Community- and individual-level risk factors of past month e-cigarette use among adolescents in France

Abstract Purpose Studies of adolescent e-cigarette use infrequently consider how environmental effects impact use. Adolescent e-cigarette use in France is also understudied, yet an important contrast since e-cigarette use rarely precedes conventional tobacco use and daily tobacco use is common. We examine whether there is significant variation in e-cigarette use across the geographic unit of departements (n = 95), and whether community factors explain these differences and individual-level probabilities of e-cigarette use. Methods The ESCAPAD survey is a cross-sectional, nationally representative survey collected at a day of civic and military information mandatory for French 17-year-olds. We use the 2014 (n = 22,023) and 2017 (n = 39,115) surveys and geographic information from Eurostat and INSEE. Multilevel, multiple logistic regression models examine any and daily past month e-cigarette use. Results We find significant departement-level variation in both outcomes, with a considerable proportion of this variation explained by departement-level factors. Net of numerous significant individual-level covariates, departement-level unemployment (OR = 1.049, p Conclusions Researchers should incorporate community effects into studies of e-cigarette use. Particularly, the tobacco use environment contributes to risk of e-cigarette use. For policymakers, resources may be mobilized to address local socioeconomic, demographic, and tobacco use patterns to potentially affect adolescent e-cigarette use.