Proposing an Integrated Theory of Electronic Nicotine Delivery Systems Susceptibility Among Latinx and Non-Latinx Youth

Introduction: Despite a reduction in overall cigarette smoking rates in the last several decades, recent increases in the use of electronic nicotine delivery systems (ENDS), such as e-cigarettes and Juul devices, prompted the Surgeon General to declare the use of such products to be an “epidemic.” Along with the increase in the overall incidence of ENDS use, there are corresponding disparities in initiation, attitudes, and use patterns among Latinx populations. The present study sought to examine how elements of several behavioral theories, including parent, peer, media and environmental factors, are associated with a comprehensive measure of ENDS use susceptibility among both Latinx and non- Latinx youth. Methods: Data from 9630 adolescents between the ages of 12 and 17 years were collected in wave 3 of the Population Assessment of Tobacco and Health (PATH). Data were used to create and test a covariance structural path model examining the effects of parental modeling, communication, attitudes, rule-setting, and peer perceptions on ENDS use susceptibility. Multigroup model comparisons between Latinx and non-Latinx youth were completed. Results: Despite non-Latinx youth having more risk factors associated with ENDS use susceptibility, including parental ENDS use, more lenient rules regarding ENDS use in the home, and less perceived harm from ENDS use, Latinx youth had higher overall susceptibility. Additionally, despite predictions from prior research and theory, perceived social norms regarding ENDS use were not associated with susceptibility among non-Latinx youth. Parental ENDS use and having ENDS products available in the home were associated with greater susceptibility in Latinx, but not non-Latinx youth. Conclusions: Key differences in ENDS susceptibility between Latinx and non-Latinx youth warrant both further investigation and increased culturally tailored prevention programming.