PSYCHO PROJECT

HOW SOCIAL MEDIA IS PROMOTING AND PUSHING

ADOLESCENTS TOWARDS NEW KINDS OF SUBSTANCE ABUSE.

INTRODUCTION

Substance use disorder in DSM-5 combines the DSM-IV categories of substance abuse and
substance dependence into a single disorder measured on a continuum from mild to severe.
Each specific substance (other than caffeine, which cannot be diagnosed as a substance use
disorder) is addressed as a separate use disorder (e.g., alcohol use disorder, stimulant use
disorder, etc.), but nearly all substances are diagnosed based on the same overarching criteria.
In this overarching disorder, the criteria have not only been combined but strengthened.
Whereas a diagnosis of substance abuse previously required only one symptom, mild
substance use disorder in DSM-5 requires two to three symptoms from a list of 11. Drug craving
will be added to the list, and problems with law enforcement will be eliminated because of
cultural considerations that make the criteria difficult to apply internationally. In DSM-IV, the
distinction between abuse and dependence was based on the concept of abuse as a mild or
early phase and dependence as the more severe manifestation. In practice, the abuse criteria
were sometimes quite severe. The revised substance use disorder, a single diagnosis, will better
match the symptoms that patients experience. Additionally, the diagnosis of dependence
caused much confusion. Most people link dependence with “addiction” when in fact
dependence can be a normal body response to a substance.

DSM-5 will not include caffeine use disorder, although research shows that as little as two to
three cups of coffee can trigger a withdrawal effect marked by tiredness or sleepiness. There is
sufficient evidence to support this as a condition, however, it is not yet clear to what extent it is
a clinically significant disorder. To encourage further research on the impact of this condition,
caffeine use disorder is included in Section III of DSM-5.

Substance use disorder (SUD) is a complex condition in which there is uncontrolled use
of a substance despite harmful consequences. People with SUD have an intense
focus--sometimes called an addiction--on using a certain substance(s) such as alcohol,
tobacco, or other psychoactive substances, to the point where their ability to function in
day-to-day life becomes impaired. People keep using the substance even when they
know it is causing or will cause problems.
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Repeated substance use can cause changes in how the brain functions. These changes
can last long after the immediate intoxication wears off. Intoxication is the intense
pleasure, euphoria, and calm that is caused by the substance; these symptoms are
different for each substance. With continued use of a substance, tolerance can develop,
where someone may require larger amounts to feel these effects. Additionally,
discontinuing use can lead to symptoms of withdrawal and intense cravings to return to
use, often experienced as anxiety.

People with a substance use disorder may have distorted thinking and behaviors.
Changes in the brain's structure and function are what cause people to have intense
cravings, changes in personality, abnormal movements, and other behaviors. Brain
imaging studies show changes in the areas of the brain that relate to judgment,
decision-making, learning, memory, and behavioral control.

People with substance use and behavioral addictions may be aware of their problem but
not be able to stop even if they want and try to. The addiction may cause physical and
psychological problems as well as interpersonal problems such as with family members
and friends or at work.

Symptoms of substance use disorder are grouped into four categories:

● Impaired control: the experience of a craving or strong urge to use the substance;
desire or failed attempts to cut down or control substance use.
● Social problems: substance use causes failure to complete major tasks at work,
school, or home; social, work, or leisure activities may be cut back or given up
entirely.
● Dangerous use: substance is used in unsafe settings; continued use despite
known problems.
● Drug effects: tolerance (need for larger amounts to get the same effect);
withdrawal symptoms (different for each substance).

