Electronic Cigarettes Associated With Incident and Polysubstance Use Among Youth

Kathryn Bentivegna, Nkiruka C. Atuegwu, Cheryl Oncken, Joseph R. DiFranza, Eric M. Mortensen

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Purpose: Electronic cigarette (e-cigarette) use has increased exponentially among the youth in the United States and may increase the incidence of substance use. Methods: Youth participants (12–17 years) were surveyed through the Population Assessment of Tobacco and Health study over a three-year time period. Youth with any baseline substance use or diagnosis of an attention deficit disorder were excluded from the analysis. Multivariable logistic regressions were used to assess the association between e-cigarette use at Wave 1 and incident substance use (marijuana, painkillers, sedatives, or tranquilizers and Ritalin/Adderall) and polysubstance use at Wave 2 or 3, and marijuana use in the electronic nicotine device at Wave 3. Results: Baseline ever e-cigarette users who had no history of marijuana, nonprescribed drugs and illicit substance use in Wave 1 had increased odds of reporting incident use of marijuana (odds ratio 2.59, 95% confidence interval: 1.90–3.52), nonprescribed Ritalin/Adderall use (1.89, 1.09–3.28), or polysubstance use (2.09, 1.43–3.05) in Wave 2 or 3 compared to never e-cigarette users. They were also more likely to report use of marijuana in the electronic nicotine product (2.26, 1.56–3.27) in Wave 3 compared to never e-cigarette users. There was no statistically significant association between baseline e-cigarette use and incident use of painkillers, sedatives, or tranquilizers in Wave 2 or 3 (1.21,. 79–1.87). Conclusions: E-cigarette use is associated with incident use of marijuana, marijuana in electronic nicotine devices, Ritalin/Adderall, and polysubstance use but not painkillers, sedatives, or tranquilizers. Results indicate that e-cigarettes are associated with subsequent additional risky health behaviors in youth.

Original languageEnglish (US)
Pages (from-to)123-129
Number of pages7
JournalJournal of Adolescent Health
Issue number1
StatePublished - Jan 2021
Externally publishedYes


  • Adolescent
  • Electronic cigarettes
  • Electronic nicotine delivery systems
  • Marijuana use
  • Polysubstance use
  • Substance use
  • Tobacco
  • Vaping
  • Youth
  • e-cigarettes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health


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