e-cigarette use among US adolescents

Just when it had appeared that the hard-fought public health battle against the uptake of cigarette smoking was being won, a new threat has emerged among peri-millennial adolescents: the e-cigarette. A new study has linked e-cigarette use among US adolescents to an increased risk of a range of school-related and substance-related risk behaviors.


The use of e-cigarettes is more common among US adolescents than ever before, with rates now significantly exceeding those of regular cigarette smoking. During the period from 2011 to 2015, e-cigarette use among US high school students rose from 1.5% to 16%, overtaking that of any other nicotine or tobacco product. Greater than one in every six US high school seniors now report some level of e-cigarette use, giving rise to concerns regarding early exposure as a gateway to increasing rates of cigarette smoking and other drug use later on. While e-cigarettes are broadly perceived to have fewer associated health risks than any other substance, in reality, the health implications of e-cigarette use include asthma, nicotine dependence, adverse brain development, adverse fetal development, lung cancer and acute toxicity.

Prior empirical data has linked cigarette smoking among adolescents with risk behaviors such as binge drinking, marijuana use, illicit drug use, truancy and poor academic performance. However, the relationship between e-cigarette use and such risk behaviors is notwell understood. A recent study, published in the Journal of Adolescent Health, aimed to clarify patterns of e-cigarette use among US adolescents and examine its associations with risk behaviors.

The study examined the use of e-cigarettes only, cigarettes only and dual e-cigarette and cigarette use during the past month. Data was obtained from a nationally-representative sample of 8,696 US high school seniors, through the use of a self-reported questionnaire, as a component of the annual Monitoring the Future (MTF) study. The questionnaire collected demographic data regarding age, race, parental education, plans to attend college and geographical region. Frequency of past-month e-cigarette use, cigarette use and dual e-cigarette and cigarette use were assessed, as was frequency of binge-drinking and use of other drugs. Information regarding school-related risk behaviors, such as academic grades and truancy were also collected.

The results of this study found that 9.9% of US high school seniors reported e-cigarette use only during the past month, while 6.0% reported cigarette smoking only during the same timeframe. A further 7.3% reported dual use of regular and e-cigarettes. A strong association was found between e-cigarette use and all risk behaviors, with those who were regular dual users of both and e-cigarettes only most likely to engage in risk behaviors. Those who used e-cigarettes more frequently were at higher risk than those who used them less often, while the lowest rates of risk behavior were found among non-users.

The long-term health effects of e-cigarettes are largely unknown; however, these results highlight potential risks associated with early initiation of e-cigarette use. As well as being correlated with higher rates of future smoking uptake, e-cigarettes can also increase the risk of school and substance-related risk behaviors among adolescents. With e-cigarette use continuing to rise, novel public health initiatives must be developed in order to curb their uptake and educate individuals on the associated risks.


Written By: Jill Padrotta, MBBS, Medical Writer

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