Many people experience substance use disorder along with other psychiatric disorders.
Another psychiatric disorder can, but does not necessarily, precede another psychiatric
disorder. It is also possible that the use of a substance may trigger or worsen another
psychiatric disorder.
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Gambling Disorder
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
gambling disorder is included in a category of behavioral addictions. This reflects
research findings that gambling disorders are similar to substance-related disorders
and these similarities will help people with gambling disorders get the necessary
treatment and services, and may help others better understand the challenges. More
about gambling disorder

Internet Gaming
Internet gaming disorder is included in DSM-5 in the section of disorders requiring
further research. This reflects the scientific literature showing that persistent and
recurrent use of Internet games, and a preoccupation with them, can result in clinically
significant impairment or distress. The condition criteria do not include general use of
the Internet or social media. More about Internet gaming

Technology Addiction
Smartphones and other technology are an integral and growing part of our lives.
However, excessive and compulsive use of the internet or online activities can lead to
negative consequences in various aspects of an individual's life. Technology addiction
can potentially involve various forms of online activity including social media, gaming,
gambling, problematic use of online pornography, and others.

E-Cigarettes and Vaping

The use of e-cigarettes, informally called "vaping," involves using electronic cigarettes to
inhale vapor created from a liquid heated inside of the device. E-cigarettes have become
the most commonly used tobacco product among youth since 2014. The aerosol from
vaping generally can contain harmful substances, including nicotine, heavy metals like
lead, volatile organic compounds, and cancer-causing agents, according to the CDC.
More about vaping.

Caffeine Intoxication and Withdrawal

Caffeine intoxication and caffeine withdrawal are included in DSM-5-TR. Caffeine use
disorder, however, is in the section of DSM-5-TR for conditions requiring further
research. While there is evidence to support this as a disorder, experts conclude it is not
yet clear to what extent it is a clinically significant disorder.
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REVIEW OF LITERATURE
1)Influence of Social Media on Alcohol Use in Adolescents and Young Adults

Influence of Social Media on Alcohol Use in Adolescents

and Young Adults
Part of the Topic Series: Alcohol Research and eHealth Technology
Megan A. Moreno, M.D., M.S.Ed., M.P.H., and Jennifer M. Whitehill, Ph.D.
Volume 36 Issue 1 January 1, 2014

Megan A. Moreno, M.D., M.S. Ed., M.P.H., is an associate professor at the

University of Washington and the Seattle Children’s Research Institute, Center
for Child Health Behavior and Development, Seattle, WA.

Jennifer M. Whitehill, Ph.D., is an assistant professor in the Department of Public

Health, University of Massachusetts Amherst, Amherst, MA.

Participation in online social media Web sites (e.g., Facebook and Twitter) has
skyrocketed in recent years and created a new environment in which adolescents
and young adults may be exposed to and influenced by alcohol-related content.
Thus, young people are exposed to and display pro-alcohol messages and
images through online portrayals of drinking on personal pages as well as
unregulated alcohol marketing on social media sites that may reach underage
people. Such online displays of alcohol behavior have been correlated with offline
alcohol behavior and risky drinking. Health behavior theories have been used to
describe the influence of social media sites, including Social Learning Theory, the
Media Practice Model, and a more recent conceptual approach called the
Facebook Influence Model. Researchers are beginning to assess the potential of
social media sites in identifying high-risk drinkers through online display patterns
as well as delivering prevention messages and interventions.

Today’s generation of adolescents and young adults are growing up immersed in

social media, such as Facebook and Twitter, that promote user-generated
content and interactions between users. Social media sites are an environment in
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which alcohol-related content is frequently created and consumed by
adolescents and young adults.

Content posted by adolescents and young adults is likely seen by peers and
younger users of these sites. Early studies on the effects of this exposure
focused on MySpace; however, research efforts have kept pace with changes in
the popular social media platforms including Facebook and Twitter. Several
studies have illustrated that adolescents’ displays on social media frequently
include the portrayal of health-risk behaviors related to alcohol, other substances,
and sexual behaviors. Alcohol-related displays may include texts (e.g., “Matt got
drunk last night”), photographs depicting alcohol consumption, or links to
alcohol-related groups or companies

Social media have a broad reach into the lives of many young people and
therefore have the potential to strongly influence their decisions. The growing
body of literature on social media and alcohol suggests that researchers can
consider the role of social media in alcohol consumption in two ways. First, social
media can serve as a source of information about the behavior of the individual
user, as illustrated by studies that link online content to offline behavior or
demonstrate links between online and offline alcohol consumption patterns
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2)Substance Abuse Amongst Adolescents: An Issue of Public Health Significance - PMC

Substance Abuse Amongst Adolescents: An Issue of

Public Health Significance
Monitoring Editor: Alexander Muacevic and John R Adler
Cureus. 2022 Nov; 14(11): e31193.
Published online 2022 Nov 7.

