Sources of acquisition and frequency of e-cigarette use among adolescents in the United States

Abstract Purpose: Despite strategies prohibiting e-cigarettes use and purchase, the literature suggests continued use and access by adolescents. Guided by the Socio-Ecological Model, we examined sources and types of e-cigarettes along with the associated frequency of use among U.S school-going adolescents. Methods: We used the 2019 National Youth Tobacco Survey comprising U.S middle and high schoolers (n=19,018). Multinomial logistic regression was conducted to evaluate associations between sources and types of e-cigarettes, and the frequency of use while controlling for covariates. Results: The final sample was 3,537 with 76.9% high schoolers, 51.6% males, and 59.7% prefilled pods/cartridges users (JUUL). Past-month e-cigarette use was 60.8% for 1-10 days, 14.3% for 11-20 days, and 24.9% for 21-30 days. Sources adolescents obtained e-cigarettes included retail stores (20.1%), vape shops (15.2%), internet (7.1%), social networks (74.0%), and unknown sources (5.9%). Compared to 1-10 days, 21-30 days e-cigarette use was higher among participants who obtained e-cigarettes from retail stores [OR= 3.03; 95% CI= 3.009-3.046; P<0.001], vape shops [OR= 3.42; 95% CI= 3.393-3.439; P<0.001], and the internet [OR= 1.85; 95% CI= 1.839-1.872; P<0.001] than from other sources, but lower when obtained from social networks [OR= 0.63; 95% CI= 0.628-0.636; P<0.001]. Using e-cigarettes like JUUL was associated with higher odds of 21-30 days [OR= 1.11; 95% CI= 1.106-1.120; P<0.001] use than refillable e-cigarette tank. Conclusion: Factors within the organizational and community levels, including types (JUUL) and sources of e-cigarette (retail stores, vape shops, and internet), were associated with a higher frequency of past-month use.