Review of: Danielle L. Hoyt et al., “An investigation of racial and ethnic differences in e-cigarette beliefs and use characteristics,” Journal of Ethnicity in Substance Abuse (2020), pp. 1-15.
While the majority of people still use e-cigarettes for cessation, the data are mixed on how effective the device is for that purpose. Many adults who regularly use e-cigarettes also smoke combustible cigarettes, and research suggests that this pattern may be even more common among Hispanics and non-Hispanic Blacks than non-Hispanic whites. Furthermore, some research has shown race to be associated with differences in knowledge and beliefs about e-cigarettes. In particular, the study indicated that white participants were more knowledgeable about e-cigarettes than their Black or Hispanic counterparts and that Black participants perceived less risk associated with e-cigarette use than either Hispanic or white individuals. A so-called “dual use” has thus emerged as a public health concern that may disproportionately affect communities of color.
As such, in a study published in the Journal of Ethnicity in Substance Abuse, Danielle L. Hoyt and colleagues sought to examine racial and ethnic differences in beliefs and behaviors around e-cigarette use, including: amount of e-cigarette use; e-cigarette dependence; perceived risks and benefits; and patterns of dual use. The current study included a subset of 535 respondents from a larger dataset recruited via the national survey management program Qualtrics.
Participants were all current e-cigarette users aged 18 to 65, and racial and ethnic composition roughly reflected the general U.S. population. Because of this, there were relatively low numbers of participants of Asian, Native American, Alaskan Native and Native Hawaiian or Pacific Island descent. Therefore, the study authors limited analyses to focus on Black (17.4 percent), white (75.9 percent) and Hispanic (14.4 percent) individuals. Slightly more than half of study participants were female (53.6 percent) and the mean age was 35.2 years.
In addition to demographic information, the survey incorporated questions about several measures, including:
- Frequency of e-cigarette use, impulses to use e-cigarettes and experiences of cravings or withdrawal symptoms
- Details about electronic and combustible cigarette use, such as length and frequency of use
- Perceived risks and benefits of e-cigarette use
- Anxiety sensitivity, which prior studies have found to be related to nicotine use
Hoyt et al. conducted analyses to elucidate the relationship between four predictor variables—race, ethnicity, gender and anxiety sensitivity—and the outcome variables of e-cigarette dependence, perceived risks of e-cigarette use, perceived benefits of e-cigarette use, the number of days of e-cigarette use in the past month and dual-user status. They also looked at whether interactions between anxiety sensitivity and race or ethnicity were associated with any of the dependent variables. For all analyses, the research team controlled for potential covariates, including income, sex and education.
Nearly two-thirds of participants said they used e-cigarettes on a daily basis, and there were statistically significant racial, though not ethnic, differences associated with frequency of use. White participants reported more days (with a mean of 15.65 days) of past-month e-cigarette use than Black participants (with a mean of 12.5 days), but Hispanics and non-Hispanics reported similar frequencies of use. However, while there were no significant racial associations, Hispanic participants reported higher anxiety sensitivity levels than non-Hispanics.
Both race and anxiety sensitivity turned out to be important predictors of participants’ e-cigarette dependence, but not necessarily in expected ways. White participants were more likely than Black participants to be dependent on e-cigarettes as were individuals with higher comparative levels of anxiety sensitivity. Interestingly, those with greater anxiety sensitivity were both more likely to perceive using e-cigarettes as a risky behavior and to see benefits associated with using e-cigarettes. Furthermore, whereas white adults’ risk perceptions appeared to be linked to levels of anxiety sensitivity, this was not the case for Black participants.
More than three-quarters of respondents reported dual use of electronic and combustible cigarettes. Neither race, ethnicity nor anxiety sensitivity were found to be associated with this behavior. However, gender may play a role, as female participants reported higher levels of dual use than their male counterparts.
Hoyt et al. note that several of their findings run counter to previous research. In particular, where prior studies have found Black adults to be at elevated risk for using and becoming dependent on e-cigarettes, the current study found no such significant relationship. Furthermore, none of the independent variables were found to be associated with this behavior, although one of the potential confounders (gender) did predict dual use.
The authors acknowledge several limitations, including the reliance on a self-selected sample; the focus on only Black/white racial comparisons, which hinders generalizability; and the cross-sectional design which does not allow for claims about causality. Thus, while the current study adds interesting data to the growing body of research on e-cigarettes, it highlights the need for work that goes deeper and stretches broader. In particular, the findings show that there remains much to learn about how factors such as anxiety sensitivity, race and ethnicity as well as sex and gender affect e-cigarette dependence, beliefs and behaviors.