Professional Doctorate in Health Psychology thesis portfolio (Clarke : 2015) : Adolescents' views of the electronic cigarette: a new gateway to addiction?

Clarke, Tilean Naomi (2015) Professional Doctorate in Health Psychology thesis portfolio (Clarke : 2015) : Adolescents' views of the electronic cigarette: a new gateway to addiction? Doctoral thesis, London Metropolitan University.


In the UK alone it is estimated that there are 2.1 million adult electronic cigarette (e-cigarette) users (Action on Smoking and Health, 2014). Introduced to the UK in 2006, ecigarette use has grown rapidly from 700,000 users in 2012 (Kmietowicz, 2014). Given that smoking initiation begins for the most part during adolescence, it is debatable as to whether the e-cigarette could be a gateway into addiction for adolescent non-smokers. This study examined awareness and use of the e-cigarette amongst adolescents, exploring factors that could lead to willingness to try the e-cigarette and susceptibility to smoking conventional cigarettes.

Using a between-participants survey design, power analysis calculated a sample size of at least 103 for medium effect. Exceeding this, 256 adolescent pupils aged 16 to 19 years consented to take part in the study. Survey data was collected in November 2013, during a series of 45-minute workshops held during school time. Data was analysed using chi-squared analysis and hierarchical multiple regression. RESULTS: Nearly all participants had heard of the e-cigarette (94.5%), with friends/family (49.2%) being the most frequently named source of information, followed by television (35.2%). Of the sample 14.5% had used an e-cigarette. Participants were more willing to try flavoured as opposed to the unflavoured version. Smoking status significantly predicted over a third of the variance of willingness to try an e-cigarette (F(1,254) = 141.81, p < .05) and a further 7.8% of the variance was significantly predicted by a positive prototype of a smoker and a negative prototype of an e-cigarette user (R² change = .078, F (8,246) = 4.27, p < 0.05). Willingness to try an e-cigarette was a significant predictor of susceptibility to use of an e-cigarette in the next year (F (1,253) = 174.71, p < .05) and smoking in the next year, in non-smokers (F(1,190) = 60.34, p < .05).

Findings illustrated high levels of e-cigarette awareness among adolescents in a London, UK population. Use, whilst at low levels, had increased from the 10% reported in 2012 by Action on Smoking and Health (2014). Willingness to try an e-cigarette was associated with use susceptibility in the next year for both e-cigarettes and conventional cigarettes. This could be interpreted as a gateway effect, in terms of adolescents inclined to use e-cigarettes and then switch to conventional cigarettes (Bell and Keane, 2014). Future research using longitudinal methodologies would enable researchers to track the trend in e-cigarette use over time, observing whether e-cigarettes are truly serving as a gateway to addiction for other forms of nicotine products. Furthermore, prevention efforts to minimise smoking in youths should educate them about e-cigarette use as a cessation aid for smokers.

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