Identity, Acculturation, and E-Cigarette Use among Bicultural Hispanic Youth and Young Adults.

Introduction: Research suggests Hispanic/Latino/a/x/e (hereafter Hispanic) youth/young adult (YYA) tobacco use may vary by acculturation level, but few studies have explored e-cigarette use by acculturation or how bicultural identity may affect tobacco susceptibility. This study examined acculturation's role in U.S. Hispanic YYA e-cigarette use to better understand risk and protective factors. Methods: We conducted 20 virtual focus groups in English/Spanish with Hispanic 13-24-year-olds (December 2021-January 2022). We coded transcripts in their original language (intercoder reliability kappa 0.89) and conducted thematic analysis segmented by age cohort, e-cigarette use, and acculturation level. Results: More acculturated participants had greater knowledge/familiarity with tobacco/nicotine compared with less acculturated participants. Bicultural participants more commonly mentioned curiosity and direct peer pressure as e-cigarette use drivers. While bicultural participants noted the negative impacts of e-cigarette use on family relationships, this was not a use deterrent. Less acculturated participants were most concerned with stigma, negative family impacts, and broader Hispanic community disapproval. Discussion: This study suggests that differences related to Hispanic identity and the acculturative process may increase or decrease e-cigarette use risk. Bicultural YYA, who represent more than half of U.S. Hispanic YYA, toggle between Hispanic roots and mainstream U.S. culture, which can lead to unique stressors that may increase susceptibility to e-cigarettes. Health Equity Implications: Public health efforts must recognize the heterogeneity of the Hispanic population and the role acculturation plays in e-cigarette use. A nuanced understanding can inform the design of targeted and effective public health strategies to reduce disparities in e-cigarette risk and use.