title: E-cigarette Use, Cigarette Smoking, Dual Use, and Problem Behaviors Among U.S. Adolescents: Results From a National Survey.
abstract: OBJECTIVE
  There is a need to obtain greater clarity regarding adolescents' e-cigarette use and the associations of use with a wider range of risk behaviors. This study examines the associations among past-month e-cigarette use only, traditional cigarette smoking only, dual use (i.e., concurrent e-cigarette use and cigarette smoking), school-related (i.e., truancy and poor academic performance) risk behaviors, and substance-related (i.e., alcohol use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) risk behaviors.
  
  
  METHODS
  Data were collected via self-administered questionnaires from a nationally representative sample of 8,696 high school seniors.
  
  
  RESULTS
  An estimated 9.9% of U.S. high school seniors reported past-month e-cigarette use only, 6.0% reported past-month cigarette smoking only, and 7.3% reported past-month dual use. School- and substance-related risk behaviors had strong associations with past-month e-cigarette use. Adolescents who only used e-cigarettes had significantly greater odds of all school- and substance-related risk behaviors relative to nonusers. Dual users had significantly greater odds of frequent/daily e-cigarette use as well as all school- and substance-related risk behaviors relative to those who only used e-cigarettes. Finally, adolescents who engaged in frequent/daily e-cigarette use had significantly greater odds of binge drinking, marijuana use, other illicit drug use and nonmedical prescription drug use, relative to experimental e-cigarette users.
  
  
  CONCLUSIONS
  E-cigarette use is common among U.S. adolescents, and there are robust associations between e-cigarette use and school- and substance-related risk behaviors. There is evidence that e-cigarette use clusters with risk behaviors and appears to represent a problem behavior, especially dual use of e-cigarettes and traditional cigarettes.
authors.affiliation: Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan. Electronic address: plius@umich.edu.
authors.forename: Sean Esteban
authors.initials: SE
authors.lastname: McCabe
authors.affiliation: Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Brady T
authors.initials: BT
authors.lastname: West
authors.affiliation: Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan.
authors.forename: Phil
authors.initials: P
authors.lastname: Veliz
authors.affiliation: Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan; School of Nursing, Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, Addiction Research Center, University of Michigan, Ann Arbor, Michigan.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Boyd
mesh_terms: D000124:Achievement; D000293:Adolescent; D000294:Adolescent Behavior; D000428:Alcohol Drinking; D000073865:Cigarette Smoking / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking; D063487:Prescription Drug Misuse; D000066553:Problem Behavior; D012309:Risk-Taking; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires
keywords: Academic performance; Adolescence; Cigarette smoking; E-cigarette; Epidemiology; High school; Problem behaviors; Substance use