E-cigarette use and concurrent risk behaviors among adolescents

Adolescent E-cigarette use and associated socio-contextual variables, psychological variables, and problem behaviors

PURPOSE

E-cigarette use by adolescents has reached epidemic proportions. This study's purpose was to explore adolescent e-cigarette use and dual use of e-cigarettes with other tobacco products and the relationships between socio-contextual variables (in-school/electronic bullying, threats with a weapon), psychological variables (sadness, suicide attempts) and problem behaviors (alcohol/marijuana use, sexual risk behavior, weapon carrying).

DESIGN AND METHODS

Cross-sectional descriptive study using secondary data from the 2019 Youth Risk Behavior Survey. Multiple logistic regression was used to examine the relationship between socio-contextual variables, psychological variables, problem behaviors and current adolescent e-cigarette use or dual use. E-cigarette users and dual users were examined in separate regression equations.

RESULTS

Most adolescent e-cigarette users (59 %) and dual users (63 %) were white with e-cigarette only users being majority female (55 %) and dual users majority male (57 %). E-cigarette use was significantly correlated with experiencing electronic bullying, sadness, threats with a weapon, alcohol use, marijuana use, and sexual risk behaviors. Dual use was significantly correlated with experiencing electronic bullying, sadness, alcohol use, marijuana use, sexual risk behaviors, and weapon carrying.

IMPLICATIONS TO PRACTICE

Problem behaviors, psychological variables, and socio-contextual variables are associated with e-cigarette use. It is imperative that adolescents are screened for use in addition to other behaviors.

CONCLUSIONS

E-cigarette use and dual use of e-cigarettes and other tobacco products is linked to other problem behaviors and feelings of sadness, with dual users being at significantly higher risk. Adolescents should be screened for e-cigarette use and dual use at every health care visit.

A systematic review on risk factors and reasons for e-cigarette use in adolescents

INTRODUCTION

The aim was to establish EC use risk and protective factors, the reasons for use, associations with tobacco and other substance use, and use for smoking cessation.

METHODS

A systematic review following PRISMA guidelines was registered in PROSPERO (CRD42024532771). Searches in Web of Science and PubMed/MEDLINE (March-April 2024) used terms like 'electronic cigarette' and 'adolescents' with a PICO framework. Inclusion criteria covered studies on adolescents aged 10-19 years, published in English or Spanish (2018-2024). Three reviewers independently screened studies, achieving 96% inter-rater reliability. Data extraction followed standardized tables, and methodological quality was assessed using MMAT and GRADE tools, ensuring a robust evaluation of evidence on adolescent electronic cigarette use.

RESULTS

From 895 studies, 50 met the inclusion criteria. The strongest risk factors for adolescent EC use include social acceptance and use within peer or family circles (13 studies), male gender (10 studies), low risk perception (6 studies), younger age (3 studies), and greater financial resources (3 studies). Motives for use include low perceived risk and appealing flavors, supported by both longitudinal and cross-sectional studies. EC use is significantly associated with smoking initiation (7 studies), cannabis consumption (8 studies), and alcohol use (4 studies). Evidence on the effectiveness of ECs as harm reduction or smoking cessation tools in adolescents remains inconclusive, with some cross-sectional studies supporting their utility and others finding contrary evidence. High-quality research indicates ECs are predominantly used alongside traditional cigarettes, with dual nicotine consumption patterns commonly observed.

CONCLUSIONS

Evidence on adolescent EC use identifies risk factors, motives, and links to substance use. However, its role in harm reduction and smoking cessation remains insufficient and controversial. High-quality research is needed, as most studies are low quality. Targeted prevention strategies addressing social influences, perceptions, and accessibility are crucial to reduce adolescent EC use.

Vaping: The Key to Quitting Cigarettes or a Gateway to Addiction?

Background and Objectives: In 2022, the Centers for Disease Control and Prevention (CDC) discovered that 2.55 million middle and high school students were using electronic cigarettes (e-cigarettes) in the US alone. E-cigarettes allow people to inhale a nicotine solution (e-liquid) into their bodies. While e-cigarettes are often advertised as a way to help people quit traditional tobacco products, the World Health Organization (WHO) has stated that there is no proof of e-cigarettes being effective at reducing an individual's tobacco use. The objective of this study is to determine why adolescents start smoking e-cigarettes. Materials and Methods: For the following study, the National Youth Tobacco Survey (NYTS) 2021 was used. This is a nationally representative cross-sectional survey that includes middle and high school students. The data were analyzed using SAS v.9.4. The odds ratio for smoking e-cigarettes was evaluated for both sex and race via a logistic regression. Results: It was discovered that the percentage of only e-cigarette smokers (12.10%) was 5.5 times the percentage of only traditional smokers (2.19%). Additionally, the median age at which adolescents started smoking e-cigarettes was fifteen years with an IQR (Inter Quartile Range) of two. We used a logistic regression to show that biological sex and race were significant predictors of e-cigarette usage. Conclusions: In general, we saw that adolescents were mostly starting to smoke e-cigarettes because their friends were doing it, out of curiosity, they were depressed or anxious, and/or to get a "high", implying that adolescents mostly started smoking in order to fit in and/or to numb themselves. Interestingly, reasons like cost, using them to quit smoking, seeing them in the media, and ease of attainment were ranked the lowest when it came to smoking e-cigarettes. However, their lower costs naturally lead to increased accessibility compared to traditional cigarettes, making them easier to reach the hands of teenagers. Overall, in this paper, we aim to identify if adolescents are choosing e-cigarettes as their first foray into tobacco products and why.

