Triple use of electronic cigarettes, combustible cigarettes, and marijuana is prevalent among adolescents and is associated with elevated risk profiles on levels of psychosocial variables, according to a study published online Sept. 28 in Pediatrics.
Thomas A. Wills, Ph.D., from the University of Hawaii Cancer Center in Honolulu, and colleagues classified ever and recent use of e-cigarettes, combustible cigarettes, and marijuana among U.S. high school students from the 2019 Youth Risk Behavior Survey (YRBS) yielding eight distinct groups. The levels of 14 risk and protective factors were compared across groups.
The researchers found that 43.9 percent of the sample was classified as the nonuser group. The most frequent user groups were triple users (ever use), dual users (e-cigarette and marijuana), and exclusive e-cigarette users (16.9, 15.8, and 13.2 percent, respectively). On psychosocial variables, risk profiles were typically elevated in the triple-user group above all other groups. Exclusive e-cigarette users had a risk profile that was below that of dual users but above the profile of nonusers. Similar results were seen for ever use and recent use. The result patterns were similar for 2019 YRBS and 2017 YRBS data.
"We confirmed previous findings that e-cigarettes differentially appeal to lower-risk adolescents who otherwise would be less likely to use cigarettes or marijuana; this suggests that e-cigarettes are an important part of the pathways from never use to dual and triple use," the authors write.