title: Adolescent Risk Behaviors and Use of Electronic Vapor Products and Cigarettes.
abstract: BACKGROUND
  Adolescent use of tobacco in any form is unsafe; yet the use of electronic cigarettes and other electronic vapor products (EVPs) has increased in recent years among this age group. We assessed the prevalence and frequency of cigarette smoking and EVP use among high school students, and associations between health-risk behaviors and both cigarette smoking and EVP use.
  
  
  METHODS
  We used 2015 national Youth Risk Behavior Survey data (N = 15 624) to classify students into 4 mutually exclusive categories of smoking and EVP use based on 30-day use: nonuse, cigarette smoking only, EVP use only, and dual use. Prevalence of cigarette smoking and EVP use were assessed overall and by student demographics and frequency of use. Prevalence ratios were calculated to identify associations with health risk-behaviors.
  
  
  RESULTS
  In 2015, 73.5% of high school students did not smoke cigarettes or use EVPs, 3.2% smoked cigarettes only, 15.8% used EVPs only, and 7.5% were dual users. Frequency of cigarette smoking and EVP use was greater among dual users than cigarette-only smokers and EVP-only users. Cigarette-only smokers, EVP-only users, and dual users were more likely than nonusers to engage in several injury, violence, and substance use behaviors; have ≥4 lifetime sexual partners; be currently sexually active; and drink soda ≥3 times/day. Only dual users were more likely than nonusers not to use a condom at last sexual intercourse.
  
  
  CONCLUSIONS
  EVP use, alone and concurrent with cigarette smoking, is associated with health-risk behaviors among high school students.
authors.affiliation: Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and izj5@cdc.gov.|US Public Health Service Commissioned Corps, Rockville, Maryland.
authors.forename: Zewditu
authors.initials: Z
authors.lastname: Demissie
authors.affiliation: Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and.
authors.forename: Sherry
authors.initials: S
authors.lastname: Everett Jones
authors.affiliation: Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and.
authors.forename: Heather B
authors.initials: HB
authors.lastname: Clayton
authors.affiliation: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and.
authors.forename: Brian A
authors.initials: BA
authors.lastname: King
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000009:adverse effects* / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data