This article presents an expanded model of acculturation among international migrants and their immediate descendants. Acculturation is proposed as a multidimensional process consisting of the confluence among heritage-cultural and receiving-cultural practices, values, and identifications. The implications of this reconceptualization for the acculturation construct, as well as for its relationship to psychosocial and health outcomes, are discussed. In particular, an expanded operationalization of acculturation is needed to address the "immigrant paradox," whereby international migrants with more exposure to the receiving cultural context report poorer mental and physical health outcomes. We discuss the role of ethnicity, cultural similarity, and discrimination in the acculturation process, offer an operational definition for context of reception, and call for studies on the role that context of reception plays in the acculturation process. The new perspective on acculturation presented in this article is intended to yield a fuller understanding of complex acculturation processes and their relationships to contextual and individual functioning.

The prevalence of e-cigarette use has risen rapidly since introduction of this product to the United States in 2007. Quiz Ref ID Among US high school students, the prevalence of past 30-day use of e-cigarettes increased 10-fold from 1.5% in 2011 to 16.0% in 2015, when the prevalence of past 30-day e-cigarette use in this population exceeded its prevalence of past 30-day cigarette smoking (9.3%).¹ e-Cigarette use occurs at an appreciable prevalence among both cigarette-smoking and never cigarette-smoking youth.^2-4 Furthermore, longitudinal studies^5-10 have reported that e-cigarette use is associated with an increased risk of cigarette smoking initiation among never cigarette-smoking adolescents and young adults even after adjusting for known demographic, psychosocial, and behavioral risk factors. Recently, the US Surgeon General noted this increased risk as an important public health concern.¹¹

Quiz Ref ID Nicotine is addictive when delivered in tobacco smoke, which provides a significant dose that travels quickly to the brain after inhalation.¹ Combustible tobacco, which has well-known health consequences, has long been the dominant nicotine-delivering product used in the population. Electronic cigarettes (e-cigarettes), which are devices that deliver inhaled aerosol generally containing nicotine, are becoming increasingly popular, particularly among adolescents, including teens who have never used combustible tobacco.^2,3 According to 2014 US estimates, 16% of 10th graders reported use of e-cigarettes within the past 30 days, of whom 43% reported never having tried combustible cigarettes.³

BACKGROUND: There has been little research examining whether e-cigarette use increases the risk of cigarette initiation among adolescents in the transition to adulthood when the sale of cigarettes becomes legal. METHODS: The Children’s Health Study is a prospectively followed cohort in Southern California. Data on e-cigarette use were collected in 11th and 12th grade (mean age = 17.4); follow-up data on tobacco product use were collected an average of 16 months later from never-smoking e-cigarette users at initial evaluation (n = 146) and from a sample of never-smoking, never e-cigarette users (n = 152) frequency matched to e-cigarette users on gender, ethnicity, and grade. RESULTS: Cigarette initiation during follow-up was reported by 40.4% of e-cigarette users (n = 59) and 10.5% of never users (n = 16). E-cigarette users had 6.17 times (95% confidence interval: 3.30–11.6) the odds of initiating cigarettes as never e-cigarette users. Results were robust to adjustment for potential confounders and in analyses restricted to never users of any combustible tobacco product. Associations were stronger in adolescents with no intention of smoking at initial evaluation. E-cigarette users were also more likely to initiate use of any combustible product (odds ratio = 4.98; 95% confidence interval: 2.37–10.4), including hookah, cigars, or pipes. CONCLUSIONS: E-cigarette use in never-smoking youth may increase risk of subsequent initiation of cigarettes and other combustible products during the transition to adulthood when the purchase of tobacco products becomes legal. Stronger associations in participants with no intention of smoking suggests that e-cigarette use was not simply a marker for individuals who would have gone on to smoke regardless of e-cigarette use.

Rationale: Rates of adolescent electronic (e-) cigarette use are increasing, but there has been little study of the chronic effects of use. Components of e-cigarette aerosol have known pulmonary toxicity. Objectives: To investigate the associations of e-cigarette use with chronic bronchitis symptoms and wheeze in an adolescent population. Methods: Associations of self-reported use of e-cigarettes with chronic bronchitic symptoms (chronic cough, phlegm, or bronchitis) and of wheeze in the previous 12 months were examined in 2,086 Southern California Children’s Health Study participants completing questionnaires in 11th and 12th grade in 2014. Measurements and Main Results: Ever e-cigarette use was reported by 502 (24.0%), of whom 201 (9.6%) used e-cigarettes during the last 30 days (current users). Risk of bronchitic symptoms was increased by almost twofold among past users (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.37–2.49), compared with never-users, and by 2.02-fold (95% CI, 1.42–2.88) among current users. Risk increased with frequency of current use (OR, 1.66; 95% CI, 1.02–2.68) for 1–2 days and 2.52 (95% CI, 1.56–4.08) for 3 or more days in past 30 days compared with never-users. Associations were attenuated by adjustment for lifetime number of cigarettes smoked and secondhand smoke exposure. However, risk of bronchitic symptoms among past e-cigarette users remained elevated after adjustment for relevant potential confounders and was also observed among never–cigarette users (OR, 1.70; 95% CI, 1.11–2.59). There were no statistically significant associations of e-cigarette use with wheeze after adjustment for cigarette use. Conclusions: Adolescent e-cigarette users had increased rates of chronic bronchitic symptoms. Further investigation is needed to determine the long-term effects of e-cigarettes on respiratory health.