Vaping Behaviors and Criminal Activity among a Nationally Representative Sample of U.S. Adults

Background: Prior research has discovered an association between vaping activities and increased delinquent behaviors. However, this relationship has been exclusively studied among adolescents and has not been examined among an adult sample. Methods: The current study uses a nationally representative sample of approximately 45,000 adults from the 2021 National Survey on Drug Use and Health. Logistic regression and negative binomial regression are employed to assess the association between three types of vaping (marijuana, nicotine, flavor) and five crime measures (arrest, sold drugs, stole >$50, attack, crime index), net of covariates. A vaping index is also examined to determine whether the number of substances vaped is related to criminal outcomes. Results: Results indicate that past year and past month marijuana and nicotine vaping are associated with higher odds of almost all crime measures, but flavor vaping was not significantly associated with the crime outcomes. Additionally, the vaping index suggests that the number of substances vaped is associated with the likelihood of engaging in certain crimes. Conclusions: The findings of the current study indicate the need for more awareness of the negative social consequences associated with vaping, particularly marijuana vaping. Additionally, the crime patterns among adults in this study are different from previous studies using adolescent samples. Specifically, flavor vaping is not associated with criminal behavior among the adult only sample. Thus, vaping studies that use adolescent samples may not generalize to adults.

Noncigarette Tobacco Product Use Among Smoking-Susceptible and Nonsusceptible Adolescent Never Smokers, 2009-2021

PURPOSE

Examine trends in noncigarette tobacco use among smoking susceptible and nonsusceptible adolescents from 2009-2021.

METHODS

Data came from cross-sectional samples of the National Youth Tobacco Survey (N = 183,198). Using Pierce's smoking susceptibility scale, participants were classified as either susceptible or nonsusceptible to cigarette smoking. Their use of noncigarette tobacco products was classified into four mutually exclusive categories: nonuse, noncigarette combustibles use, noncombustibles use, and noncigarette combustibles and noncombustibles dual use. We produced covariate-adjusted predicted marginal proportions of noncigarette tobacco use for 12 National Youth Tobacco Survey years, which were entered into Joinpoint trend analysis software to determine (a) trends in noncigarette tobacco use from 2009-2021 using the average annual percent changes (AAPCs) and (b) changes in each time segment using the average percent change. Models were fitted by smoking susceptibility, sex, and race/ethnicity.

RESULTS

Nonuse was lower among susceptible (vs. nonsusceptible) adolescents whereas noncigarette tobacco use was higher. Trends show significant declines in nonuse (nonsusceptible: AAPC = -0.3%) and noncigarette combustibles use (susceptible: AAPC = -12%) between 2009-2021, increases in noncombustibles use (susceptible: AAPC = 18%, nonsusceptible: AAPC = 19%) between 2009 and 2019, and steadiness in dual use. Parallel trends were observed when stratified by sex and race/ethnicity with notable increases in noncombustibles use among females and Latinos.

DISCUSSION

Noncigarette tobacco use differed by smoking susceptibility. Observed trends, especially when stratified by sex and race/ethnicity, raise concerns about tobacco use disparities among females and Latinos. Smoking susceptibility can help identify at-risk adolescents for current or future tobacco use.

Comprehensive review of the national surveys that assess E-cigarette use domains among youth and adults in the United States

Surveillance of e-cigarette use among different population groups is important for the timely implementation and evaluation of tobacco regulatory policies. In this review, we identified 13 nationally representative, repeatedly conducted epidemiologic surveys that assess e-cigarette use among U.S. youth and/or adults and have been instrumental in e-cigarette surveillance. These surveys included National Youth Tobacco Survey, Youth Risk Behavior Surveillance System, Monitoring the Future Survey, International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, Tobacco Use Supplement of the Current Population Survey, Health Information National Trends Survey, Tobacco Products and Risk Perception Surveys, ITC Four Country Smoking and Vaping Survey, National Health and Nutrition Examination Survey, National Survey on Drug Use and Health, and Population Assessment of Tobacco and Health. These surveys vary in scope and detail, with their unique strengths and the regulatory questions that can be answered using each survey data. We also highlighted the gaps in these surveys and made recommendations for improvement.

