Date of Award

Summer 2024

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Daniela Friedman

Abstract

BACKGROUND

This dissertation examines self-identity in the context of smoking and vaping among adults in South Carolina (SC) using data from the 2023 SC Adult Tobacco Survey (n=1370). The conceptual model created to guide this dissertation is called the “Smoker and Vaper Behavior-Identity Model” and draws constructs from theoretical frameworks in health behavior and social identity theories. Behavior was defined as lifetime and past 30 day cigarette or e-cigarette use. Self-identity was defined by asking respondents with a history of cigarette or e-cigarette use “Do you consider yourself a smoker/vaper”, respectively.

METHODS

First, this study assesses the prevalence of mismatching behavior and identity among current and former smokers and vapers, compares the current identities of those who tried to quit smoking by vaping (i.e., switching), and evaluates the susceptibility to trying e-cigarettes of current and former smokers based on their current identity as a smoker or a non-smoker, as described in Manuscript 1. Comparisons were made using chi-square analysis and Fisher’s Exact Test as applicable. Then, this study measures the relationship between identity and perceptions of e-cigarettes relative to cigarettes based on: 1) general harm, 2) addictiveness, and 3) harm from secondhand vape emissions, as described in Manuscript 2. Logistic regressions were prepared to compare models of identity and models of behavior for smokers and vapers with people with no history of smoking and vaping as the reference group.

RESULTS

Results from Manuscript 1 indicated that about one tenth of all current and former smokers and vapers (n=161) had a mismatch between their current behavior and their current identity. Former smokers who tried switching to e-cigarettes were less likely to identify themselves as smokers compared to former smokers who did not try switching (p < 0.0001). Current smokers who considered themselves smokers were more susceptible to trying vaping than those who did not consider themselves smokers (OR=4.1, 95% CI=2.2–7.8, p < 0.0001).

Results from Manuscript 2 indicated that, compared to the reference group (n=1136), people identifying as a smoker (n=120) were more likely to believe breathing secondhand vape causes no harm (OR = 3.3, 95% CI = 1.5 to 7.2, p = 0.0033); people identifying as a vaper were more likely to perceive e-cigarettes are safer than cigarettes (OR = 9.6, 95% CI = 4.4 to 20.6, p < 0.0001) and perceive ecigarettes are less addictive than cigarettes (OR = 3.1, 95% CI = 1.1 to 8.3, p = 0.0255).Lifetime use of cigarettes (n=492) was not significantly associated with ecigarette harm perceptions. Lifetime use of e-cigarettes (n=215) was significantly associated with the perception that e-cigarettes are safter than cigarettes (OR = 3.9, 95% CI = 2.1 to 7.3, p < 0.0001) and the belief that breathing secondhand vape causes no harm (OR = 2.5, 95% CI = 1.3 to 4.7, p = 0.0062). Those who smoked cigarettes in the past 30 days (n=142) were significantly more likely to perceive ecigarettes are less addictive than cigarettes (OR = 2.4, 95% CI = 1.2 to 4.5, p = 0.0091); those who only vaped in the past 30 days (n=73) were no more or less likely to agree with any of the harm reduction statements than the reference group.

CONCLUSION

This research builds upon previous understandings of the relationship between self-identity and current smoking and vaping behavior. This is the first study to provide a statewide estimate of the prevalence of people who identify as smokers or vapers and compares the relationship between self-identity and behavior in the context of e-cigarette harm perceptions. In general, self-identity was more significant in determining positive e-cigarette harm perceptions than past 30 day behavior.

Rights

© 2024, Jaron Hoani King

Download

Share

COinS