Determinants of E-cigarette Use Intentions and Behaviors among US Young Adults: Risk Perception, Social Media Use, and Social Media Ad Exposure
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Tobacco use remains the leading preventable cause of disease and death in the United States. While cigarette smoking has declined, e-cigarette use has increased among young adults. Research shows that the majority of US young adults perceive e-cigarettes as less harmful than conventional cigarettes. This diminished risk perception is reported to be largely influenced by tobacco industry marketing, which has been designed to position e-cigarettes as a safer alternative to traditional products, particularly on social media. Traditionally, anti-tobacco interventions have focused on altering risk perception, assuming that improving them would decrease intentions to use e-cigarettes. However, recent behavioral economics research suggests that the relationship between risk perception and intentions may not always be unidirectional. Rather, prior intentions can distort risk perception among people at risk. To address these gaps, this dissertation examined 1) the cross-lagged relationships between risk perception and e-cigarette use intentions over time, and 2) the relationship between social media use, social media ad exposure, risk perception, and intentions, using a nationally representative sample of US young adults.This study targeted young adults aged 18 to 24 in the United States. Wave 3 to Wave 6 data from the Population Assessment of Tobacco and Health (PATH) Study was used. A series of Structural Equation Modeling (SEM) models were analyzed in Mplus using replicate weights. Weights were created using Fay's method, a type of Balanced Repeated Replication (BRR) to produce stable variance estimates. The analyses showed that prior higher e-cigarette use initiation intention was associated with lower risk preception, and prior higher cessation intention was associated with higher risk perception at later waves. These results suggest a novel finding that young adults may exhibit distortions in their risk perception, contingent upon their prior intentions to initiate or cease e-cigarette use, highlighting the susceptibility of risk perception as a critical cognitive factor. Additionally, this study indicated that social media ad exposure mediated the relationship between social media use and risk perception and e-cigarette use intentions, demonstrating that social media use does not directly affect risk perception and intentions. This suggests that while pro-tobacco ads on social media can promote initiation and demote cessation of e-cigarette use, social media platforms can be used as a measure to promote healthy behaviors among young adults. This dissertation offers insights into how risk perception is shaped in the digital age and evaluates whether it remains a reliable predictor of e-cigarette use intentions and behaviors in future interventions among US young adults.
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