Adolescence is a crucial time for biological, psychological, and social

development. It is also a time when substance addiction and its adverse effects are
more likely to occur. Adolescents are particularly susceptible to the negative
long-term effects of substance use, including mental health illnesses, sub-par
academic performance, substance use disorders, and higher chances of getting
addicted to alcohol and marijuana. Over the past few decades, there have been
substantial changes in the types of illegal narcotics people consume. The present
article deals with the review of substance abuse as a public health problem, its
determinants, and implications seen among adolescents.
Drug misuse is a widespread issue; in 2016, 5.6% of people aged 15 to 26 reported
using drugs at least once. Because alcohol and illegal drugs represent significant
issues for public health and urgent care, children and adolescents frequently visit
emergency rooms. It is well known that younger people take drugs more often than
older adults for most drugs. Drug usage is on the rise in many Association of
Southeast Asian Nations, particularly among young males between the ages of 15
and 30 years According to the 2013 Global Burden of Disease report, drug
addiction is a growing problem among teenagers and young people. Early
substance use increases the likelihood of future physical, behavioral, social, and
health issues Furthermore, recreational drug use is a neglected contributor to
childhood morbidity and mortality One of the adverse outcomes of adolescent
substance use is the increased risk of addiction in those who start smoking,
drinking, and taking drugs before they are of 18 years. Moreover, most individuals
with Substance Use Disorders begin using substances when they are young.
Substance use disorders amongst adolescents have long-term adverse health effects
but can be mitigated with efficient treatment.
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The use of tobacco frequently begins before adulthood. A worryingly high
percentage of schoolchildren between 13 and 15 have tried or are currently
using tobacco, according to the Global Youth Tobacco Survey. It is more
likely that early adolescent cigarette usage will lead to nicotine dependence
and adult cigarette use. Teenage smoking has been associated with traumatic
stress, anxiety, and mood problems. Nicotine usage has been associated with
a variety of adolescent problems, including sexual risk behaviors,
aggressiveness, and the use of alcohol and illegal drugs. High levels of
impulsivity have been identified in adolescent smokers.

Additionally, compared to non-smokers, smoking is associated with a higher

prevalence of anxiety and mood disorders in teenagers. Smoking is positively
associated with suicidal thoughts and attempts. Peer pressure, attempting
something new, and stress management ranked top for current and former smokers.
Most teenagers say that when they start to feel down, they smoke to make
themselves feel better and return to their usual, upbeat selves. Smoking may have
varying effects on people's moods. Teenagers who smoke seem more reckless, less
able to control their impulses, and less attentive than non-smokers.

Around the world, adolescent drug and alcohol addiction has significantly
increased morbidity and mortality. The menace of drugs and alcohol has been
woven deep into the fabric of society. As its effects reach our youth, India's current
generation is at high stake for the risk associated with the abuse of drugs like
cannabis, alcohol, and tobacco. Even though the issue of substance abuse is
complicated and pervasive, various stakeholders like healthcare professionals,
community leaders, and educational institutions have access to a wealth of
evidence-based research that can assist them in adopting interventions that can
lower rates of teenage substance misuse. It is realized that while this problem is not
specific to any one country or culture, individual remedies might not always be
beneficial. Due to the unacceptably high rate of drug abuse that is wreaking havoc
on humanity, a strategy for addressing modifiable risk factors is crucial. Because
human psychology and mental health influence the choices the youth make related
to their indulgence in drug misuse, it is the need of the hour to give serious
consideration to measures like generating awareness, counseling, student guidance
cells, positive parenting, etc., across the world. It will take time to change this
substance misuse behavior, but the more effort we put into it, the greater the reward
we will reap.
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3)Children, Adolescents, Substance Abuse, and the Media | Pediatrics

