Perceived Harm of Using Electronic Cigarettes Moderates Grade Level and Past Month Use in a National Sample of Youth in the United States.

PurposeTo examine if perceived harm moderates the relation between grade level and past 30-day use of electronic cigarettes for a nationally representative sample of youth in the United States.DesignSecondary data analysis of the 2022 National Youth Tobacco Survey (NYTS); a cross-sectional survey.SettingYouth in the United States.ParticipantsA nationally representative sample of the students in private and public schools, grades 6^th-12^th, collected via online questionnaire that included 341 schools and 28 291 participants.MeasuresDemographic variables and covariates (ie, sexual identity, sex, race/ethnicity), independent variables (ie, grade level 6-12, perceived harm of using electronic cigarettes) and dependent variable (ie, past 30-day use of electronic cigarettes).ResultsA binary logistic regression, including interaction F(6, 131) = 1.87, P = 0.000, indicated that perceived harm moderated the relation between grade level and electronic cigarette use in the past 30 days. As grade level increased so did the probability of using electronic cigarettes; however, the tested model extended these findings by including perceived harm as a moderator. Thus, the model allowed testing differences within and between grade levels. The highest probability of electronic cigarette use was for youth in 12^th grade with low perceived harm whereas the lowest use was in 6^th grade, regardless of perceived harm level.ConclusionWe believe our findings present novel ways to approach adolescent electronic cigarette health promotion, prevention, and education with the goal of influencing perceptions of harm for electronic cigarette use, especially with youth at lower grade levels.