Stress coping strategies among college
students: Associations with e-cigarettes
and physical activity.
Sarah Beth Lynch, MPH
University of Colorado-Denver
Melissa Napolitano, PhD
George Washington University, Milken Institute School of Public Health
Cassandra Stanton, PhD
Georgetown University; Westat
Background
➧ The use of e-cigarettes has increased exponentially
among young adults.
➧ In 2014, 21.6% of US adults between the ages of 18-24
years reported ever trying an e-cigarette.1
➧ Estimates of ever use of trying e-cig among college
students range from 4.9%2- 29%.3
2
Public Health Significance
➧ American Heart Association4 and American Lung
Association5 issued position statements asserting e-cigs
may prime young adults for nicotine addiction.
➧ Health consequences of e-cigarette smoking is under-
researched.4
3
What are e-cigarettes?
4
E-cigarettes and perceived stress
➧ Cigarette users report greater perceived stress than
non-cigarette users.6,7
➧ The perceived novelty and accessibility of e-cigs8 may
make e-cigs a convenient way for college students to
manage stress.
➧ Transition from high school to college may be stressful.9
➧ Students may adapt to stress using readily available
coping strategies, including engaging in unhealthy
lifestyle choices (e.g. tobacco and/or nicotine use,
sedentary behavior). 5
Research Question
➧ Do ever e-cigarette smokers and never
e-cigarette smokers report different levels
of:
Perceived Stress (PSS)
Physical Activity
➧IPAQ and 1 question about using
physical activity to manage stress
Sedentary Activities to manage stress
➧1 item from APA Stress in America
Survey 6
Methods
➧ College students (N=230) completed an anonymous
online survey.
➧ Recruited through social media and classroom
announcements.
➧ Separated into two groups based on yes/no response to
following question:
“Have you ever tried an e-cigarette, even one or two
puffs?”
7
Sample
8
Ever tried e-cigs Never tried e-cigs
37% (n=84) 63% (n=146)
BMI 22.5 23.3
AGE 20.9 years 21.1 years
% FEMALE 58.3% (n=49)* 74.0% (n=108)*
TRIED CIGARETTES 43.9% (n=54) 56.1% (n=69)
*X2 (1,230)=7.03; p <.05
Results: Perceived Stress
➧ Ever e-cigarette users reported significantly lower levels
of perceived stress than never e-cigarette users user
[F(1,228) =3.7; p<.05) 9
28.1 26.40
5
10
15
20
25
30
35
40
Ever tried e-cigarettes Never tried e-cigarettes
PSS Score
Results: Sedentary Stress Coping
➧ Ever e-cigarette users were more likely than never e-
cigarette users to utilize sedentary behaviors as a way to
manage stress [X2 (1,230)=5.08; p <.05)].
10
No33%
Yes67%
Never tried e-cigarettes
No19%
Yes81%
Ever tried e-cigarettes
“Do you watch
TV/Netflix/surf the
internet to relieve or
manage stress?”
Results: Physical Activity to Manage Stress
➧ No significant difference between groups with regards to
utilizing physical activity as a way to manage stress [X2
(1,230)=1.36; p >.05)].11
No41%Yes
59%
Never tried e-cigarettes
No33%
Yes67%
Ever tried e-cigarettes
“Do you exercise, walk or play sports to relieve or manage stress? ”
Results: Minutes of Moderate Physical
Activity/Week
➧ No significant difference
in minutes of physical
activity per week
between e-cig users
and non-users
[F(1,228)=0.3, p >.05]
12
0
50
100
150
200
250
300
Never tried e-cigarettes Ever tried e-cigarettes
min
ute
s
Minutes of Moderate PA/Week
Summary
➧ College students who have ever tried an e-cigarette were
more likely than college students who never tried an e-
cigarette to report coping with stress with sedentary
activities.
➧ The sample size in this pilot study was relatively small;
future studies are needed to examine whether the
frequency of use (ever tried versus regular use) shows
different associations with stress management
13
Limitations
➧ Sample size
➧ Classification of “ever used e-cigarettes” and “never used
e-cigarettes”
Individuals who smoking e-cigarettes every day may
present different scores on the outcome measures
compared with someone experimenting or using
socially
14
Comments
➧ Ever e-cigarette users may adapt to stress with distraction
or quick fix coping strategy more than never e-cigarette
users.
➧ Methods of managing stress result in a variety of
behaviors that, over time, may influence health outcomes.
➧ Understanding differences in adaptive health behaviors
among college students may assist in the development of
primary prevention programs for young adults.
15
References
1. Centers for Disease Control and Prevention (2015). Data Briefs on e-cigarettes. Available at
http://www.cdc.gov/nchs/data/databriefs/db217.pdf
2. Stufin et al. (2013). Electronic cigarette use by college students. Drug and alcohol dependence, 131(3), 214-221.
3. Littlefield et al. (2016). Electronic Cigarette Use Among College Students: Links to Gender, Race/Ethnicity, Smoking,
and Heavy Drinking. Journal of American College Health.
4. Bhatnagar et al. (2014). Electronic cigarettes a policy statement from the American Heart
Association. Circulation, 130(16), 1418-1436.
5. American Lung Association. (2015). E-Cigarettes and Lung Health. Available at http://www.lung.org/stop-
smoking/smoking-facts/e-cigarettes-and-lung-health.html.
6. Magid, V., Colder, C. R., Stroud, L. R., Nichter, M., Nichter, M., & Members, T. E. R. N. (2009). Negative affect,
stress, and smoking in college students: Unique associations independent of alcohol and marijuana use. Addictive
behaviors, 34(11), 973-975.
7. Black, D. S., Sussman, S., Johnson, C. A., & Milam, J. (2012). Testing the indirect effect of trait mindfulness on
adolescent cigarette smoking through negative affect and perceived stress mediators. Journal of substance
use,17(5-6), 417-429.
8. Dutra, L. M., & Glantz, S. A. (2014). Electronic cigarettes and conventional cigarette use among US adolescents: a
cross-sectional study. JAMA pediatrics, 168(7), 610-617.
9. Arnett JJ. Emerging adulthood: A theory of development from the late teens through the twenties. American
Psychologist. 2000;55(5):469-480.16
Thank you!
•Dr. Krista Ranby
•Participants