From the American Academy of Pediatrics| Policy

Statement| October 01 2010

Children, Adolescents, Substance Abuse, and the Media

Victor C. Strasburger, MD; The Council on Communications and Media

Although parents, schools, and the federal government are trying to get children and
teenagers to “just say no” to drugs, more than $25 billion worth of cigarette, alcohol, and
prescription drug advertising is effectively working to get them to “just say yes” to
smoking, drinking, and other drugs In addition, television programs and movies contain
appreciable amounts of substance use. Unlike traditional advertising, media depictions
of legal drugs are generally positive and invite no criticism, because they are not viewed
as advertising. The result is that young people receive mixed messages about
substance use, and the media contributes significantly to the risk that young people will
engage in substance use.

Although illegal drugs take their toll on American society, 2 legal drugs—alcohol and
tobacco—pose perhaps the greatest danger to children and teenagers. Both represent
significant gateway drugs and are among the earliest drugs used by children or
teenagers. A preadolescent or adolescent who smokes tobacco or drinks alcohol is 65
times more likely to use marijuana, for example, than someone who abstains. The
younger the age at which experimentation occurs, the greater the risk of serious health
problems.
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4)The Use of Social Media in Children and Adolescents: Scoping Review on the
Potential Risks

The Use of Social Media in Children and

Adolescents: Scoping
Review of the Potential Risks
Elena Bozzola,Giulia Spina , Rino Agostiniani,Sarah Barni , Rocco Russo, Elena Scarpato, Antonio
Di Mauro,Antonella Vita Di Stefano, Cinthia Caruso , Giovanni Corsello and Annamaria Staiano

In recent years, social media has become part of our lives, even among children.
From the beginning of the COVID-19 pandemic period, media devices and
Internet access rapidly increased. Adolescents are connected Internet alone,
consulting social media, mostly Instagram, TikTok, and YouTube. During the
“lockdown”, Internet usage allowed communication with peers and the continuity
of activities such as school teaching. However, we have to keep in mind that
media usage may be related to some adverse consequences, especially for the
most vulnerable people, such as the young.

Social media is increasingly being used by children and adolescents, especially

during the COVID-19 pandemic and the health emergency. Although social media
use is demonstrated to be of utility, excessive or non-correct use may be a risk
factor for mental health, including depression, anxiety, and addiction. Social
media use may also correlate to inadequate nutrition with consumption of junk
food marketing leading to weight gain, obesity, dental caries, and unhealthy
eating behaviors. Associations have been found also with increasing physical
problems due to sedentary lifestyles, obesity, and non-physiological postures. On
the other hand, social media can cause problems with body image visualization
and acceptance, especially in young adolescent girls with lower self-esteem, who
may look for content for losing weight rapidly, and this can help the extension of
anorexia disorders. Children and adolescents who use social media for many
hours a day are also at higher risk for behavioral problems, cyberbullying, online
grooming, sleep difficulties, eye problems, (such as myopia, eye fatigue, dryness,
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blurry vision, irritation, burning sensation, conjunctival injection, ocular redness,
and dry eye disease), and headache. Moreover, uncontrolled social media use
can lead to sexting, exposure to pornography, exposure to unwanted sexual
material online, and early sexual activity. Social media users meet more online
risks than their peers do, with an increased risk for those who are more digitally
competent. Public and medical awareness must rise over this topic and new
prevention measures must be found, starting with health practitioners,
caregivers, and websites/application developers. Families should be educated on
the dangers and concerns of having children and adolescents online. A
prerequisite to informing families how to handle social media is to educate those
responsible for training, including health practitioners. In detail, pediatricians
should be reminded to screen for media exposure (amount and content) during
periodic check-up visits. They need to keep in mind the potential correlation of
problematic social media use with depression, obesity unhealthy eating behavior,
psychological problems, sleep disorders, addiction, anxiety, sex-related problems,
behavioral problems, body image, physical inactivity, online grooming, sight
compromising, headache, and dental caries. Pediatricians can also counsel
parents to guide children to the appropriate content by consulting ratings,
reviews, and plot descriptions, and by a previous screening of the material. They
should inform parents about the potential risk of digital commerce to facilitate
junk food, poor nutrition, and sweetened aliments, facilitating overweight and
obesity. On the contrary, a healthy diet, adequate physical activity, and sleep need
to be recommended. Pediatricians may also play a role in preventing
cyberbullying by educating both adolescents and families on appropriate online
behaviors and privacy respect. They should also promote face-to-face
communication and limit online communication via social media. Pediatricians
may encourage parents to develop rules and strategies about media devices and
social media use at home as well as in everyday life.
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5)Full article: Adolescents and substance abuse: the effects of substance abuse on
parents and siblings

