A cross-sectional study of predictors of perceptions of addiction among college students using Electronic Nicotine Delivery System users

Introduction: It is estimated that almost one quarter of young adults use electronic nicotine delivery systems (ENDS) despite health risks. Perceptions of addiction to nicotine has been linked with motivation to quit, highlighting the importance of understanding contributors to addiction perceptions among young adults. Methods: The current study used cross-sectional survey data to examine how perceptions of addiction were impacted by physical dependence, risk perception, intention to quit, number of quit attempts, and initiation regret among a sample of undergraduate students (n=99) who had used ENDS within the past 30 days. Participants were aged 18-23 years with a mean age of 19.64 years (SD=1.156). The majority (64.6%) identified as women, and 61.6% identified as White. Results: Only symptoms of nicotine dependence were significantly related to perception of addiction (β=-0.636; 95% CI: -0.829--0.474, t=-7.415, p<0.001) indicating that experiencing more symptoms of nicotine dependence predicted stronger perceptions of nicotine addiction. The number of lifetime quit attempts moderated the relationship between symptoms of addiction and perception of addiction (β=0.129; 95% CI: 0.069-0.190, p<0.000) such that symptoms of nicotine dependence have a stronger relationship with perceptions of addiction when an individual has engaged in fewer quit attempts. The number of quit attempts did not moderate the relationship between initiation regret and perceptions of addiction or the relationship between perceptions of the risk of becoming addicted to vaping and perceptions of addiction. Conclusions: The results highlight the role of symptoms of physical dependence on perceptions of addiction among young adults attending college. Surprisingly, this relationship was stronger for individuals with fewer quit attempts. Perhaps more failed quit attempts lead young adults to adopt self-exemption beliefs and disconnect their symptoms of nicotine dependence from their perception that they are addicted to ENDS.