The increasing prevalence of electronic cigarette (e-cigarette) use among U.S. college students has raised significant concerns in recent years. The transition to college represents a major life change and stressful event for many young adults, who must navigate academic pressures, adapt to new social environments, and cope with emotional challenges such as anxiety and depression. While these complex stressors are considered important risk factors for e-cigarette use, research specifically targeting college students remains limited and has yielded inconsistent findings. Conversely, positive self-esteem and perceived social support from family, friends, and significant others have been identified as protective factors that help college students manage stress effectively; however, most research on these protective factors has focused on traditional smoking, with minimal evidence regarding their association with e-cigarette use. Therefore, the current study aims to address these research gaps by investigating the associations between perceived stress, perceived social support, self-esteem, and both current and lifetime e-cigarette use among U.S. college students.
The study utilized an online cross-sectional survey administered to 220 college students aged 18-24 years attending Slippery Rock University of Pennsylvania. The dependent variables were current use and ever use of e-cigarette, while the independent variables included perceived stress (measured by the Perceived Stress Scale, PSS), perceived social support (measured by the Multidimensional Scale of Perceived Social Support, MSPSS), and self-esteem (measured by Rosenberg’s Self-Esteem Scale, RSES). Data analysis involved descriptive statistics and bivariate logistic regression to examine relationships between dependent variables, independent variables, and covariates (socio-demographic characteristics, use of cigarettes and other tobacco products). Additionally, multivariable logistic regression models were employed to test associations between the variables after adjusting for age, sex, and other significant variables identified in the bivariate analysis.
Among the 220 college students studied, 55% reported ever using e-cigarettes and 30.1% were current users, with most participants (72.4%) experiencing moderate stress levels. The research found significant associations between e-cigarette use and several factors: unemployed students and those in health professions showed higher likelihood of current use; users of traditional cigarettes or other tobacco products had significantly increased odds of e-cigarette use; and higher self-esteem was associated with decreased likelihood of current use. No significant association was found between perceived social support and e-cigarette use. Most notably, the multivariable analysis revealed that high perceived stress was strongly associated with both current and lifetime e-cigarette use, with each unit increase in stress score raising the likelihood of current use by 10-11% and ever use by 7-8%. These findings suggest that college students may be using e-cigarettes as a stress coping mechanism, highlighting the importance of developing interventions that address both psychological factors and addiction aspects, with particular focus on healthy stress management techniques and self-esteem building strategies to prevent and reduce e-cigarette use among this population.
Takeaway: High perceived stress significantly increases e-cigarette use among college students while self-esteem serves as a protective factor, indicating that interventions targeting stress management techniques and self-esteem enhancement could effectively reduce e-cigarette consumption in this population.