Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Kathleen O'Connor Duffany


Purpose: In a study of middle school students, the objectives were to (1) document prevalence of early e-cigarette use and characteristics of users, and (2) identify psychosocial and behavioral factors that predict susceptibility and uptake.

Methods: Students in 12 randomly selected public schools in New Haven, Connecticut, completed health and behavior surveys in grades 7 and 8 (N=490). Descriptive statistics were calculated to assess the prevalence of e-cigarette susceptibility (considering e-cigarette use) and e-cigarette uptake among students at grade 7 and grade 8. Multivariate logistic regression analyses were used to assess associations between psychosocial and behavioral characteristics measured at grade 7 and both e-cigarette susceptibility and e-cigarette uptake at grade 8, controlling for school clustering and potential confounders.

Results: In grade 7, only 1.2% (n=6) of students reported using e-cigarettes; there was a seven-fold increase by grade 8, with 8.4% (n=41) of students reporting e-cigarette use. Perceived stress was a predictor of e-cigarette susceptibility (adjusted odds ratio [AOR], 1.21; 95% CI, 1.07-1.36), and school connectedness protected against e-cigarette uptake (AOR, 0.93; 95% CI, 0.87-0.98).

Conclusions: Both individual and organizational psychosocial and behavioral factors in grade 7 were found to be associated with e-cigarette susceptibility and uptake in grade 8. Findings suggest schools may be able to play a role in impacting rates of e-cigarette use among adolescents.

Open Access

This Article is Open Access