Cecille Joan Avila is a policy analyst at Boston University School of Public Health. She tweets @cecilleavila.
Rates of combustible cigarette use have decreased over the years, but the rate of United States teenagers vaping or using e-cigarettes has recently increased. Perhaps this is because e-cigarettes are aesthetically enticing or come in fun flavors, or because many teenagers believe vaping is less dangerous and less addictive than smoking – although many e-cigarettes having comparable nicotine levels and absorption rates as traditional cigarettes. Another possible reason? Optimism bias.
Optimism bias is when an individual over-estimates their ability to quit an activity when compared to others. (This is despite believing they might still succumb to addiction.) Optimism bias is well documented when it comes to combustible cigarettes among adults, but there is limited research about e-cigarette use among youth.
Youth are arguably most at-risk for lifetime nicotine addiction, particularly if they perceive vaping to be easier to quit and are more enticed to start. Thus, more research exploring the role optimism bias plays in teen vaping behavior is critical.
A recently published paper examines optimism bias in quitting vaping, specifically among youths aged 14 to 18 who were aware of e-cigarettes, and factors that might affect their optimism bias.
(Author affiliations for this paper include Kiersten Strombotne, Department of Health Law, Policy and Management at Boston University School of Public Health and Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System; Jody Sindelar, Department of Health Policy and Management, Yale School of Public Health; and John Buckell, Health Economics Research Center, Nuffield Department of Population Health and Health Behaviours and Department of Primary Care Health Sciences, University of Oxford.)
The researchers conducted a nationally representative, online, cross-sectional survey in December 2018. Considering previous research on combustible cigarettes, they hypothesized that individuals would be more optimistic about their own ability to quit, while believing others would likely have a harder time, with perceived difficulty quitting increasing with social relationship distance.
Along with collecting demographic data, the survey measured optimism bias by asking respondents (N=1,610) how they perceived their own ability to quit vaping and how well they thought others would be able to quit vaping. Respondents were asked to rate the ability to quit for someone as close as their best friend, all the way to a distant but age-similar teenager.
Researchers analyzed this data not only to determine the extent to which optimism bias existed in this sample, but also to gain insight on how optimism bias was formed and what factors impacted it. Descriptive statistics were used to determine how much optimism bias existed in this study population. A regression model (ordinary least squares) was then used to examine what factors went into youth optimism bias.
Among the study population, the average age of respondents was 16 years, mostly suburban and white, 49% female, and 48% who reported being a free or reduced lunch recipient (a variable used as a proxy for socioeconomic status). Thirty-eight percent reported ever having tried e-cigarettes, and 37% reported having ever tried JUUL.
As expected with their hypotheses, researchers found that individuals were more optimistic about their ability to quit vaping than others’ ability. Results showed that as social relationship distance increased, so did an individual’s perceived difficulty of another person’s ability to quit.
Meanwhile, actual use of e-cigarettes and JUUL were associated with lower optimism bias, although findings related to e-cigarettes were not statistically significant. Optimism bias also decreased with reports of smoking in the last 30 days, if a respondent was Black or Hispanic, and if a respondent reported receiving free or reduced lunch.
This research is limited in that it may not be generalizable outside of this age group and, due to its cross-sectional design, causality cannot be determined. Also, because it is impossible to know how likely a respondent would be able to quit if they tried, reported perception cannot be compared to an actual attempt.
It’s critical to prevent teens from vaping before they even start – no matter how high their optimism bias is. Considering that Black and Hispanic youths and those of lower socioeconomic status generally report lower optimism bias, focusing on outright prevention could also have significant impact on nicotine use disparities. A more tailored approach that accounts for nuances in optimism bias may be more effective, such as targeting how difficult it is to quit vaping in general.
This research adds to the literature by providing evidence that optimism bias exists among youths as it pertains to vaping. It has significant policy implications, especially for targeting youths at a critical point: before they even initiate use of an addictive substance. Specific state or federal policies could include bans on appealing flavors, taxes on e-cigarettes, or even purchasing age restrictions, with all three options possibly preventing teens from even starting.
Although it will take considerable effort to change public behavior and perception, more research like this is needed to show what areas we can better target to address issues associated with vaping. While it might be a difficult challenge to curb the rapid rates of youth vaping, it is a doable one, considering how perception towards combustible cigarettes changed over time.