (p < .05).


Youth ENDS exposure may contribute to normalizing adult cigarette smoking and may in turn heighten susceptibility to cigarette smoking. If confirmed by longitudinal studies, these findings suggest that ENDS policy interventions may help prevent youth cigarette smoking.


Acceptability; Cigarette smoking; Electronic nicotine delivery systems; Susceptibility

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