Stealth vaping and associated attitudes, perceptions, and control beliefs among US college students across four tobacco-free campuses.
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OBJECTIVES: Stealth vaping gained popularity among college students in recent years. It may undermine the benefits introduced by tobacco-free policies. Yet, no studies have investigated attitude and belief factors associated with stealth vaping. The objective of the study was to explore the relationship between attitudes toward on-campus tobacco regulations, normative perceptions of stealth vaping behaviors, and control beliefs with on-campus stealth vaping among U.S. college students. METHODS: Participants from four large, public universities with policies prohibiting use of all forms of tobacco (including e-cigarettes) on campus (N=863) completed an online survey in Fall 2020. On-campus stealth vaping behavior was captured by past 30-day stealth vaping status and frequency. Hurdle models with logistic and negative binomial regressions were conducted, where stealth vaping status was treated as a binary variable based on the non-zero and zero frequency, and stealth vaping frequency was treated as a count variable. Multiple imputation by chained equations was employed to handle the missing data. RESULTS: Participants with more positive attitudes toward regulating on-campus tobacco use were less likely to practice stealth vaping on campus (OR=1.16, p<0.01 [predicting zero]). Those with higher perceptions of stealth vaping among other students were more likely to stealth vape more frequently (IRR=1.03, p<0.01). CONCLUSION: Our results highlight the need for interventions to address students' attitudes and normative beliefs about stealth vaping. Efforts are needed to educate college students about the risk of e-cigarettes and to enhance enforcement of campus tobacco-free policies.
