Frequency of E-cigarette Use, Health Status, and Risk and Protective Health Behaviors in Adolescents

Objectives: E-cigarettes (ECs) are increasingly popular among adolescents, who perceive them as safer'' than cigarettes. Although research has examined risk factors for adolescent EC use, little is known about how EC use correlates with health status and protective health behaviors. Methods: In all, 2488 adolescents (mean age = 17.31 years, SD = 0.67; 46% male) completed a survey on EC and cigarette use, physical and mental health, physical activity, diet, sleep, and alcohol and other drug (AOD) use. Logistic regression compared EC-only users to dual EC/cigarette users, cigarette-only users, and nonusers on these health factors. Among EC-only users, separate ordinary least-squares regression models assessed the effects of health status/behavior variables on frequency of past-year EC use, controlling for demographics and smokeless tobacco use. Results: User groups were similar on physical health and engagement in protective health behaviors (physical activity, sleep duration/quality, healthy diet), but EC-only users reported fewer mental health symptoms and less AOD use than dual or cigarette-only users. Among EC-only users, AOD use (all P < 0.0001) predicted more frequent EC use; healthy diet predicted less frequent use (P < 0.01). Conclusions: EC-only use is associated with lower engagement in risky behaviors, but not better health status or higher engagement in protective health behaviors, compared with cigarette smoking. Dual EC/cigarette users may represent a particularly high-risk group due to their greater AOD use and cigarette consumption. Among intermediate-risk'' EC-only users, AOD use and unhealthy diet correlated with heavier use, and may be important targets for preventing escalation to more harmful tobacco use.