Trends in Social Norms Toward Cigarette Smoking and E-cigarette Use Among U.S. Youth Between 2015 and 2021.

introductionThis study examines trends in social norms toward cigarette smoking and e-cigarette use among US youth during 2015-2021, focusing on descriptive interpersonal norms (friends' behavior) and injunctive norms at interpersonal (perceived important others' negative view) and societal level (perceived public disapproval).

methodsRespondents were youth aged 12 to 17 from the Population Assessment of Tobacco and Health Study of the United States, Wave 3 (2015-2016) to Wave 6 (2021). Logistic regression models that adjusted for demographics and participation effects assessed norm changes over time and their association with use status in Wave 6.

resultsBetween 2015 and 2021, the probability of having friends who smoked cigarettes decreased (26.1% vs. 7.9%, adjusted odds ratio [aOR] = 0.81 [95% confidence interval = 0.72 to 0.91]), while having friends who use e-cigarettes generally decreased (31.6% vs. 22.3%, aOR = 0.46, [0.37-0.58]) despite an increase in 2018-2019. Perceived negative views from important others remained stable for both products during 2015-2019, peaked in 2020 (85.2% and 86.2%) before declining slightly in 2021. Perceived public disapproval increased to a peak in 2020 for both products (73.3% to 84.2% for cigarettes and 55.4% to 77.5% for e-cigarettes). In 2021, having friends who used e-cigarettes was associated with current e-cigarette use (relative risk ratio [RRR] = 15.07 [9.94-22.85]) and current dual use (RRR = 3.38 [1.41-8.13]), while important others' negative view toward e-cigarette use reduced the likelihood of current e-cigarette use (RRR = 0.3 [0.2-0.44]).

conclusionsAmong US youth during 2015-2021, norms consistently indicated denormalization of cigarette smoking. e-cigarette norms showed greater variability, particularly during the coronavirus disease 2019 (COVID-19) pandemic.