The Journal of School Nursing2025, Vol. 41(4) 426–430© The Author(s) 2023Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405231185594journals.sagepub.com/home/jsn
Abstract
E-cigarettes are a popular type of nicotine product among youth in the United States. Hispanic youth, one of the fastest growing populations in the United States, are second only to white youth for e-cigarette use. Analysis of the Parents’ Resource Institute for Drug Education data was conducted to determine past 30-day e-cigarette use among Hispanic youth (n = 4,602) and also examined school factors related to such use. Findings indicated that 13.8% of Hispanic youth used e-cigarettes in the past 30 days. Multivariate logistic regression analysis determined several school factors (e.g., poor grades, grade level) related to e-cigarette use. School-based prevention programs are needed to reduce and eliminate e-cigarette use among Hispanic youth.
Keywordssecondary data analysis, e-cigarettes, school, Hispanic youth
E-cigarettes, one popular type of nicotine product, convert a liquid (e.g., e-liquid that may contain propylene glycol, water, and other chemicals) into aerosol through heat and are responsible for numerous poisonings, hospitalizations, and long-term health consequences such as pulmonary damage, and heightened risk of addiction (Nowak et al., 2014; Wang et al., 2020a, 2020b). In 2018, e-cigarettes were the most commonly used nicotine product used by adolescents, with an estimated 20% of high school students in the United States (US) reported using e-cigarettes in the past 30 days (Wang et al., 2020a, 2020b). From 2017 to 2019, the use of vaping products within the past 30 days nearly doubled among adolescents in the US (Miech et al., 2020). Moreover, the US Surgeon General has warned of the potential risks of e-cigarettes (Office of the Surgeon General, 2016), highlighting the need for further research into risk factors and correlates for use.
The Hispanic population is the fastest-growing populace in the US (Colby & Ortman, 2015). Notably, e-cigarette use has been increasing among Hispanic youth (Truth Initiative, 2020). According to the 2018 National Youth Tobacco Survey, Hispanic youth were the second-highest users of any tobacco product (21.7%) after white, non-Hispanic youth (32.4%). Similar results were reported for e-cigarettes with Hispanic youth (14.8%) second only to White (non-Hispanic) (26.8%) youth (Gentzke et al., 2020).
Although Hispanic individuals report a lower prevalence of tobacco use compared to non-Hispanic Whites, Hispanic youth are at higher risk of nicotine addiction, nicotine dependency, and health consequences during the early stages of e-cigarette usage (Lanza & Vasilenko, 2015; Lanza et al., 2017; Unger & Falcon, 2022). Further, Hispanic youth are more likely to report higher levels of curiosity and willingness to try e-cigarettes than non-Hispanic Whites (Tackett et al., 2021).
One area that deserves further attention associated with adolescent vaping is the school setting. The school represents a milieu designed to adequately connect kids and promote adolescent development. Wills et al. (2015) emphasized that social support and school connectedness are protective factors in reducing the use of e-cigarettes. Youth with a positive insight about their future and those who have healthy dynamics with their parents are protected against various health risk behaviors, including e-cigarettes. According to the risk and resiliency model, strengthening protective risk factors can combat multiple health risk behaviors, such as e-cigarette use (Crane et al., 2019; Richardson et al., 1990; Szoko et al., 2021).
Although studied in other populations, a paucity of literature exists between e-cigarette use and school factors among Hispanic youth. Additional attention is needed, given the significant health disparities among this population (Price & Khubchandani, 2016). The present study sought to identify the prevalence of e-cigarette use among a large sample of Hispanic youth and investigate potential school factors associated with use. Specifically, the following research questions were examined: (1) What is the extent of past 30-day e-cigarette use among Hispanic youth? (2) Are school factors (e.g., grade level, grades) associated with e-cigarette use among Hispanic youth?
Data from the 2019–2020 Parents’ Resource Institute for Drug Education (PRIDE) survey were analyzed. The PRIDE survey is a biannual survey conducted by the Coalition for a Drug-Free Greater Cincinnati organization to assess health risk behaviors such as substance use, gang involvement, and violence. The PRIDE survey utilized a complex sampling design to ensure an equal probability selection of adolescents. Participants from the present study were in the 7th–12th grade and were recruited from 133 local and private schools in the greater Cincinnati area. For the present analysis, we limited our sample to Hispanic adolescents ages 12–17 years old (n = 4,602). The PRIDE survey is psychometrically valid and reliable (Craig & Emshoff, 1987).
The question, “During the past 30 days, did you ever use an electronic vapor product,” was used to assess past-30-day e-cigarette use.
The following were used to assess school factors: “Do you ever participate in School Clubs (i.e., band, etc.),”“Do you ever participate in Sports?,” Do you ever get in trouble at school?,” and “Do you often make good grades?” All answers were binary (“Always/Often,” “Sometimes/Never/Seldom”).
Participants’ sex (“Male,”“Female”) and grade level (8th,9th,10th, 11th, and 12th ) were used as covariates in our adjusted models.
Descriptive statistics with appropriate 95% confidence intervals were estimated. We presented all missing data prior to imputation in accordance with the Treatment and Reporting of Missing data in Observational Studies framework (Lee et al., 2021). Multivariate logistic regression analyses were built to determine conditional associations with past-month e-cigarette use. All analyses took place in SAS (version 9.4, SAS Institute). Nonoverlapping confidence intervals were judged to be p < .05.
A University of Cincinnati Institutional Review Board approved this study as nonhuman subjects.
The final analytic sample was Hispanic adolescents ages 12–17 years old (n = 4,602).The sample comprised of nearly equal percentages of Hispanic boys and girls (see Table 1) (49.2% vs. 49.3%, respectively). There were more Hispanic youth in 8th–10th grade vs 11th and 12th grade. An estimated 13.8% of Hispanic youth reported using vaping products in the past 30 days.
