title: Use and Perceived Risk of Electronic Cigarettes Among North Carolina Middle and High School Students.
abstract: Electronic cigarette (e-cigarette) use continues to rise among adolescents, but little is known regarding their risk perceptions of e-cigarette use. We aimed to describe the lifetime use and perceived risk of e-cigarette use in the context of other risk-taking behaviors among adolescents in North Carolina.
  
  
  
  Data were derived from the 2015 North Carolina Youth Risk Behavior Survey, which was administered to 503 middle school and 444 high school students in the Chapel Hill-Carrboro public school district. Survey participants self-reported their sex; ethnicity; school grade; ever-use of cigarettes, e-cigarettes, alcohol, and other illicit substances; perceived risk of harm of these products; and perceived view of their parents' and friends' perceptions of these products. Logistic regression analyses were used to assess associations between student-reported characteristics, risk behaviors, perceived product risk, and ever-use of e-cigarettes.
  
  
  
  This study found that 4.6% of middle school students and 37.2% of high school students reported ever-use of e-cigarettes. E-cigarette use increased and perception of e-cigarette risk decreased with advancing grade. Ever-use of e-cigarettes surpassed ever-use of combustible cigarettes at all grades; 49.4% of e-cigarette users had never smoked cigarettes. The perception that friends view e-cigarette use as "wrong" correlated negatively with e-cigarette use (adjusted odds ratio = 0.43; 95% confidence interval, 0.19-0.97).
  
  
  
  Self-reported results from students in one school district have limited generalizability to larger groups.
  
  
  
  E-cigarette use among adolescents in North Carolina correlates positively with perceived friends' views of e-cigarettes, and use correlates negatively with personal perception of the risk of e-cigarettes. Based on our survey results, education and public health intervention regarding e-cigarette use may be best targeted at youth prior to their transition to high school.
authors.affiliation: pulmonary critical care fellow, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Coral X
authors.initials: CX
authors.lastname: Giovacchini
authors.affiliation: postdoctoral fellow, Addiction Division, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
authors.forename: Lauren
authors.initials: L
authors.lastname: Pacek
authors.affiliation: professor, Addiction Division, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
authors.forename: F Joseph
authors.initials: FJ
authors.lastname: McClernon
authors.affiliation: associate professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina Loretta.Que@dm.duke.edu.
authors.forename: Loretta G
authors.initials: LG
authors.lastname: Que
mesh_terms: D000293:Adolescent; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008297:Male; D009657:North Carolina; D057566:Self Report; D013334:Students