Adult e-cigarette use has increased dramatically from 2019 to 2023, and while e-cigarettes may serve as smoking cessation aids, they pose unique health risks including pulmonary inflammation, hypertension, and emphysema, making research on harm reduction strategies urgently needed. Protective behavioral strategies (PBS) have been proven effective in mitigating harmful consequences of alcohol and cannabis use, and preliminary research findings suggest that PBS for vaping (PBSV) show negative correlations with usage frequency and dependence; however, additional research is needed to more clearly elucidate these associations. Furthermore, since most e-cigarette users demonstrate low motivation to quit in the short term and exhibit high relapse rates, harm reduction approaches are being proposed as more realistic alternatives than complete cessation. In this context, the present study aims to examine how perceived behavioral control (PBC) over PBSV use influences e-cigarette usage frequency and dependence through actual PBSV use, based on the Theory of Planned Behavior.
The study recruited 298 participants who reported daily e-cigarette use and resided in the United States through the Academic Prolific platform. The study employed an online survey design where participants completed first assessments of demographics, e-cigarette dependence (PSECDI), past-month e-cigarette use frequency, and protective behavioral strategies for vaping (PBSV) use. Participants were then randomly assigned to control (n=156) or intervention (n=143) conditions, followed by completion of a perceived behavioral control (PBC) over PBSV measure. Path analysis was conducted to examine the relationship where PBC predicted PBSV use, and both PBSV and e-cigarette use frequency predicted e-cigarette dependence.
The study findings revealed that participants used e-cigarettes on an average of 24.74 days per month, with 33.9% reporting cessation attempts lasting one day or longer in the past 12 months, and most participants showing low to moderate dependence levels (25.5% and 33.2%, respectively) with only 9.1% reporting no dependence. Participants demonstrated low confidence in using protective strategies (mean PBC = 3.64, between “somewhat not confident” to “indifferent”) and infrequent actual use of protective behavioral strategies for vaping (mean PBSV = 87.54, “rarely” to “occasionally” range). The path analysis indicated that higher perceived behavioral control was positively associated with PBSV use, while White race was negatively associated with PBSV use, and PBSV use was negatively associated with e-cigarette use frequency but not significantly with dependence, whereas e-cigarette use frequency was positively associated with dependence. PBSV accounted for 36.6% of the variance in e-cigarette use frequency, and both PBSV and e-cigarette use frequency together explained 17.2% of the variance in e-cigarette dependence, with significant mediation effects showing that PBSV and e-cigarette use frequency mediated the relationship between perceived behavioral control and dependence.
Takeaway: Protective behavioral strategies for vaping (PBSV) can effectively reduce e-cigarette use frequency through enhanced perceived behavioral control (PBC), highlighting their potential as harm reduction interventions for e-cigarette users.