E-cigarette Use, Cigarette Smoking, Dual Use, and Problem Behaviors Among U.S. Adolescents: Results From a National Survey

Abstract

Purpose There is a need to obtain greater clarity regarding adolescents’ e-cigarette use and their use with a wider range of risk behaviors. This study examines the associations among past-month e-cigarette use only, traditional cigarette smoking only, dual use (i.e., concurrent e-cigarette use and cigarette smoking), school-related (i.e., truancy and poor academic performance), and substance-related (i.e., alcohol use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) risk behaviors. Methods Data were collected via self-administered questionnaires from a nationally representative sample of 8,696 high school seniors. Results An estimated 9.9% of U.S. high school seniors reported past-month e-cigarette use only, 6.0% reported past-month cigarette smoking only, and 7.3% reported past-month dual use. School-related and substance-related risk behaviors had strong associations with past-month e-cigarette use. Adolescents who only used e-cigarettes had significantly greater odds of all school-related and substance-related risk behaviors relative to non-users. Dual users had significantly greater odds of frequent/daily e-cigarette use as well as all school-related and substance-related risk behaviors relative to those who only used e-cigarettes. Finally, adolescents who engaged in frequent/daily e-cigarette use had significantly greater odds of binge drinking, marijuana use, other illicit drug use and nonmedical prescription drug use, relative to experimental e-cigarette users. Conclusion E-cigarette use is common among U.S. adolescents and there are robust associations between e-cigarette use and school-related and substance-related risk behaviors. There is evidence that e-cigarette use clusters with risk behaviors and appears to represent a problem behavior, especially dual use of e-cigarettes and traditional cigarettes.

Patterns of concurrent cigarette, alcohol, and e‐cigarette use: Off‐setting or additive behaviors?

“…Previous studies have shown that e‐cigarette users tend to have higher rates of conventional cigarette use, and our work supports this assertion on a national level. McQueen et al specifically examined 110 patients with head and neck cancer and a smoking history and demonstrated that non–e‐cigarette users achieved higher quit rates than e‐cigarette users.…”

“…8 Recently, in adolescents and youths, e-cigarette use was also shown to be associated with conventional cigarette and alcohol use. 7 In older adults, who tend to use ecigarettes as smoking cessation aids, 9 e-cigarette use has been demonstrated to be significantly associated with tobacco cigarette use [10][11][12][13][14][15] ; longitudinal studies suggest that e-cigarettes are not effective for smoking cessation. 9,10 However, the relationship between e-cigarettes and alcohol use in adults is less clearly documented, with studies finding mixed results.…”

The association between alcohol, marijuana, illegal drug use and current use of E-cigarette among youth and young adults in Canada: results from Canadian Tobacco, Alcohol and Drugs Survey 2017

“…Due to the lack of studies on the dual use of illicit drugs and e-cigarettes in Canada, it is not possible to compare these results to previous Canadian data to assess trends. However, some international studies have shown findings similar to those in the present study [15][16][17]34]. Additionally, even fewer studies have explored the potential use of ecigarettes as illicit drug delivery systems.…”

“…Additionally, e-cigarettes have been associated with a decline in overall health, including lung tissue damage, worse cardiovascular health outcomes and increased inflammatory responses [10][11][12]. Although none in Canada, some international studies have also shown positive associations between risky behaviors such as the use of illicit drugs, marijuana, alcohol and e-cigarette use [13][14][15][16][17][18][19][20][21][22]. Consequently, increased concerns have arisen among substance use researchers since recent e-cigarette designs have grown to accommodate illicit substances.…”

Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents

“…Participants with high perceived risk could be concerned about the possibility of increased nicotine dependence or other risks associated with dual-use. 22,23 In addition, compared to those with low-risk perception, those with high-risk perception had higher odds of e-cigarette-only use relative to cigarette-only users. Our findings indicate that, relative to e-cigarette users, those with a high-risk perception of both products had lower odds of dual-use than those with a low-risk perception of both products.…”