Perceptions, Initiation, and Use of E-cigarettes Among Middle School Students: A New Generation of Tobacco Users?

A rapid rise in adolescent use of electronic cigarettes (e-cigarettes) is a significant public health concern, as the effects of using e-cigarettes are largely unknown. Researchers are teaming up with middle school students to learn what youth think about e-cigarettes, how common e-cigarette use is, & if e-cigarette use leads to use of other tobacco products.
Co Investigators

Youth are using electronic cigarettes (e-cigarettes) at a rapidly increasing rate. Unfortunately, there is a lack of scientific knowledge regarding why e-cigarettes appeal to youth, the effects of ecigarette use, and how e-cigarette marketing influences adolescents’ beliefs, intentions, and willingness to use these novel tobacco products.

Investigators are using multiple methods of data collection with middle school youth to assess the appeal and perceptions of e-cigarettes, whether e-cigarettes are acting as a “gateway” to combustible tobacco products, and if youth are becoming dependent on nicotine from e-cigarette use. Data collected will contribute to the currently sparse body of scientific knowledge and guide future regulation of e-cigarettes by the FDA.


9/20/16 - 8/31/19


National Cancer Institute (NCI)


High Use of Electronic Cigarettes seen in 8th-9th graders in Oregon;
Associated with Use of Other Substances

“Our data was collected in 2017, prior to regulation of e-cigarettes by the Food and Drug Administration (FDA). There were no limits on advertising, flavorings, or e-liquid content, and e-cigarettes were being heavily marketed to youth,” said Westling. “Given the high rates of use and previous marketing efforts, youth access to and willingness to use e-cigarettes may not be easily changed.”

Results from this study showed that rates of electronic cigarette (e-cigarette) use among Oregon 8th and 9th graders is higher than seen in national samples, and that e-cigarette use is closely linked with use of marijuana and other tobacco products. Led by ORI scientist Erika Westling, Ph.D., study investigators examined e-cigarette prevalence rates in 8th graders and tracked early usage patterns from 8th grade through 9th grade, the first year of high school. Westling and her team also examined gender, ethnicity, and the use of other substances. Study results were published in the June 2017 issue of the Journal of Adolescent Health.

The study showed that adolescents are using e-cigarettes at high rates, and many are using e-cigarettes before trying regular cigarettes or chewing tobacco. In addition, e-cigarette users were more likely to have used and be using other substances, with marijuana being the most common. At the beginning of the study, 27.7% of 8th grade students reported some use of e-cigarettes and 16.8% were current users. By the spring of 9th grade, 31.4% of students had used e-cigarettes and 17.4% were current users.

“We found that e-cigarettes were being used at much higher rates than conventional cigarettes,” noted Westling, “and about 5% of students were using e-cigarettes daily in the 9th grade, which suggests addiction to nicotine via e-cigarettes in these young adolescents.”

The research team surveyed 1100 Oregon students from seven school districts once at the end of 8th grade and three times across 9th grade. Results indicated there were no significant gender or ethnicity differences in prevalence of use in 8th grade or in accelerated usage rates through 9th grade. Males, females, Hispanics, and non-Hispanics were at equal risk for trying and escalating use of e-cigarettes over time. This reveals the broad appeal, access, and popularity of e-cigarettes to this population, and indicates that anti-e-cigarette marketing strategies should target all of these groups.