Most youth think that cigarette and e-cigarette use among their peers is more common than it is, according to a recent study by the Centers for Disease Control and Prevention.

The study, published in Tobacco Control, found that 74 percent of students overestimated cigarette use among their peers and 61 percent overestimated e-cigarette use. Researchers used data from the 2015 and 2016 National Youth Tobacco Survey, which asked middle and high school students to estimate how many of their peers used cigarettes and e-cigarettes, if they have ever been curious about using the products, if they think that they’ll use them in the next year and if they would try them if offered by their best friend.

While data show declines in e-cigarette use among middle and high school students between 2015 and 2016, perceived e-cigarette use increased or remained the same among most grades. Data on youth e-cigarette use, however, may be underestimating actual use rates due to measurement challenges.

Overall, 14.6 percent of students who never used an e-cigarette were curious about e-cigarettes. Nineteen percent of students who never used an e-cigarette were willing to use one in the next year, and nearly a quarter (23.1 percent) of students who never used an e-cigarette reported they were open to trying it if offered by a best friend.

Additionally, compared with those who didn’t overestimate the use of either product:

  • Those who only overestimated e-cigarette use had 3.29 times higher odds of being curious about e-cigarettes, while those who only overestimated cigarette use had 1.5 times higher odds of being curious about cigarettes.
  • Those who only overestimated e-cigarette use had 5.86 times higher odds of ever using e-cigarettes, while those who only overestimated cigarette use had 2.04 times higher odds of ever smoking cigarettes.
  • Those who only overestimated e-cigarette use had 8.15 times higher odds of being current e-cigarette users, while those who only overestimated cigarette use had 2.52 times higher odds of being current cigarette smokers.

The data suggest that “youth still continue to be exposed to pro-tobacco social influences which could perpetuate the impression that e-cigarette use is more common than it actually is,” according to the study. Several studies have highlighted the fact that youth and young adults are uniquely susceptible to social and environmental influences to use tobacco, and that these influences — such as entertainment and pop culture and retail marketing — and the normalization of tobacco use can affect tobacco-related behaviors.

For example, one report found that among middle and high school students who used e-cigarettes in 2016, the most common reason they reported for using them was because a friend or family member did. Another study found that youth and young adults who are heavily exposed to tobacco imagery in movies are twice as likely to begin smoking as those with less exposure. More research shows that youth who are frequently exposed to point-of-sale tobacco marketing are twice as likely to try smoking as those who are not as frequently exposed.

The CDC study highlights the need for measures to educate the public about the dangers of tobacco use, reduce youth exposure to tobacco advertising and help denormalize and reduce tobacco use among youth.

“Our findings underscore the importance of youth-oriented preventive health messages to counteract pro-tobacco messages that potentially increase the attractiveness of tobacco products among youth,” the researchers state. “Such messages could be delivered in a variety of youth-oriented settings, including media-based platforms, school, pediatric and family practices, recreational facilities and other relevant settings.”

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