Adolescent school connectedness, particularly positive relationships with teachers, generally protects from health risk behaviors such as tobacco use, yet how this relates to adolescent e-cigarette use has not yet been described. This study examines the relationship between school connectedness and e-cigarette susceptibility and use in a diverse adolescent longitudinal sample.
This is a secondary analysis of a school-based intervention including ten public schools in one urban school district. We surveyed 661 middle (66.6% eighth grade) and high school (33.4% eleventh grade) student participants at three time points between spring 2019 and spring 2020. The 2020 surveys were completed early in the COVID-19 pandemic, prior to the transition to remote learning. Respondents had a mean age of 14.1 years, were 53% female, and 28% identified as non-Hispanic white,15.6% as Hispanic, 23.8% as Black, 29.8% as Asian, and 2.9% as American Indian/Alaska Native. Ordinal logistic regression models examined unadjusted and adjusted associations between school connectedness (both baseline and concurrent) and an ordinal measure of e-cigarette susceptibility (any vs. none) and use (any vs. no past 30-day use) at all three time points. Covariates in the adjusted models included grade, intervention condition, English language learner status, gender, race/ethnicity, baseline use of any tobacco, and baseline weighted grade point average.
Levels of any tobacco use were low in the spring of 2019 (3.8%), e-cigarettes represented the predominant form of tobacco use (2.4%), and most respondents reported no e-cigarette susceptibility (69%). E-cigarette susceptibility and use remained relatively stable during the follow-up period. Higher levels of baseline school connectedness were consistently associated with lower odds of e-cigarette susceptibility/use in spring 2019 (OR: 0.37, 95% CI: 0.26, 0.53), fall 2019 (OR: 0.51, 95% CI: 0.35, 0.74), and spring 2020 (OR: 0.47, 95% CI: 0.30, 0.73). Higher levels of concurrent school connectedness were also associated with lower odds of e-cigarette susceptibility/use over time: spring 2019 (OR: 0.36, 95% CI: 0.25, 0.51), fall 2019 (OR: 0.48, 95% CI: 0.34, 0.66), and spring 2020 (OR: 0.65, 95% CI: 0.42, 0.99). Findings were similar for eighth and eleventh graders and did not differ significantly both before and after adjusting for other covariates.
Both adolescents’ baseline levels of connection to their schools and their connectedness over time appear to serve as protective factors for e-cigarette susceptibility and use. These findings highlight the importance of promoting positive school experiences and strong teacher-student relationships as a mechanism of reducing adolescent risk behaviors such as e-cigarette use among diverse adolescent populations.
Sources of Support
This project was funded by a grant from the National Institute of Minority Health and Health Disparities (NIMHD) grant number R01MD010586 (PI: Allen).
© 2022 Published by Elsevier Inc.