Association between online exposure, literacy, and adolescent e-cigarette use and cigarette smoking

Objectives: This study examined the relationship between online exposure, media literacy, eHealth literacy, electronic cigarette (e-cigarette) use, cigarette smoking, and intentions to use e-cigarettes and cigarettes. among adolescents. Methods: The study included 2595 seventhgrade students from 30 middle schools in Taiwan to complete a self-administered survey in 2020. Results: Among the participants, 2.4% reported ever using e-cigarettes, with 0.88% using e-cigarettes within the past year. Additionally, 2.2% reported ever smoking cigarettes, and 0.8% reported smoking within the past year. Generalized estimating equations revealed that adolescents’ exposure to online e-cigarette marketing and lower levels of attitudinal media literacy were associated with e-cigarette use. Among nonusers, exposure to online e-cigarette marketing and lower conceptual media literacy were associated with greater e-cigarette use intentions. Furthermore, adolescent e-cigarette use was associated with cigarette smoking and cigarette use intentions. Conclusions: Online exposure to e-cigarette marketing was identified as a risk factor for e-cigarette use and e-cigarette use intention, and e-cigarette use was linked to cigarette smoking and intention to smoke. Attitudinal media literacy was a protective factor against e-cigarette use and cigarette smoking.