Perceived Stress and E-cigarette Use During Emerging Adulthood: A Longitudinal Examination of Initiation, Progression, and Continuation

E-cigarettes are the most commonly used tobacco product among youth and young adults in the US. Limited research has examined how stress impacts e-cigarette use among young people. We examine the longitudinal associations between perceived stress scale (PSS) score and e-cigarette use behaviors among a diverse cohort of emerging adults. We analyzed two waves of data collected in Fall 2019 (baseline) and Spring 2020 (6-month follow-up) of the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were classified into three mutually exclusive subsamples at baseline: (1) n = 1177 never e-cigarette users; (2) n = 806 ever but not current (past 30-day) e-cigarette users (i.e., ever users); and (3) n = 257 current (past 30-day) e-cigarette users. Three multivariate logistic regression models examined the relationship between PSS at baseline and: (1) initiation among never users; (2) progression to current use among ever users; and (3) continuation among current users, at 6-month follow-up. PSS scores were standardized using z-scores. Models controlled for race/ethnicity, sex, age, ever marijuana use, and ever use of other tobacco products. Mean age ranged from 18.6 to 19.4 among cohorts. Risk for e-cigarette progression among ever users (aOR: 1.30; 95%CI: 1.01-1.69) and e-cigarette continuation among current users (aOR: 1.33 (95%CI: 1.01-1.75) increased with each unit increase in PSS score at baseline. PSS at baseline was not associated with e-cigarette initiation among never users. PSS predicted greater risk of e-cigarette progression and continuation but not initiation among a diverse cohort of emerging adults. E-cigarette prevention and cessation strategies should consider perceived stress an important risk factor for e-cigarette use during emerging adulthood.