Factors that influence decision-making among youth who vape and youth who don't vape.

Vaping rates among Canadian youth are significantly higher compared to adults. While it is acknowledged that various personal and socio-environmental factors influence the risk of school-aged youth for vaping uptake, we don't know which known behavior change factors are most influential, for whom, and how. The Unified Theory of Behavior (UTB) brings together theoretically-based behavior change factors that influence health risk decision making. We aimed to use this framework to study the factors that influence decision making around vaping among school-aged youth. Qualitative interviews were conducted with 25 youth aged 12 to 18 who were either vaped or didn't vape. We employed a collaborative and directed content analysis approach and the UTB constructs served as the coding framework for analysis. Gender differences were explored in the analysis. We found that multiple intersecting factors play a significant role in youth decision making to vape. Youth who vaped and those who did not vape reported similar mediating determinants that either reinforced or challenged their decision-making, such as easy access to vaping, constant exposure to vaping, and the temptation of flavors. Youth who didn't vape reported individual determinants that strengthened their intentions to not vape, including more negative behavioral beliefs (e.g., vaping is harmful) and normative beliefs (e.g., family disapproves), and strong self-efficacy (e.g. self-confidence). Youth who did vape, however, reported individual determinants that supported their intentions to vape, such as social identity, coolness, and peer endorsement. The findings revealed cohesion across multiple determinants, suggesting that consideration of multiple determinents when developing prevention messages would be beneficial for reaching youth.

Factors that influence the decision to vape among Indigenous youth.

BACKGROUND: The use of e-cigarettes (vaping) among Indigenous youth is much higher than that of their non-Indigenous counterparts, which has raised the concerns of various Indigenous scholars and communities. To better understand the most salient constructs that influence Indigenous youth decision-making around vaping, we co-created a qualitative research study with a Syilx First Nation community that was guided by the Unified Theory of Behavior (UTB). METHODS: Through semi-structured interviews and a sharing circle, we gathered the perspectives and experiences of 16 Syilx youth in British Columbia, Canada. After an initial collaborative coding and training session, the interviews were transcribed and coded by Indigenous peer researchers using Nvivo. Through both directed and conventional qualitative content analysis methods, the final conceptual framework was collaboratively developed. RESULTS: Syilx youth reported that vaping decision-making is underpinned by colonialism, and the historical disproportionate impact of the tobacco industry. The youth spoke to several individual determinants that influence intentions to vape (e.g., vaping helps you cope) and to not vape (e.g., family and community connectedness), and determinants that translate intentions to vape to decision to vape (e.g., access to vaping), and to not vape (e.g., access to trusted adults and support from the band). The youth suggested that prevention efforts must be informed by an understanding of why Indigenous youth vape and what strengthens their resolve to not vape. CONCLUSIONS: Vaping decision-making among Indigenous youth is underpinned by their cultures, contexts, and histories. To effectively address vaping among Indigenous youth, continued engagement of Indigenous youth in planning, developing, implementing, and evaluating both prevention and policies efforts is a necessity.