Adolescents and substance abuse:

the effects of substance abuse on
parents and siblings
Glynnis Dykes &Riefqah Casker

Alcohol use by young people is an increasing concern worldwide (World Health

Organization (WHO). Alcohol use is initiated at a worrying age; 14% of
adolescent girls and 18% of boys between the ages of 13–15 years in low- and
middle-income countries. Consequently, 5% of deaths of young people below 30
years are attributed to alcohol abuse. In Central and Eastern Europe, it was
reported that 25% of under 20-year-olds use drugs, high usage across Western
Europe, Australasia, and North America, as well as lifetime cannabis use in these
countriesThe age-of-onset was similar across countries (16–19 years) except
South Africa where it was 2.0 years.

Substance abuse often develops in the transitional phase of adolescence, a time

when puberty and physical growth are occurring and when a young person seeks
independence. Adolescence is a momentous period in which the human body
undergoes significant physical growth and psychological changes; not only bodily
changes but also in the brain contend that adolescents are at greater risk of
substance addiction, due to the physiological and psychological effects of drugs
on the developing adolescents’ brain. Adolescent substance use ranges from
early-stage experimental use to compulsive and problematic drug abuse; which
in turn is compounded by various social problems, such as troubled relationships,
family difficulties, and challenging peer relationships.
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6)(PDF) SOCIAL MEDIA ADDICTION AND YOUNG PEOPLE: A SYSTEMATIC REVIEW OF
LITERATURE

SOCIAL MEDIA ADDICTION AND YOUNG PEOPLE: A

SYSTEMATIC REVIEW OF LITERATURE
Yap Jing Xuan, Muhammad Asyraf Che Amat

Social media/ Social Networking Sites (SNSs) have been a bridge for people to have
interpersonal interaction. It is prevalent in our daily lives, changing how people
communicate individually as well as professionally. The need for social media in the
modern era has been phenomenally growing (Abbasi, 2019). Users can create individual
public profiles, meet other people with common interests, and connect with real-life
friends through the virtual communities in SNS

Social media has had an important role following the development of digital technology
and with its extensive and collaborative framework, it has created new horizons in the
communication field. Regardless of the setting in which the studies were conducted,
social media has a major impact on young people, which raises the level of addiction
among young people, and the time they spend on these networks to increase

There are several factors, for instance, economic problems, psychological disorders,
and physical inabilities that make young people escape from the real world. However,
young people with poor social relationships and isolation have a higher chance of
plugging into social media and addicted (Kirik et al., 2015). The poor social relationships
in real life may drive young people to seek attention through social media. Young people
were seeking acceptance through social media through a series behaviors such as
frequently updating status on Facebook, expressing feelings on Twitter, or posting
photos on Instagram.

