{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:13:11Z","timestamp":1790878391057,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["T32SR5359"],"award-info":[{"award-number":["T32SR5359"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["T30IP0965"],"award-info":[{"award-number":["T30IP0965"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["T34IP8179"],"award-info":[{"award-number":["T34IP8179"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["T33IR6633"],"award-info":[{"award-number":["T33IR6633"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["T32KT4896"],"award-info":[{"award-number":["T32KT4896"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["T34IR8251"],"award-info":[{"award-number":["T34IR8251"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["K24HL155884"],"award-info":[{"award-number":["K24HL155884"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["R01HL137052"],"award-info":[{"award-number":["R01HL137052"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["R01HL147326"],"award-info":[{"award-number":["R01HL147326"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["1I01BX004767"],"award-info":[{"award-number":["1I01BX004767"]}]},{"name":"California State Tobacco-Related Disease Research Program (TRDRP) Smoke and Vape-Free Scholar Initiative (SVFSI)","award":["1I01BX006447"],"award-info":[{"award-number":["1I01BX006447"]}]},{"name":"TRDRP","award":["T32SR5359"],"award-info":[{"award-number":["T32SR5359"]}]},{"name":"TRDRP","award":["T30IP0965"],"award-info":[{"award-number":["T30IP0965"]}]},{"name":"TRDRP","award":["T34IP8179"],"award-info":[{"award-number":["T34IP8179"]}]},{"name":"TRDRP","award":["T33IR6633"],"award-info":[{"award-number":["T33IR6633"]}]},{"name":"TRDRP","award":["T32KT4896"],"award-info":[{"award-number":["T32KT4896"]}]},{"name":"TRDRP","award":["T34IR8251"],"award-info":[{"award-number":["T34IR8251"]}]},{"name":"TRDRP","award":["K24HL155884"],"award-info":[{"award-number":["K24HL155884"]}]},{"name":"TRDRP","award":["R01HL137052"],"award-info":[{"award-number":["R01HL137052"]}]},{"name":"TRDRP","award":["R01HL147326"],"award-info":[{"award-number":["R01HL147326"]}]},{"name":"TRDRP","award":["1I01BX004767"],"award-info":[{"award-number":["1I01BX004767"]}]},{"name":"TRDRP","award":["1I01BX006447"],"award-info":[{"award-number":["1I01BX006447"]}]},{"name":"NIH NHLBI","award":["T32SR5359"],"award-info":[{"award-number":["T32SR5359"]}]},{"name":"NIH NHLBI","award":["T30IP0965"],"award-info":[{"award-number":["T30IP0965"]}]},{"name":"NIH NHLBI","award":["T34IP8179"],"award-info":[{"award-number":["T34IP8179"]}]},{"name":"NIH NHLBI","award":["T33IR6633"],"award-info":[{"award-number":["T33IR6633"]}]},{"name":"NIH NHLBI","award":["T32KT4896"],"award-info":[{"award-number":["T32KT4896"]}]},{"name":"NIH NHLBI","award":["T34IR8251"],"award-info":[{"award-number":["T34IR8251"]}]},{"name":"NIH NHLBI","award":["K24HL155884"],"award-info":[{"award-number":["K24HL155884"]}]},{"name":"NIH NHLBI","award":["R01HL137052"],"award-info":[{"award-number":["R01HL137052"]}]},{"name":"NIH NHLBI","award":["R01HL147326"],"award-info":[{"award-number":["R01HL147326"]}]},{"name":"NIH NHLBI","award":["1I01BX004767"],"award-info":[{"award-number":["1I01BX004767"]}]},{"name":"NIH NHLBI","award":["1I01BX006447"],"award-info":[{"award-number":["1I01BX006447"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["T32SR5359"],"award-info":[{"award-number":["T32SR5359"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["T30IP0965"],"award-info":[{"award-number":["T30IP0965"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["T34IP8179"],"award-info":[{"award-number":["T34IP8179"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["T33IR6633"],"award-info":[{"award-number":["T33IR6633"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["T32KT4896"],"award-info":[{"award-number":["T32KT4896"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["T34IR8251"],"award-info":[{"award-number":["T34IR8251"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["K24HL155884"],"award-info":[{"award-number":["K24HL155884"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["R01HL137052"],"award-info":[{"award-number":["R01HL137052"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["R01HL147326"],"award-info":[{"award-number":["R01HL147326"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["1I01BX004767"],"award-info":[{"award-number":["1I01BX004767"]}]},{"name":"Department of Veterans Affairs (VA) Merit Awards","award":["1I01BX006447"],"award-info":[{"award-number":["1I01BX006447"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The prevalence of e-cigarette use (vaping) in young adults is concerning, particularly because the initiation of combustible tobacco use is higher in e-cigarette vapers. It is unclear why young, never-smoker vapers decide to start smoking cigarettes, but they may be influenced by perceptions of health risks and accessibility. We designed a social media questionnaire to assess factors driving the initiation of combustible tobacco use by e-cigarette vapers (multi-inhalant use) and switches between inhalant types. Respondents reported an earlier initiation of combustible tobacco versus vaping (18 vs. 19, respectively, p &lt; 0.0001), greater ease of obtaining combustibles versus vaping products (p &lt; 0.01), and pleasure of vaping being equivalent to that of smoking. The majority of subjects (57%) reported smoking first prior to adding vaping devices, 32% reported initiating both smoking and vaping within 12 months of one another, and 11% reported initiating vaping first. Among respondents (n = 864) who switched from vaping to smoking (n = 104), the primary reasons