Electronic cigarettes (e-cigarettes) are the most used tobacco product among US adolescents. Information about the prevalence of use in a pediatric primary care population has been limited. Youth aged 12 to 17 attending a well-child visit completed screening for past year e-cigarette, cigarette, cannabis, and alcohol use, as well as depression and anxiety symptoms. We examined e-cigarette-use prevalence, frequency, and relationship to demographics, mental health symptoms, and other substance use. Among 9740 patients, 8.2% reported past-year e-cigarette use. Males (7.2%) were less likely than females (9.2%) to use e-cigarettes, while more frequent use was associated with more frequent cannabis, alcohol, and cigarette use, as well as elevated depression and anxiety symptoms. Sex differences support a recent trend toward young females using e-cigarettes at higher rates than males. Polysubstance use was common, highlighting the importance of regular screening for all substances and feasible interventions for this setting.
US Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016.
2.
JohnstonLDMiechRAPatrickMEO’MalleyPMSchulenbergJEBachmanJG.Monitoring the Future National Survey Results on Drug Use, 1975-2022: Overview, Key Findings on Adolescent Drug Use. Institute for Social Research; 2023.
3.
KhoujaJNSuddellSFPetersSETaylorAEMunafòMR.Is E-Cigarette Use in Non-Smoking Young Adults Associated With Later Smoking? A Systematic Review and Meta-Analysis. Tobacco Control; 2020.
4.
McConnellRBarrington-TrimisJLWangK, et al. Electronic cigarette use and respiratory symptoms in adolescents. Am J Respir Crit Care Med. 2017;195(8):1043-1049.
5.
BlackLI.Percentage of children aged< 18 years who received a well-child checkup in the past 12 months, by age group and year—National Health Interview Survey, United States, 2008 and 2018. Morb Mortal Wkly Rep. 2020;69(8):222-223.
6.
BrownJDWissowLS.Discussion of sensitive health topics with youth during primary care visits: relationship to youth perceptions of care. J Adolesc Health. 2009;44(1):48-54.
7.
McGeeLUParkerSBulsaraS, et al. Adolescent electronic cigarette counselling: knowledge, attitudes and perceived barriers among clinical staff in a primary care setting. J Eval Clin Pract. 2021;27(6):1398-1402.
8.
TomWHarrisBShenA, et al. Mitigating the youth vaping epidemic through increasing screening rates for youth vaping/e-cigarette use in pediatrics. Perm J. 2020;25:1.
9.
JenssenBPHannanCKellyMKYliojaTSchnollRAFiksAG.Inability to recruit adolescents for a vaping cessation clinical trial within a large pediatric health system. Nicotine Tob Res. 2021;23(9):1633-1634.
10.
Barrington-TrimisJLBerhaneKUngerJB, et al. Psychosocial factors associated with adolescent electronic cigarette and cigarette use. Pediatrics. 2015;136(2):308-317.
11.
BeckerTDArnoldMKRoVMartinLRiceTR.Systematic review of electronic cigarette use (vaping) and mental health comorbidity among adolescents and young adults. Nicotine Tob Res. 2021;23(3):415-425.
12.
WangTWGentzkeASCreamerMR, et al. Tobacco product use and associated factors among middle and high school students—United States, 2019. MMWR Surveill Summ. 2019;68(12):1.
13.
BirdseyJCorneliusMEJamalA, et al. Tobacco product use among US middle and high school students—national youth tobacco survey, 2023. MMWR Morb Mortal Wkly Rep. 2023;72:1173-1182.
DaiHRamosAKFaseruBHillJLSussmanSY.Racial disparities of e-cigarette use among US youths: 2014-2019. Am J Public Health. 2021;111(11):2050-2058.
16.
SeoYSChangY-P.Racial and ethnic differences in e-cigarette and cigarette use among adolescents. J Immigr Minor Health. 2022;24(3):713-720.
17.
LevySWeissRSherrittL, et al. An electronic screen for triaging adolescent substance use by risk levels. JAMA Pediatr. 2014;168(9):822-828. doi:10.1001/jamapediatrics.2014.774.
