Credit: UPMC

PITTSBURGH, July 26, 2021 – Adolescents who set goals for their future and those with strong parental support are less likely to use e-cigarettes and other tobacco products, according to a study by UPMC Children’s Hospital of Pittsburgh and University of Pittsburgh School of Medicine physician-scientists.

The research, published today in the journal Pediatrics, suggests that strategies to prevent youth vaping may be different from what works to dissuade youth from smoking cigarettes.

“The use of e-cigarettes by young people is at epidemic proportions, with 27% of youth surveyed saying they’d vaped in the last 30 days,” said lead author Nicholas Szoko, M.D., a fellow in the Division of Adolescent and Young Adult Medicine at UPMC Children’s. “And a lot of the traditional methods we think of for counseling youth on the dangers of tobacco and drug use may not apply to vaping. Pediatricians and parents need a better understanding of what motivates adolescents to eschew e-cigarettes.”

Szoko and his colleagues analyzed anonymous questionnaires administered in partnership with the Allegheny County Health Department and completed by 2,487 high school students in Pittsburgh Public Schools. The surveys asked questions to ascertain if and how often the students used e-cigarettes or other tobacco products, and to determine if any of four “protective factors” validated by previous research were associated with a lower likelihood of vaping or smoking.

The protective factors examined were:

  • Future orientation: A person’s beliefs, hopes and goals related to the future.
  • Parental monitoring: Parent-child interactions and communication.
  • Social support: The ability to rely on friends and peers.
  • School connectedness: A sense of belonging and inclusion at school.

In the study, positive future orientation and high levels of parental monitoring were both linked with a 10% to 25% lower prevalence of recently or ever vaping, compared to peers with lower scores on those protective factors. There was no link between social support or school connectedness and use of e-cigarettes.

All four protective factors were associated with lower prevalence of smoking or use of other tobacco products, but none were linked to intent to quit using tobacco products. This suggests that once young people begin to use tobacco, quitting may be more difficult to promote. The researchers note that these findings should be explored to develop improved youth tobacco prevention efforts, but that it isn’t surprising that the results for vaping weren’t exactly the same as for smoking.

“E-cigarettes are positioned and marketed differently than tobacco cigarettes. They’ve been popularized as tools for smoking cessation, and previous research has found the various flavors and trendy ads for vaping are attractive to youth,” said Szoko. “We also know that vaping primes adolescents to transition to smoking cigarettes and other substance use. So, it stands to reason that we may need different approaches to keep kids from vaping, than we use to stop them from smoking.”

Senior author Alison Culyba, M.D., Ph.D., M.P.H., assistant professor of pediatrics, public health, and clinical and translational science at Pitt, noted that frameworks already exist to help clinicians use future orientation and encourage parental monitoring when providing health care to young people, which bodes well for developing e-cigarette intervention programs to strengthen these protective factors.

“Future orientation is something very tangible that pediatricians and other health care providers can talk with teens about in the clinic–motivational interviewing is something we’re very comfortable doing with our patients,” said Culyba, also an adolescent medicine physician and director of the Empowering Teens to Thrive program at UPMC Children’s. “And we can help parents to navigate their roles as their children become pre-teens and teens, and help encourage open conversations with their kids about what they’re encountering.”


Additional authors on this research are Maya I. Ragavan, M.D., Susheel K. Khetarpal, and Kar-Hai Chu, Ph.D., all of Pitt or UPMC, or both.

This research was supported by The Heinz Endowments, The Grable Foundation and National Institutes of Health grants KL2TR001856, UL1TR001857, K23HD098277-01.

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About UPMC Children’s Hospital of Pittsburgh

Regionally, nationally, and globally, UPMC Children’s Hospital of Pittsburgh is a leader in the treatment of childhood conditions and diseases, a pioneer in the development of new and improved therapies, and a top educator of the next generation of pediatricians and pediatric subspecialists. With generous community support, UPMC Children’s Hospital has fulfilled this mission since its founding in 1890. UPMC Children’s is recognized consistently for its clinical, research, educational, and advocacy-related accomplishments, including ranking in the top 10 on the 2021-2022 U.S. News Honor Roll of America’s Best Children’s Hospitals. UPMC Children’s also ranks 15th among children’s hospitals and schools of medicine in funding for pediatric research provided by the National Institutes of Health (FY2019).

About the University of Pittsburgh School of Medicine

As one of the nation’s leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region’s economy. For more information about the School of Medicine, see

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