included 1. the perception that smoking was healthier (44%) and 2. greater accessibility of cigarettes (40%). For those who switched from smoking to vaping (n = 178), the predominant motivations included 1. having friends or family who vape (40%) and 2. the perception that vaping was healthier (36%). Among multi-inhalant users (n = 223), key factors driving this behavior included 1. increased enjoyment (47%) and 2. greater variety (42%). Our findings imply that there is no single, dominant reason driving the initiation of combustible use or switching from one inhalant to another. Further, tobacco users are receiving mixed messaging, leading many to believe that combustible tobacco is the healthier option. Public health interventions are needed to prevent the initiation of e-cigarette vaping by youth and to educate the public about the health effects of tobacco products.<\/jats:p>","DOI":"10.3390\/ijerph22050800","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T06:54:28Z","timestamp":1747724068000},"page":"800","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Perceptions of Health Risks and Accessibility: A Social Media-Based Pilot Study of Factors Influencing Use of Vaping and Combustible Tobacco Products"],"prefix":"10.3390","volume":"22","author":[{"given":"Enitan","family":"Banjo","sequence":"first","affiliation":[{"name":"Department of Health Sciences, California State University, Dominguez Hills (CSUDH), Carson, CA 90747, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1969-5041","authenticated-orcid":false,"given":"Zoya","family":"Ahadian","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego (UCSD), San Diego, CA 92093, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5767-1122","authenticated-orcid":false,"given":"Nikita","family":"Kasaraneni","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego (UCSD), San Diego, CA 92093, USA"},{"name":"Medicine Service, Pulmonary and Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA 92161, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4813-7271","authenticated-orcid":false,"given":"Howard","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego (UCSD), San Diego, CA 92093, USA"},{"name":"Medicine Service, Pulmonary and Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA 92161, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarala","family":"Perera","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego (UCSD), San Diego, CA 92093, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Emory","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, California State University, Dominguez Hills (CSUDH), Carson, CA 90747, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5091-2660","authenticated-orcid":false,"given":"Laura E.","family":"Crotty Alexander","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Physiology, University of California San Diego (UCSD), San Diego, CA 92093, USA"},{"name":"Medicine Service, Pulmonary and Critical Care Section, Veterans Affairs San Diego Healthcare System, La Jolla, CA 92161, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jamapediatrics.2017.1488","article-title":"Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis","volume":"171","author":"Soneji","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zhong, J., Cao, S., Gong, W., Fei, F., and Wang, M. (2016). Electronic Cigarettes Use and Intention to Cigarette Smoking among Never-Smoking Adolescents and Young Adults: A Meta-Analysis. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13050465"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1136\/tc-2022-057542","article-title":"Effects of dual use of e-cigarette and cannabis during adolescence on cigarette use in young adulthood","volume":"33","author":"Islam","year":"2023","journal-title":"Tob. Control"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jama.2015.8950","article-title":"Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence","volume":"314","author":"Leventhal","year":"2015","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1001\/jamapediatrics.2015.1742","article-title":"Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults","volume":"169","author":"Primack","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1136\/tobaccocontrol-2021-056528","article-title":"Exploring the gateway hypothesis of e-cigarettes and tobacco: A prospective replication study among adolescents in the Netherlands and Flanders","volume":"32","author":"Martinelli","year":"2023","journal-title":"Tob. Control"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1136\/tc-2022-057491","article-title":"Longitudinal bidirectional association between youth electronic cigarette use and tobacco cigarette smoking initiation in Thailand","volume":"33","author":"Patanavanich","year":"2024","journal-title":"Tob. Control"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Pisinger, C., and Rasmussen, S.K.B. (2022). The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.21203\/rs.3.rs-1116605\/v1"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"00976","DOI":"10.1183\/23120541.00976-2020","article-title":"Prospective association between use of electronic cigarettes and use of conventional cigarettes: A systematic review and meta-analysis","volume":"7","author":"Adermark","year":"2021","journal-title":"ERJ Open Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gunge, D., Marganski, J., Advani, I., Boddu, S., Chen, Y.J.E., Mehta, S., Merz, W., Fuentes, A.L., Malhotra, A., and Banks, S.J. (2021). Deleterious Association of Inhalant Use on Sleep Quality during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182413203"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1164\/rccm.201904-0890LE","article-title":"Use of Electronic Cigarettes with Conventional Tobacco Is Associated with Decreased Sleep Quality in Women","volume":"200","author":"Boddu","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Advani, I., Gunge, D., Boddu, S., Mehta, S., Park, K., Perera, S., Pham, J., Nilaad, S., Olay, J., and Ma, L. (2022). Dual use of e-cigarettes with conventional tobacco is associated with increased sleep latency in cross-sectional Study. