59 Addictive environments and vaping in adolescence

Abstract Background Increasing number of adolescents are now exposed to the risks of nicotine addiction through vaping. According to the concept of addictive environments, behaviors and their related risks are influenced by the contexts in which they occur. Settings where adolescents encounter e-cigarettes, such as family, friendship groups and school, are therefore likely addictive environments towards nicotine. Objectives Our study explored how family, friendship groups and school environments are associated with nicotine dependence among adolescent vapers. Design/Methods Our study used 2024 data from the COMPASS-Quebec cohort. We included 2107 students from 32 secondary schools who reported vaping more than once in the past 12 months and completed the Hooked on Nicotine Checklist (HONC) adapted for e-cigarettes, reflecting their loss of autonomy regarding nicotine (Cronbach-alpha 0.91 within our population). On an ecological basis, schools’ characteristics included the average number of students per school who recognized vaping as harmless, considered vaping products as accessible, and felt a strong sense of belonging to their school. On an individual basis, family and friendship groups were captured by the cohabitation with vapers, number of friends vaping, and state of social relationships. Analyses were based on multilevel linear regressions to examine variances between individuals and contexts on the HONC score. Post-modeling was used to estimate mean HONC score (adjusted predicted values) for various groups. Results After introducing school-related variables, considering individual and confounding factors, the intra-class coefficient of inter-school variance on the HONC score is reduced by more than 50%, from 4.9% to 2.3%. It is estimated that a young vaper attending the school where the highest proportion of students consider that vaping is not a significant health risk adds 6.93 points to their HONC score, compared to the school with the lowest proportion, and 2.68 points when attending the school where the highest proportion of students consider vaping products to be readily available. Similarly, it is estimated that the HONC score increases by 0.78 points when an adolescent using e-cigarette lives with a vaper, by 2.40 points when they have 5 or more friends vaping compared to none, and 1.78 points when they perceive their social relationships as more negative than positive. Conclusion Our results highlight the contribution of addictive environments to nicotine dependence among adolescents engaging in vaping. Further research may identify the contours of such unfavourable environments. The potential benefit of public health interventions targeting these contexts in a coordinated way remains to be established.

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