Electronic Theses and Dissertations



Document Type


Degree Name

Doctor of Philosophy


Social & Behavioral Sciences

Committee Chair

Satish Kedia

Committee Member

Satish Kedia

Committee Member

Kenneth Ward

Committee Member

Latrice Pichon


Adolescent e-cigarette use has reached an epidemic level in the United States (US). It is therefore critical to encourage adolescents to quit e-cigarettes. The present research draws upon the Stages of Change (SOC) of the Trans-theoretical Model (TTM) and the Socio-Ecological Model to examine: 1) the association of socio-ecological factors with the SOC for intention to quit e-cigarettes among US adolescents; 2) the transitions across stages of e-cigarette quitting and its association with socio-ecological factors; and 3) the association of socio-ecological factors among US adolescents who quit using e-cigarettes (quitters) vs. those who did not quit (non-quitters). We conducted one cross-sectional (n=349) and two prospective observational studies (n=243 and n=177) using data from past 30-day adolescent exclusive e-cigarette users participating in Wave 3 and/or Wave 4 of the Population Assessment of Tobacco and Health (PATH) survey. Data analyses were performed using weighted unadjusted and/or adjusted multivariate and multinomial logistic regression analysis, and structural equation modeling (SEM). At the individual level, we found that adolescents who perceived that people cause a lot of harm to themselves relative to no harm when they use e-cigarettes were approximately 11 times more likely to be in the preparation stage than pre-contemplation stage. Furthermore, adolescents were significantly less likely to quit e-cigarettes if they perceived that people harm themselves a little/some from e-cigarettes and nicotine in e-cigarettes was slightly/somewhat harmful to health. At the interpersonal level, those adolescents who reported that important people in their life used e-cigarettes were significantly less likely to transition from pre-contemplation to action stage and 6.8 times more likely to remain stagnant in the pre-contemplation stage. At the environmental/policy level factors, adolescents who often/very often and rarely/sometimes noticed health warnings on e-cigarette packages relative to those who never noticed such warnings were approximately 4.7 times and 3.2 times, respectively, more likely to be in the contemplation stage than pre-contemplation stage. The SEM findings showed direct significant relationship of individual (b =0.206, p = 0.02) and interpersonal factors (b = 0.170, p = 0.04) with e-cigarette quitting behavior. Multi-level interventions are needed to encourage adolescents to positively navigate through stages of quitting e-cigarettes, and eventually help them to quit using these products.


Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest