Correlates of e-cigarette use susceptibility among never-smoking youth: A cross-sectional study in Shenzhen, China

Purpose: Identifying youth at risk of future e-cigarette use is crucial for informing effective prevention strategies. The current study aims to examine the correlates of e-cigarette use susceptibility among never-smoking youth from four levels: personal, psychological, parental, and social factors. Methods This Cross-sectional study recruited 2487 never-smoking students (aged 12–17 years) from 15 junior and high schools in the Bao'an District of Shenzhen, China from October to December 2021. E-cigarette susceptibility was measured by two items assessing the possibility to use e-cigarettes in the future and willingness to use if offered by a friend. Random-effects logistic regression models were used to explore risk factors of e-cigarette use susceptibility from four levels. Results Of the 2487 youth who never smoked, 5.5% (n = 136) were susceptible to e-cigarette use. The regression model identified the following correlates of e-cigarette susceptibility: perceptions of e-cigarettes, perceived social support, parental style, pro- and anti-tobacco information exposure, SHS exposure, and friends using e-cigarettes. Youth believing it is not easy to get addicted to e-cigarettes (aOR = 2.19; 95%CI: 1.21–3.96; p = 0.010), having father rejection (aOR = 2.38; 95%CI: 1.22–4.65; p = 0.011), having SHS exposure at home for 5–7 days (aOR = 2.04; 95%CI: 1.24–3.37; p = 0.005), noticing e-cigarette advertising (aOR = 1.80; 95%CI: 1.22–2.65; p = 0.003), and having friends using e-cigarettes (aOR = 2.59–5.28; 95%CI: 1.76–14.73; p < 0.001) were more susceptible to e-cigarette use. Youth thinking e-cigarette use less attractive (aOR = 0.55; 95%CI: 0.37–0.83; p = 0.005), having high social support (aOR = 0.49; 95%CI: 0.24–0.97; p = 0.041), and noticing the effects of e-cigarette use (aOR = 0.53; 95%CI: 0.36–0.78; p = 0.001) were less susceptible to e-cigarette use. Conclusions Youth' susceptibility to e-cigarette use is affected by multiple factors. A multi-level approach involving personal, psychological, parental, and social environment factors is needed to prevent youth from e-cigarette initiation.