EXPRESS: Early Vaping Openness among Adolescent and Young Adult Never-Users: A Systematic Review and Conceptual Framework

Electronic cigarette (EC) use among young people remains a global public health concern. This article examines early vaping openness among adolescents and young adults as a prevention, marketplace and public policy issue. We conduct a systematic review of empirical studies on the determinants of early vaping openness among adolescent and young adult never-users (11–25 years). This focus allows us to examine the pre-initiation stage, before any direct vaping experience has occurred. We searched Scopus, Web of Science and PubMed, identifying 63 eligible articles that met our inclusion criteria. Across these studies, we examined determinants and consumer decision constructs, including how susceptibility, intention, and willingness were operationalized. The most consistently supported risk factors are positive beliefs and attitudes about ECs, peer vaping, and exposure to e-cigarette marketing, whereas the most consistently protective factors are negative risk beliefs. Building on these findings, we develop an integrative conceptual framework that explains how the commercial marketing-mix environment and the prevention and informational environment may shape early vaping openness. A marketing- and policy-oriented research agenda is offered to guide efforts to reduce early vaping openness among young never-users.