Young people may struggle while applying interventions to reduce social media
addiction. Several negative outcomes for instance outdated with current trends, losing
contact with virtual peers, and having less fun will face by them
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7)MarijuMarijuana promotions on social media: adolescents’ views on prevention
strategies

Marijuana promotions on social media:

adolescents’ views on prevention strategies
Megan A. Moreno, Aubrey D. Gower, Marina C. Jenkins, Bradley Kerr & Jesse Gritton

Youth exposure to positive marijuana messages increases their risk of

marijuana use. Since Washington State legalized recreational marijuana in
2012, marijuana businesses have used social media business pages to promote
their products. Regulations to prevent youth access and targeting by
marijuana businesses on social media in Washington State are absent.

Alcohol and tobacco industry advertising guidelines include provisions

restricting access and specific content. There are no such industry codes for
marijuana companies. As marijuana advertising and promotions are still in
their infancy, understanding emergent issues that have arisen while only a few
states have legalized marijuana may help inform policies that prevent future
harm. Our findings bring youth voices to support the development and
implementation of policies to restrict underage access to and regulation of
marijuana businesses’ content on social media.
Based on these findings, we recommend that all states with legalized
recreational marijuana should implement specific policies related to social
media to restrict youth access and youth-friendly content. These policies
should include language to implement requirements for all marijuana
businesses to use age-gating (i.e. limiting page access by age present on the
user’s profile) on social media. The prevalence and effectiveness of marijuana
business page age-gating have not been assessed, though studies of age-gating
to prevent youth access to alcohol business pages have shown poor compliance
by alcohol companies. Thus, routine evaluations of age-gating need to be part
of the implementation and ongoing monitoring of these rules.
Further, we recommend that content appealing to youth should be restricted
and all social media posts must include warnings. The content restrictions can
be modeled off advertisements in the alcohol and tobacco realm, as well as
data collected in this study about social media memes and the promotion of
linked products.
The routine monitoring and implementation of these rules presents challenges
to state organizations that are charged with developing and implementing
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these restrictions. Leveraging fines for non-compliance in this
multimillion-dollar industry may offset the costs to state agencies tasked with
monitoring social media, a continuously moving target. Thus, research on
strategies to monitor and identify infractions is needed. Another possible
avenue is to work directly with marijuana businesses to promote best practice
sharing and collaboration to ensure compliance. Given the importance of
youth marijuana prevention, policies to prevent youth access to influential
marijuana messages on social media are a critical consideration for
lawmakers, prevention scientists, and child advocates.
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8)Adolescents and E-cigarettes in India: A Qualitative Study of Perceptions and
Practices - PMC

Adolescents and E-cigarettes in India: A Qualitative Study

of Perceptions and Practices
Himanshu A Gupte, Nilesh Chatterjee, Gauri Mandal, Marina D’Costa

Electronic cigarettes, also known as e-cigarettes, e-cigs, or Electronic

Nicotine Delivery Systems are inhalation devices that deliver an aerosol
created by heating a solution, usually composed of propylene glycol or
glycerol (glycerin) and flavorings, generally with nicotine. E-cigarettes, also
seen as harm-reduction tools for smokers, have been shown to be beneficial
by acting as cessation aids for people trying to quit smoking. However, the
aerosol may include cancer-causing chemicals and tiny particles that reach
deep into the lungs and could lead to respiratory problems. Further,
dual-users, people who use both e-cigarettes and smoking tobacco products,
are 3.3 times more likely to develop respiratory illness as compared to
non-smokers who never used e-cigarettes

Worldwide, e-cigarette popularity and use among adolescents and children

has increased alarmingly. Roughly a fifth of India’s population, 236 million,
is between the ages of 10-19 years. The use of e-cigarettes has been found to
be common among adolescents in the country, and around 4% of adolescents
aged 15-24 years were reportedly aware of e-cigarettes according to the
Global Adult Tobacco Survey (GATS)-2. Currently, there are more than 460
brands of e-cigarettes with over 7,700 different flavors available for use; and
e-cigarettes are marketed to youth by promoting flavors through a wide range
of media channels, particularly through social media. In India, there were 75
companies selling e-cigarettes online

Some researchers argue that e-cigarettes are expanding the tobacco epidemic
by bringing lower-risk youth into the fold as e-cigarette use has been found to
be associated with greater risk of smoking initiation and in addition to
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respiratory problems, the nicotine present in e-cigarettes can make
adolescents prone to other addictions. It also harms the developing brain,
which can have long-lasting impacts, cause mood disorders, and lead to low
impulse-control . There are also reports of unintended injuries and poisoning
due to accidental swallowing of e-cigarette liquid by children . Are
e-cigarettes helpful for certain age-categories such as adult smokers and
potentially harmful for others such as young non-smokers? Ongoing research
is attempting to clarify our understanding of the balance between benefits and
harms of e-cigarettes.