18.
RossJAMinegishiMBrognaMSubramaniamGLevySWeitzmanE.Identifying adolescent vaping with screening to brief intervention and brief screener for tobacco, alcohol, and drugs screening tools. J Adolesc Health. 2024;75(1):196-199.
19.
BushKKivlahanDRMcDonellMBFihnSDBradleyKA; Ambulatory Care Quality Improvement Project. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789-1795.
20.
KroenkeKSpitzerRLWilliamsJB.The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
21.
KroenkeKSpitzerRLWilliamsJBMonahanPOLöweB.Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317-325.
GnambsTKasparK.Disclosure of sensitive behaviors across self-administered survey modes: a meta-analysis. Behav Res Methods. 2015;47(4):1237-1259.
24.
TamJ.E-cigarette, combustible, and smokeless tobacco product use combinations among youth in the United States, 2014–2019. Addict Behav. 2021;112:106636.
25.
Barrington-TrimisJLKongGLeventhalAM, et al. E-cigarette use and subsequent smoking frequency among adolescents. Pediatrics. 2018;142(6):e20180486.
26.
KreskiNTAnkrumHCerdáM, et al. Nicotine vaping and co-occurring substance use among adolescents in the United States from 2017–2019. Subst Use Misuse. 2023;58(9):1075-1079.
27.
GilbertPAKavaCMAfifiR.High-school students rarely use e-cigarettes alone: a sociodemographic analysis of polysubstance use among adolescents in the United States. Nicotine Tob Res. 2021;23(3):505-510.
28.
ChadiNSchroederRJensenJWLevyS.Association between electronic cigarette use and marijuana use among adolescents and young adults: a systematic review and meta-analysis. JAMA Pediatr. 2019;173(10):e192574.
29.
UngerJBFalconA.E-cigarette use among Hispanics: reducing risk or recruiting new tobacco users?Addict Behav. 2022;125:107149.
30.
DuanZWangYHuangJ.Sex difference in the association between electronic cigarette use and subsequent cigarette smoking among US adolescents: findings from the PATH study waves 1–4. Int J Environ Res Public Health. 2021;18(4):1695.
31.
OliverBEJonesSEHopsEDAshleyCLMiechRMpofuJJ.Electronic vapor product use among high school students—youth risk behavior survey, United States, 2021. MMWR Suppl. 2023;72(1):93.
32.
SingerJMTackettAPKleinEG, et al. Demographic and behavioral differences between adolescents and young adults who use e-cigarettes at low and high frequency. Subst Use Addctn J. 2024;45(2):232-239. doi:10.1177/29767342231214115.
33.
PedersonLLKovalJJVingilisE.E-cigarette use by Ontario public elementary school and secondary school students: has the use among sociodemographic groups changed from 2017 to 2019. Prev Med Rep. 2023;34:102257. doi:10.1016/j.pmedr.2023.102257.
34.
LechnerWVJanssenTKahlerCWAudrain-McGovernJLeventhalAM.Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Prev Med. 2017;96:73-78.
35.
RiehmKEYoungASFederKA, et al. Mental health problems and initiation of e-cigarette and combustible cigarette use. Pediatrics. 2019;144(1):e20182935.
36.
HarlowAFHanDHEckelSPMcConnellRLeventhalAMBarrington-TrimisJL.The interaction of e-cigarette use and mental health symptoms on risk of cigarette smoking initiation among young adults in the United States. Addiction. 2023;118(12):2317-2326.
37.
DuanZWangYSpearsCA, et al. Role of mental health in the association between e-cigarettes and cannabis use. Am J Prev Med. 2022;62(3):307-316.
38.
Audrain-McGovernJRodriguezDTestaSAlexanderEPianinS.Adolescent e-cigarette onset and escalation: associations with internalizing and externalizing symptoms. J Adolesc Health. 2021;68(4):801-807.
39.
MatheusCHeinNNarahariP, et al. Improving standardized screening for e-cigarette and vaping use among adolescents. Pediatrics. 2021;147:1002. doi:10.1542/peds.147.3MA10.1002.
