Rationale of the Study

Electronic cigarettes (e-cigarettes) are devices that provide nicotine to users and
other substances like flavorings, moisture-retaining substances (i.e., propylene glycol or
glycerol), and nicotine through vaporization of a nicotinic solution and are the most
commonly used tobacco product among adolescents and young adults (Cahn, L., Siegel
A., 2011; National Institute on Drug Abuse, 2018; National Academies of Sciences,
2017; Johnston L., Miech S., et al., 2014). E-cigarettes are such devices for the
adolescents and young adults who use them with device modification adding to their
appeal (Barrington J.L., Gibson, L.A., Halpern, B., et al., 2018). The availability of e-
liquids in a multitude of flavors and favorable perceptions of harm associated with e-
cigarettes (Eastman J.K., Lyer, R., Liao, S., et al., 2014) including e-cigarettes being
considered the least harmful of all tobacco products (Gorukanti, A., Delucchi K., Ling, P.,
2016) have also contributed to the rapid global adoption of e-cigarettes by adolescents
and young adults.

Around the world, there is seemingly ceaseless demand by adolescents and

young adults for novel and have surpassed alternative tobacco products in popularity,
indicating an increase in both awareness and interest in these products (Naumovska,
L., 2017; Barrington J.L., Gibson, L.A., Halpern, B., et al., 2018; Ayers, W., Ribisl, O.,
Brownstein, B., 2015). The availability of e-liquids in a multitude of flavors and favorable
perceptions of harm associated with e-cigarettes (Naumovska, L., 2017) including e-
cigarettes being considered the least harmful of all tobacco products (Gorukanti, A.,
Delucchi, K., Ling, P., et al. ,2016) have also contributed to the rapid global adoption of
e-cigarettes by adolescents and young adults. Although evidence of the health risks of
e-cigarettes is nascent (Harris, C.C., 2018) ample evidence exists that exposure to
nicotine by adolescents and young adults is associated with myriad health risks
(Bunnell, R.E., Agaku, I.T., Arrazola, R.A., et al., 2017) and the use of e-cigarettes
increases the odds of initiation of smoking traditional tobacco cigarettes.
 Given the novelty, popularity, and potential for harm of pod-based e-cigarettes,
data describing how adolescents and young adults use and perceive pod-based devices
are both timely and important. Thus far, 1 scientific study has reported data on the use
and perceptions of e-cigarettes among US adolescents and young adults aged 15 to 24
years (Willet, J.G., Bennett, M., Hair, E.C., et al., 2018). That study’s data, collected
November 2017, showed that 25% of the sample recognized the e-cig, of whom only
25% knew all contained nicotine. Furthermore, 10% reported ever use of e-cig and 8%
reported past 30-day use. Levels of recognition and use of e-cig were higher among
those aged 18 to 24 years compared with those aged 15 to 17 years (Willet, J.G.,
Bennett, M., Hair, E.C. et al., 2018). Despite limited empirical data (Huang, J., Duan, Z.,
Kwok, J., et al., 2018) numerous articles in the popular press have highlighted the
marketing28 and popularity of pod-based e-cigarettes (Belluz, J., 2018).

Recent research suggests that the individuals most likely to try or use e-cigs in
college are: males, past or present traditional cigarette smokers, and Greek affiliated
(Sutfin, McCoy, Morrell, Hoeppner, et al., 2013). However, little is known about other
characteristics of college students that may be associated with e-cig use (e.g., work
status, perceptions of individual health). Further, findings suggest that college e-cig use
is not motivated by the desire to quit smoking (Palazzolo, 2013; Saddleson et al.,
2016; Sutfin et al., 2013). Instead, initial findings suggest that college students’ primary
reason for e-cig use may be enjoyment (Saddleson et al., 2016), which is frequently
emphasized by marketers to recruit customers. Potentially linked to views of enjoyment,
it is possible that some college students are drawn to e-cigs to try something new—for a
novel experience. For example, individuals higher in sensation-seeking interests are
more likely to pursue new, different, and exhilarating or stimulating experiences: thus,
they are more likely to sample new products and to be excited by new, uncertain
experiences (Noar, Zimmerman, Palmgreen, Lustria, & Horosewski, 2016).

Despite increases in e-cig use, limited research has examined college student
perceptions and use of these devices. Some studies have found that over 30% of
college students have tried an e-cig (Saddleson et al., 2015) and nearly 4% have used
an e-cig in the last month (American College Health Association, 2016). Levels of
recognition and use of e-cig were higher among those aged 18 to 24 years compared
with those aged 15 to 17 years (Willet, J.G., Bennett, M., Hair, E.C. et al., 2018).

Some argue that e-cigarettes are obviously less harmful than cigarettes and have
great potential to help smokers quit (Cahn, Z., Seigel, M., 2011) while others contend
that data on safety are needed before e-cigarettes are promoted or allowed to be sold
(Cobb, N.K., Bryon, M.J., Abrams, D.B., 2010). Anecdotal reports of smokers using e-
cigarettes to help them quit smoking abound (Etter, J., Bullen, C., 2011) but efficacy
data in the form of clinical trials are still limited (Polosa, R., Morjaria, J.B., Caponnetto,
P. et al., 2013).