Meanwhile, a range of regulatory approaches are being applied globally to

e-cigarettes with common policies that include a minimum-age-of-purchase,
indoor-use (vape-free public places) bans and marketing restrictions.
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9)Factors Associated with E-Cigarette Escalation among High School Students: A
Review of the Literature - PMC

Factors Associated with E-Cigarette Escalation among High

School Students: A Review of the Literature
Michael Short and Adam Geoffrey Cole

ackground: E-cigarette use has been identified as a behaviour of concern

among adolescents, and ever and daily use among this population has
increased recently. The purpose of this review was to summarize the relevant
studies investigating the frequency and intensity of e-cigarette use in
adolescents and the factors associated with these patterns of use. Methods: A
scoping search of two databases was conducted to identify longitudinal
studies examining escalating e-cigarette use among adolescents. Escalating
e-cigarette use could refer to an increasing frequency or intensity of use over
time. Articles were screened for relevance. Studies that met inclusion criteria
were included for synthesis. Results: Five articles were included for
synthesis. All five articles were longitudinal studies taking place in the
United States between 2013 and 2017. Age, gender, cost of e-cigarettes, use
of cigarettes, polysubstance use, and e-liquid nicotine concentration were
associated with escalation of e-cigarette use. Conclusions: A paucity of
information exists regarding the escalation of e-cigarette use among
adolescents. Given the changing popularity of devices, additional updated
evidence is needed to understand the factors associated with the escalation of
e-cigarette use among adolescents, which can be used to inform local and
national programs and policies.

E-cigarettes, also known as vapes, are electronic devices designed to

aerosolize a liquid which is then inhaled by the user. These devices can
deliver doses of sweetly flavored aerosol (often referred to as “vapor”),
which frequently contains nicotine. Even though many people believe that
e-cigarettes are harmless, the aerosol contains propylene glycol, glycerin,
aldehydes, and other toxins. By virtue of the ingredients contained in the
e-liquid, e-cigarettes have the propensity to cause a range of health issues
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including lung inflammation, irregular brain development, and alteration of
neurotransmitters such as dopamine. Other evidence has found that using
e-cigarettes is associated with higher odds of experiencing bronchitic
symptoms. The nicotine found in e-cigarettes can alter a variety of
physiological functions, including blood pressure, which may lead to adverse
health events such as strokes and myocardial infarctions. These health
concerns are especially worrisome for the adolescent population as their brain
is still developing, and the addition of nicotine at this stage of development
may make them more susceptible to addiction.

Along with the emerging health concerns of e-cigarette use, there is growing
concern that e-cigarettes may appeal to adolescents, particularly those who
would otherwise not engage in tobacco use. Recent evidence indicates that
e-cigarette use among adolescents is globally problematic. Data from the
National Youth Tobacco Survey (NYTS) illustrates that the prevalence of
e-cigarette use among grade 12 students increased from 9.0% in 2004 to
13.7% in 2014. More recent data indicate that daily e-cigarette use among
grade 12 and grade 10 students was 11.7% and 6.9%, respectively, in 2019.
Furthermore, this study also reported that ever use of e-cigarettes increased
from 34.0% to 40.5% among grade 12 students from 2018 to 2019 and
increased from 28.6% to 36.4% among grade 10 students between 2018 and
2019. The concerning increasing prevalence of e-cigarette use is not
exclusive to the United States. In a 2015 study of Irish youth, 24% of
adolescents reported having used an e-cigarette in their life while 3.2%
reported current use (defined as at least once a month). Furthermore, in 2017,
up to 18% of adolescents in the United Kingdom had ever used e-cigarettes
and 3% of adolescents reported daily use. Lastly, in a study analyzing the
trends of e-cigarette use among adolescents in Ontario, Canada, it was found
that the use of e-cigarettes increased from 7.6% in 2013 to 25.7% in 2018.