Biological determinants impact the neurovascular toxicity of nicotine and tobacco smoke: A pharmacokinetic and pharmacodynamics perspective

Accumulating evidence suggests that the detrimental effect of nicotine and tobacco smoke on the central nervous system (CNS) is caused by the neurotoxic role of nicotine on blood-brain barrier (BBB) permeability, nicotinic acetylcholine receptor expression, and the dopaminergic system. The ultimate consequence of these nicotine associated neurotoxicities can lead to cerebrovascular dysfunction, altered behavioral outcomes (hyperactivity and cognitive dysfunction) as well as future drug abuse and addiction. The severity of these detrimental effects can be associated with several biological determinants. Sex and age are two important biological determinants which can affect the pharmacokinetics and pharmacodynamics of several systemically available substances, including nicotine. With regard to sex, the availability of gonadal hormone is impacted by the pregnancy status and menstrual cycle resulting in altered metabolism rate of nicotine. Additionally, the observed lower smoking cessation rate in females compared to males is a consequence of differential effects of sex on pharmacokinetics and pharmacodynamics of nicotine. Similarly, age-dependent alterations in the pharmacokinetics and pharmacodynamics of nicotine have also been observed. One such example is related to severe vulnerability of adolescence towards addiction and long-term behavioral changes which may continue through adulthood. Considering the possible neurotoxic effects of nicotine on the central nervous system and the deterministic role of sex as well as age on these neurotoxic effects of smoking, it has become important to consider sex and age to study nicotine induced neurotoxicity and development of treatment strategies for combating possible harmful effects of nicotine. In the future, understanding the role of sex and age on the neurotoxic actions of nicotine can facilitate the individualization and optimization of treatment(s) to mitigate nicotine induced neurotoxicity as well as smoking cessation therapy. Unfortunately, however, no such comprehensive study is available which has considered both the sex- and age-dependent neurotoxicity of nicotine, as of today. Hence, the overreaching goal of this review article is to analyze and summarize the impact of sex and age on pharmacokinetics and pharmacodynamics of nicotine and possible neurotoxic consequences associated with nicotine in order to emphasize the importance of including these biological factors for such studies.

Current e-cigarette use among in-school adolescents in West Malaysia: Examining the interactions between sociodemographic characteristics and lifestyle risk behaviours

Background

Adolescent e-cigarette use has increased dramatically. Most e-cigarette liquids contain nicotine, which can harm the developing adolescent brain. Local studies examining the risk factors of adolescent e-cigarette use and interactions between its risk factors are limited. This study was aimed at determining the prevalence of current e-cigarette use and its associated factors among in-school adolescents in West Malaysia. We also examined the possible sociodemographic characteristic, lifestyle risk behaviour and parental factor interactions that affect the probability of current e-cigarette use.

Methods

We conducted a cross-sectional study using data from the National Health and Morbidity Survey 2017. Respondents aged 13–18 years were included in the study. The data were analysed using STATA (v.15).

Results

The prevalence of current e-cigarette use was 9.1%. Male gender, older age, Malay ethnicity, schooling in urban area, current smoking, current alcohol use, current drug use, having parents that are not married and living together and parental tobacco product use were significantly associated with current e-cigarette use. There were significant interactions between: i) gender with age, ethnicity, current smoking, current alcohol use and current drug use, ii) ethnicity with current smoking and current alcohol use, iii) locality with ethnicity, current smoking and current alcohol use, iv) current drug use with age, ethnicity, current smoking and current alcohol use, v) parental marital status with gender, age and ethnicity, and vi) parental tobacco use with ethnicity and current smoking.

Conclusion

Our findings identify significant associations between sociodemographic characteristics, lifestyle risk behaviours and parental factors with current e-cigarette use. They also provide new insight into the interactions between these factors that affect the probability of current e-cigarette use among West Malaysian adolescents. Efforts to tackle e-cigarette use in Malaysian adolescents should target sociodemographic characteristics, lifestyle risk behaviours and parental factors such as smoking cessation intervention for parents.

Use of Single, Dual, and Poly Tobacco Products in Korean Adolescents

This study aimed to examine the prevalence of single, dual, and poly use of conventional cigarettes, e-cigarettes, and heated tobacco products among Korean adolescent smokers and identify factors related to dual and poly tobacco product use. Data from 4028 current smokers in the 2019 Korea Youth Behavior Web-based Survey were included. Single users accounted for 53.1%, followed by dual users at 24.8% and poly users at 22.1%. The factors influencing dual and poly tobacco product use included male, living in a metropolitan area, risky alcohol drinking, sexual experience, number of cigarettes smoked, secondhand smoke exposure, and easy-to-buy tobacco products. The findings suggest restricting the use of new types of tobacco products in the high-risk group are required to prevent dual and poly use. Furthermore, it is necessary to provide support like education for new tobacco products and smoking cessation, programs for secondhand smoke prevention, or rigorous marketing regulations for adolescents.