ABSTRACT
Purpose: Adolescent school connectedness, particularly positive relationships with teachers, generally protects from health risk behaviors such as tobacco use, yet how this relates to adolescent e-cigarette use has not yet been described. This study examines the relationship between school connectedness and e-cigarette susceptibility and use in a diverse adolescent longitudinal sample. Methods: This is a secondary analysis of a school-based intervention including ten public schools in one urban school district. We surveyed 661 middle (66.6% eighth grade) and high school (33.4% eleventh grade) student participants at three time points between spring 2019 and spring 2020. The 2020 surveys were completed early in the COVID-19 pandemic, prior to the transition to remote learning. Respondents had a mean age of 14.1 years, were 53% female, and 28% identified as non-Hispanic white,15.6% as Hispanic, 23.8% as Black, 29.8% as Asian, and 2.9% as American Indian/Alaska Native. Ordinal logistic regression models examined unadjusted and adjusted associations between school connectedness (both baseline and concurrent) and an ordinal measure of e-cigarette susceptibility (any vs. none) and use (any vs. no past 30-day use) at all three time points. Covariates in the adjusted models included grade, intervention condition, English language learner status, gender, race/ethnicity, baseline use of any tobacco, and baseline weighted grade point average. Results: Levels of any tobacco use were low in the spring of 2019 (3.8%), e-cigarettes represented the predominant form of tobacco use (2.4%), and most respondents reported no e-cigarette susceptibility (69%). E-cigarette susceptibility and use remained relatively stable during the follow-up period. Higher levels of baseline school connectedness were consistently associated with lower odds of e-cigarette susceptibility/use in spring 2019 (OR: 0.37, 95% CI: 0.26, 0.53), fall 2019 (OR: 0.51, 95% CI: 0.35, 0.74), and spring 2020 (OR: 0.47, 95% CI: 0.30, 0.73). Higher levels of concurrent school connectedness were also associated with lower odds of e-cigarette susceptibility/use over time: spring 2019 (OR: 0.36, 95% CI: 0.25, 0.51), fall 2019 (OR: 0.48, 95% CI: 0.34, 0.66), and spring 2020 (OR: 0.65, 95% CI: 0.42, 0.99). Findings were similar for eighth and eleventh graders and did not differ significantly both before and after adjusting for other covariates. Conclusions: Both adolescents’ baseline levels of connection to their schools and their connectedness over time appear to serve as protective factors for e-cigarette susceptibility and use. These findings highlight the importance of promoting positive school experiences and strong teacher-student relationships as a mechanism of reducing adolescent risk behaviors such as e-cigarette use among diverse adolescent populations. Sources of Support: This project was funded by a grant from the National Institute of Minority Health and Health Disparities (NIMHD) grant number R01MD010586 (PI: Allen).