Do perceptions of harm and addictiveness influence adolescent's willingness to use various tobacco and nicotine products?

INTRODUCTION

The Theory of Reasoned Action has been widely used to explain adolescent tobacco and nicotine product (TNP) use, focusing on intentions and subjective norms. However, the 'reactive pathway', emphasizing situational influences and willingness to use, better predicts TNP use in adolescents. While prior research has examined willingness for cigarettes and e-cigarettes, its application to the broader range of available TNPs is limited. This study investigates adolescent characteristics across varying levels of TNP use willingness. We hypothesized that perceived harm and addictiveness would be associated with willingness to use tobacco.

METHODS

Secondary school students aged 14-15 years (n=348) completed a survey that assessed demographics and TNP use history, willingness to use TNPs, peer use, and perceived harm and addictiveness of TNPs. Descriptive statistics were used to characterize the population overall and by willingness to use TNPs. Multivariable logistic regression models estimated associations between TNP-specific willingness to use, gender, race, ethnicity, and peer use with TNP-specific perceived harm and addictiveness.

RESULTS

Across the TNPs, 22.1% were current users, 23.3% were willing non-users and 54.7% were non-willing non-users. Significant differences in perceived harm by willingness were for cigarettes, e-cigarettes, and hookah, while perceptions of addictiveness varied by willingness group for all TNPs with the exception of cigarillos (all p<0.05). Willing non-users had lower odds of perceived addictiveness (smokeless tobacco, OR=0.29; 95% CI: 0.11-0.81; cigar, OR=0.33; 95% CI: 0.15-0.70) and harm (e-cigarettes, OR=0.38; 95% CI: 0.19-0.76; pipe, OR=0.41; 95% CI: 0.17-0.98; cigarillos/little cigars, OR=0.34; 95% CI: 0.12-0.92; cigars, OR=0.24; 95% CI: 0.11-0.54) compared to non-willing non-users.

CONCLUSIONS

Adolescents have varying levels of susceptibility to using TNPs. In order to develop effective interventions for adolescents, the diverse range of available TNPs with specific risks and appeal need to be considered. The study is registered on the official website of ClinicalTrials.gov ID NCT05396911.