With an increase in the prevalence of e-cigarette use among adolescents, it is

imperative to understand the allure of these products to the adolescent
population. Several studies have investigated the factors associated with the
initiation of e-cigarette use. Multiple studies have reported that gender, friend
use, and perception of e-cigarettes, as well as previous cigarette use are
associated with e-cigarette initiation. However, it has yet to be seen if these
factors are also associated with escalating e-cigarette use.
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While researchers have spent a significant amount of time studying
e-cigarette initiation since the introduction of the devices, it appears as
though less attention is being paid to the increase in frequency and intensity
(both measures of escalation) of e-cigarette use. The frequency of e-cigarette
use is typically expressed as the number of days in the last 30 days in which
the participant has used an e-cigarette. Intensity can be defined as the number
of times a participant used their e-cigarette in a given day. Together,
frequency and intensity compose the metric for e-cigarette escalation, as an
increase in either metric can mark an increase in the use of e-cigarettes.

The Theory of Triadic Influence (TTI) has been used to address substance use
behavior in adolescents, being of specific use in the realm of cigarette
smoking and escalation. TTI frames substance use in the dimensions of
proximal (attitudes, beliefs, and feelings of self-efficacy) and distal
influences (intrapersonal and interpersonal issues stemming from the
socio-cultural environment). The theory highlights the complexities
surrounding substance use initiation and escalation. As such, a deep
understanding of behaviors and influences at multiple levels must be obtained
in order to exact the necessary policies and programs to tackle the
complexities associated with use.

To our knowledge, there has yet to be a review of the literature investigating

the escalating use of e-cigarettes among adolescents. Therefore, this literature
review aims to search the literature and summarize the pertinent studies on
the frequency and intensity of e-cigarette use and the factors associated with
the increases in frequency and intensity of e-cigarette use.
 PSYCHO PROJECT
10)https://www.researchgate.net/publication/350538071_Analyzing_the_Effect_of_Vapi
ng_Use_in_Teens_A_Literature_Review_and_Proposed_Solutions

Analyzing the Effect of Vaping Use

in Teens: A Literature Review and
Proposed Solutions
Damilola Ajayi, Bruce Fuchs, and Dana Reiss

Teenage vaping is a major public health issue that is emerging globally.

This review article examines what influences teens to use electronic
cigarettes (e-cigarettes) and vapes, including families, communities, social
media, and brand marketing. Nicotine, a common component of
e-cigarettes and vapes, is addictive, and teens who are using these
products are starting to report negative health outcomes. After a review of
the current literature, three recommendations/solutions are proposed to
combat this public health issue. As teen e-cigarette use is on the rise, it is
clear that the FDA and the federal government need to enforce tougher
regulations on e-cigarette and vaping brands, teens need to be properly
educated about these products that are on the market, and advertisements
for these products need to be regulated.

The overall goal of communities, parents, schools, and the federal

government should be to decrease e-cigarette prevalence. We have seen
how teens are influenced by many factors to vape, such as peers, social
media, and advertisements. We have also seen that e-cigarettes have
negative effects on people's bodies, especially teens. Potential nicotine
addiction and respiratory issues stemming from lung injuries due to
e-cigarette use should not be taken lightly. Focusing on primary, secondary,
and tertiary prevention efforts will help decrease e-cigarette prevalence as
well as promote overall health and well-being. Through harsher penalties
from the FDA and federal government for companies that are not following
the regulations, properly educating teens, and regulating advertisements,
we can help teens and communities be less affected by e-cigarettes and
save lives.
PSYCHO PROJECT