Community- and individual-level risk factors of past month e-cigarette use among adolescents in France. (1st September 2021)

• Record Type: Journal Article
• Authors: Vuolo, Mike; Janssen, Eric; Le Nézet, Olivier; Spilka, Stanislas
• Is Part Of: Drug and alcohol dependence. Volume 226(2021)
• Publication Date: 2021-09-01
• Subjects: E-cigarettes -- Multilevel models -- Community effects -- Tobacco -- Adolescents -- France; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2021.108823
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Aside from schools, multilevel studies of adolescent e-cigarette use are rare. France is a unique context where daily tobacco use is high and typically precedes e-cigarette use. Individual-level e-cigarette use is associated with geographic-level demographics, socioeconomics, and youth substance use. Tobacco use environment impacts e-cigarette use and is particularly consequential when the adolescent uses tobacco daily. E-cigarette research, prevention, and intervention should incorporate environmental effects. Abstract: Purpose: Studies of adolescent e-cigarette use infrequently consider how environmental effects impact use. Adolescent e-cigarette use in France is also understudied, yet an important contrast since e-cigarette use rarely precedes conventional tobacco use and daily tobacco use is common. We examine whether there is significant variation in e-cigarette use across the geographic unit of départements (n = 95), and whether community factors explain these differences and individual-level probabilities of e-cigarette use. Methods: The ESCAPAD survey is a cross-sectional, nationally representative survey collected at a day of civic and military information mandatory for French 17-year-olds. We use the 2014 (n = 22, 023) and 2017 (n = 39, 115) surveys and geographic information from Eurostat and INSEE. Multilevel, multiple logistic regression models examine any and daily past month e-cigarette use. Results: We find significant département-level variation in both outcomes, with a considerable proportion of this variation explained by département-level factors. Net of numerous significant individual-level covariates, département-level unemployment (OR = 1.049, p < .05), poverty (OR=0.975, p < .05), age structure (OR=0.720, p < .01), and population growth (OR=0.987 p < .01) were associated with any past month use. The département-level percentage of adolescents using conventional tobacco daily was associated with individual-level any (OR=1.029, p < .001) and daily (OR=1.033, p < .01) e-cigarette use. Predicted probabilities demonstrate that département-level and individual-level tobacco use together were associated with e-cigarette use. Conclusions: Researchers should incorporate community effects into studies of e-cigarette use. Particularly, the tobacco use environment contributes to risk of e-cigarette use. For policymakers, resources may be mobilized to address local socioeconomic, demographic, and tobacco use patterns to potentially affect adolescent e-cigarette use.