CPH Faculty & Alumni Document Increase in e-Cigarette Use in Appalachia

Dr. Hadii Mamudu, Associate Professor for the Department of Health Services Management and Policy in the East Tennessee State University College of Public Health, has authored an article in Annals of Thoracic Medicine.  The article, “Prospective study of dual use of e-cigarettes and other tobacco products among school-going youth in rural Appalachian Tennessee” discusses e-cigarette and other tobacco product usage among school-going youth in Appalachia.

Drs. Liang Wang and Mary Ann Littleton are faculty co-authors.  College of Public Health alumni Daniel Owusu, Crystal Robertson Besse, and Candice Collins are additional co-authors.

There is growing evidence at national and state levels indicating that e-cigarettes are used concurrently with other tobacco products, known as dual use.  Limited information is available, however, on e-cigarette use, either alone or in conjunction with other tobacco products among youth living in the Appalachian portion of Tennessee.  The prevalence of tobacco use and tobacco-related diseases, in Appalachian Tennessee is higher than the national average and contributes to major health disparities.

The County Health Department, Regional Health Department, Health Council, Coordinated School Health, and the School System collaborated to conduct the school survey, obtaining data on tobacco product use among school-going youth. Participants were surveyed biennially to monitor the prevalence, knowledge, opinions, or perceptions about tobacco product use, including e-cigarettes and to evaluate tobacco control interventions in the region. The study population, a cohort of youth from a rural county in Appalachian Tennessee participated in a school-based baseline survey in 2014 while in Grades 4 and 5 (Wave 1), and a follow-up survey in 2016 while in grades 6 and 7 (Wave 2).

Dual use increased from 13.3% in Wave 1 to 18.6% in Wave 2, suggesting that e-cigarettes may be creating a new generation of tobacco addicts. The significant factor associated with increased dual use in both Wave 1 and Wave 2 was exposure to tobacco industry marketing/promotion. Exposure to tobacco use at home or inside the vehicle and peer/family pressure increased dual use in both Wave 1 and Wave 2.

These findings reinforce the importance of incorporating e-cigarettes into a comprehensive tobacco intervention as suggested by the US Surgeon General.