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-06445-8"},{"key":"ref_13","unstructured":"Environment., D.o.P.H. Healthy Kids Colorado Survey Information, Colorado State."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.addbeh.2018.11.014","article-title":"E-cigarette palatability in smokers as a function of flavorings, nicotine content and propylthiouracil (PROP) taster phenotype","volume":"91","author":"Mead","year":"2019","journal-title":"Addict. Behav."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e2233938","DOI":"10.1001\/jamanetworkopen.2022.33938","article-title":"Association of e-Cigarette Advertising, Parental Influence, and Peer Influence With US Adolescent e-Cigarette Use","volume":"5","author":"Wang","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s12931-021-01737-5","article-title":"An updated overview of e-cigarette impact on human health","volume":"22","author":"Marques","year":"2021","journal-title":"Respir. Res."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Izquierdo-Condoy, J.S., Naranjo-Lara, P., Morales-Lapo, E., Hidalgo, M.R., Tello-De-la-Torre, A., Vasconez-Gonzales, E., Salazar-Santoliva, C., Loaiza-Guevara, V., Rincon Hernandez, W., and Becerra, D.A. (2024). Direct health implications of e-cigarette use: A systematic scoping review with evidence assessment. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1427752"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Erhabor, J., Yao, Z., Tasdighi, E., Benjamin, E.J., Bhatnagar, A., and Blaha, M.J. (2025). E-cigarette Use and Incident Cardiometabolic Conditions in the All of Us Research Program. Nicotine Tob. Res., ntaf067.","DOI":"10.1093\/ntr\/ntaf067"},{"key":"ref_19","first-page":"10229","article-title":"Vaping, Smoking and Lung Cancer Risk","volume":"9","author":"Bittoni","year":"2024","journal-title":"J. Oncol. Res. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"EVIDoa2300229","DOI":"10.1056\/EVIDoa2300229","article-title":"Population-Based Disease Odds for E-Cigarettes and Dual Use versus Cigarettes","volume":"3","author":"Glantz","year":"2024","journal-title":"NEJM Evid."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e045603","DOI":"10.1136\/bmjopen-2020-045603","article-title":"E-cigarette use and combustible tobacco cigarette smoking uptake among non-smokers, including relapse in former smokers: Umbrella review, systematic review and meta-analysis","volume":"11","author":"Baenziger","year":"2021","journal-title":"BMJ Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1093\/ntr\/ntab243","article-title":"Is Adolescent E-Cigarette Use Associated With Subsequent Smoking? A New Look","volume":"24","author":"Sun","year":"2022","journal-title":"Nicotine Tob. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/tobaccocontrol-2018-054446","article-title":"Examining the relationship of vaping to smoking initiation among US youth and young adults: A reality check","volume":"28","author":"Levy","year":"2019","journal-title":"Tob. Control"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s40429-022-00448-1","article-title":"Dual Use of Combustible Cigarettes and E-cigarettes: A Narrative Review of Current Evidence","volume":"9","author":"Coleman","year":"2022","journal-title":"Curr. Addict. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1177\/0022146514532817","article-title":"With a Little Help from My Friends? Asymmetrical Social Influence on Adolescent Smoking Initiation and Cessation","volume":"55","author":"Haas","year":"2014","journal-title":"J. Health Soc. Behav."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1080\/10826084.2020.1759642","article-title":"Peer Pressure and Substance Use in Emerging Adulthood: A Latent Profile Analysis","volume":"55","author":"Keyzers","year":"2020","journal-title":"Subst. Use Misuse"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Torrejon-Guirado, M.C., Baena-Jimenez, M.A., Lima-Serrano, M., de Vries, H., and Mercken, L. (2023). The influence of peer\u2019s social networks on adolescent\u2019s cannabis use: A systematic review of longitudinal studies. Front. Psychiatry, 14.","DOI":"10.3389\/fpsyt.2023.1306439"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"50","DOI":"10.14485\/HBPR.5.6.4","article-title":"\u201cIt Felt Like I Was Smoking Nothing:\u201d Examining E-cigarette Perception and Discontinuation among Young Adults","volume":"5","author":"Le","year":"2018","journal-title":"Health Behav. Policy Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1017\/cts.2018.18","article-title":"Impact of survey length and compensation on validity, reliability, and sample characteristics for Ultrashort-, Short-, and Long-Research Participant Perception Surveys","volume":"2","author":"Kost","year":"2018","journal-title":"J. Clin. Transl. Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/5\/800\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:35:38Z","timestamp":1760031338000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/5\/800"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,20]]},"references-count":29,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["ijerph22050800"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22050800","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,20]]}}}