Date of Graduation


Document Type


Degree Type



Eberly College of Arts and Sciences



Committee Chair

Christina L Duncan

Committee Co-Chair

Melissa Blank

Committee Member

Nicholas Turiano


Understanding why e-cigarettes are becoming increasingly popular with adolescents, despite the potential negative health consequences of these products, is critical to informing prevention and intervention efforts. Prior research has identified peer use as a salient risk factor of adolescent e-cigarette use, but has not expanded on the mechanism of this association. For this study, 569 adolescents were recruited from an adolescent medicine clinic and public schools in rural and suburban areas of the mid-Atlantic United States. Participants completed a study-specific demographic questionnaire, the Youth Risk Behavior Survey (YRBS) to assess substance use, and the Smoking Expectancy Scale for Adolescents (SESA) to measure perceptions about the consequences of e-cigarette use. Mediation analyses revealed that peer use has a significant direct effect on self-reported use of e-cigarettes b = -.850, p < .05 and perceived benefits, b = -.071, 95% CI [-.118, -.035], and costs had indirect effects of self-reported use, b = -.134, 95% CI [-.197, -.077]. Hierarchical multiple regressions were used to conduct the moderation analyses with perceived benefits and costs as the moderators, however no interactions were significant. Moderated mediation analyses were run to determine if gender would moderate the mediation effect of perceived benefits/costs on the peer use and self-use association. Results indicated that none of these moderated mediation pathways were statistically significant. These findings support previous research claims that peer use is a significant risk factor for adolescent e-cigarette use and adds to the literature by suggesting that perceptions about outcomes of e-cigarette use (costs and benefits) may play an important role in the association between peer and self-reported use. Additionally, this study informs future targeted strategies (e.g., social pressures or perceptions) to reduce youth e-cigarette use.