Date of Award


Document Type

Doctoral Research Project

Degree Name

Doctor of Psychology (PsyD)



First Advisor

Vida L. Tyc

Second Advisor

Anthony LoGalbo

Third Advisor

Kimberly Sloman

Fourth Advisor

Robert A. Taylor


Electronic nicotine delivery systems (ENDS), also known as electronic cigarettes, are portable battery-powered devices used to smoke or “vape” a flavored solution which usually contains nicotine. Many national organizations (CDC, AMA, AAFP, ALA, AHA) have recognized the alarmingly increased rates of ENDS use in the United States, especially among certain populations. Those most likely to engage in ENDS use are youth and young adults, and adults who already smoke combustible cigarettes. Many people perceive ENDS use as a healthier alternative to smoking regular cigarettes and thus, are more willing to initiate ENDS use. However, research has indicated that ENDS use is associated with negative health effects, especially to those already diagnosed with a respiratory illness or disease such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, and lung cancer. The purpose of this study was to determine the rates of ENDS use among those with respiratory illnesses and to examine their health risk perceptions associated with ENDS. Other risk factors, including demographic, psychosocial, and health-related factors associated with ENDS risk perceptions were also examined. This study included 270 adult participants with respiratory illnesses who were current/past smokers (n = 28, 10%), current/past vapers (n = 7, 3%), current/past dual users (n = 208, 77%), and ever dual users (n = 27, 10%). The sample included 146 men, 101 women, 19 transwomen, 3 transmen, and one individual who identified as gender fluid. Most respondents were between the ages of 25-34 years old. Results demonstrated that risk perceptions associated with ENDS use were significantly greater for those smoking or vaping a single product compared to those who were current dual users, U = 3988, z = -6.18, p < .001. ENDS risk perceptions were also significantly associated with gender, ethnicity, geographic region, and race. Particularly, participants who identified as male/transman, Hispanic/Latino, from the South and Midwest U.S. regions, and of a minority race were more likely to report lower risk perceptions associated with ENDS use. Likewise, those who had one or more friends who vaped were more likely to have lower ENDS risk perceptions compared to those who had no friends who vaped. More than half of this sample endorsed ENDS use as an effective coping method for stress management (n = 146, 54%). Similarly, 66% (n = 179) agreed that ENDS use is an effective tool for smoking cessation and 76% (n = 206) agreed that ENDS products could help with reducing the number of cigarettes smoked (i.e., harm reduction strategy). Although more than half of the participants (n = 159, 59%) endorsed that their health care providers have never advised the use of ENDS products for smoking cessation, 33% (n = 90) endorsed being advised this once or twice, and 8% (n = 21) of participants endorsed being advised frequently from a healthcare provider to use ENDS products for smoking

cessation. In terms of respiratory-health risk factors, an individual's overall health status significantly predicted ENDS Risk Perceptions, B = 0.70, t (265) = 3.42, p < .001, indicating that on average, a one standard deviation-unit increase in Health Status score increased the value of ENDS Risk Perception scores by 0.70 standard deviation units. Those with a poorer health status were more likely to have higher risk perceptions related to ENDS use. Based on the results from this study, medical practitioners can be more mindful in sharing the negative health outcomes of dual using among those who have a chronic respiratory condition and currently smoke and vape. Since this population often requires frequent medical care and hospital visits, it would be worthwhile to modify respiratory medical standards to include education about the negative health effects of vaping to be regularly discussed with patients. The association between health perceptions and smoking/vaping status demonstrated in this study, and the fact that health perceptions are modifiable, suggests that provider advice about smoking/vaping-related health risks may influence behavioral change.


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