Compared to males, Hispanic females were at increased risk of using vaping devices in the past 30 days (aOR: 1.63) (see Table 2). There was a significant increase in increased odds as grade level increased, with the highest odds among 12th graders (aOR: 4.89). Compared to youth who always/often made good grades, Hispanic youth who sometimes/seldom/never made good grades were at increased risk of reporting e-cig use (aOR: 1.70). Hispanic youth who were always/often in trouble at school were greater than three times more likely to report e-cig use (aOR: 3.08). Hispanic youth who did not participate in school sports were at increased risk of e-cig use, compared to youth who always participated in school sports (aOR: 1.31). Moreover, Hispanic youth who seldom/never participated in school activities such as band or school clubs were nearly 1.5 times (aOR: 1.42) more likely to report e-cig use in the past 30 days.
The present study found approximately 14% (13.8%) of Hispanic youth used e-cigarettes in the past 30 days. Nationally, recent research demonstrated that 18.9% of Hispanic high school students recently used e-cigarettes (Gentzke et al., 2020). As the present study includes 8th -grade students as well as a higher percentage of younger students, this may explain the difference in prevalence rates between these two studies. In addition, as grade level increased, rates of e-cigarette use increased.
Early intervention may be valuable in reducing rates of use. For example, school nurses can provide cessation resources, provide support for student development, and inform stakeholders about effective messaging surrounding the harms of e-cigarettes (Blume & Lines, 2020). Moreover, prevention programs targeting specific Social Determinants of Health (e.g., stress; Prather, 2020) may be initiated to prevent e-cigarette use among Hispanic youth, an already high-stressed population.
In addition, the present study found that Hispanic females are more likely than males to use e-cigarettes in the past 30 days. This is contrary to previous research, which found recent e-cigarette use is higher among Hispanic males than females (Singh et al., 2015). In a nationally representative sample from Tackett et al. (2021), Hispanic females perceived e-cigarettes as causing less than a lot of harm, easy to purchase, and found females to be more susceptible to e-cigarette use compared to males. The recent targeting of tobacco products toward females is of concern. Recent research found that tobacco products are being more targeted to females due to claims of curbing appetite and making females thinner and more independent (Amos & Haglund, 2000; Barbeau et al., 2004). Given that females have lower cessation rates than males regarding tobacco products (Smith et al., 2016), intervention programs aimed at educating Hispanic females on the risks of e-cigarette use, and reducing access to these products are needed.
Moreover, the present study demonstrates that youth with poor grades and those in trouble at school, those not participating in any sports, and those not participating in a school band or school clubs reported higher levels of current e-cigarette use than their counterparts. These results are consistent with the literature that the lack of social connectedness and other protective factors (academic involvement, grades, behavioral and emotional self-control, and social competence) and presence of risk factors (smoker prototype, smoking expectations, behavioral and emotional dysregulation, peer smoking, e-cigarette smoking healthier) may increase the risk of e-cigarette use among Hispanic youth (Wills et al., 2015).
Schools need to enhance protective factors in such students through other types of initiatives such as increasing parent involvement at school and communicating about the dangers of e-cigarettes to students. Additionally, research indicates that social support and school connectedness impact e-cigarette use (Wills et al., 2015). Enhancing positive social support at school may be one method of reducing e-cigarette use among Hispanic youth. For example, school nurses can provide belongingness/connectedness screenings for youth, social support programs that enhance psychological well-being, and promote healthy school engagement for students, staff, and teachers (McCabe et al., 2022). Future prevention programs are culturally sensitive and address acculturation and other factors specific to Hispanic youth.
Several study limitations should be noted. First, this study presents cross-sectional survey data. Therefore, cause-and-effect relationships cannot be determined. In addition, all data in this study were self-reported. Some participants may have responded in a socially desirable manner. Next, participation was limited to youth in grades 8 through 12; thus, data may not be generalizable to youth of other ages.
Hispanic youth are at high risk for e-cigarette use. Strengthening protective factors may combat increasing rates of use (Richardson et al., 1990; Szoko et al., 2021). Schools may create and enforce policies to reduce e-cigarette use such as having smoke-free campuses (Lanza et al., 2017). Educational initiatives may help youth to understand health risks associated with e-cigarette use (Szoko et al., 2021). School nurses can create a positive environment and promote safe health behaviors for at-risk students. Additionally, schools may offer educational sessions for parents to learn about e-cigarettes and related factors such as secondhand smoke and the influence of parenting on e-cigarette use among Hispanic youth. Future studies focusing on familial influences may be needed to further understand e-cigarette use among Hispanic youth.
R. Andrew Yockey is currently affiliated with Department of Internal Medicine and Geriatrics, Texas College of Osteopathic Medicine, University of North Texas Health Science Center.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
R. Andrew Yockey https://orcid.org/0000-0002-2140-2418
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R. Andrew Yockey is a Joint-Appointed Assistant Professor in Biostatistics and Epidemiology, and Internal Medicine and Geriatrics, at the University of North Texas Health Science Center. His research interests include substance use prevention, LGBT+ health, adolescent health, and biostatistical methods.
Kruti Chaliawala is a second-year graduate student at the University of Cincinnati. Her research interests include substance use prevention and minority health.
Rebecca A. Vidourek is a Professor at the University of Cincinnati. Her research interests include substance use, violence prevention, and adolescent health.
Keith King is a Professor and Director at the University of Cincinnati. His research interests include substance use, adolescent health, and mental health prevention.
1 Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
2 Health Promotion and Education Program, School of Human Services, University of Cincinnati, Cincinnati, OH, USA
Corresponding Author:R. Andrew Yockey, PhD, Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.Email: robert.yockey@unthsc.edu
