Psychosocial Stressors and E-cigarette Use in the Youth Risk Behavior Survey

Abstract Background: Psychosocial stressors may influence tobacco use. Few studies have examined the association of stressors and e-cigarette use in adolescents. Therefore, we examined the associations between psychosocial stressors and e-cigarette use among adolescents in the United States (U.S.). Methods: Using the 2019 Youth Risk Behavior Survey data (YRBS) (N=13,677), students were categorized as non, e-cigarette, and combustible cigarette users based on past 30-day use. The prevalence of use was assessed by participants’ sociodemographic characteristics. Poisson regression models were used to examine the association between stressors and e-cigarette and combustible cigarette use. To estimate the stressor burden score, stressors were grouped into scores: 0, 1-2, 3-4, and 5-7. Results: Overall, 65.0%, 32.7% and 6.0% were non, e-cigarette and combustible cigarettes users, respectively. E-cigarette use prevalence was higher among students who experienced stressors than those who did not ([bullying: 43.9% vs 29.0%]; [skipping school due to safety concerns: 48.0% vs 29.0%]; [depressive symptoms: 43.5% vs 26.5%]; [suicidal thoughts: 47.6% vs 29.3%]; [physical fight: 51.1% vs 28.3%]; [threatened with a weapon56.4% vs 30.9%]). Similar patterns were observed with combustible cigarette use. Students who experienced stressors were more likely to use e-cigarettes (Prevalence Ratio [PR] range: 1.08-1.21) and combustible cigarettes (PR range: 1.34-2.06) than students who did not. Students with higher burden scores had a higher prevalence and PR of e-cigarette use than those with score of zero (1-2 [1.28; 95% CI:1.15-1.42]; 3-4 [1.42; 95% CI:1.23-1.65]; 5-7 [1.45; 95% CI:1.22-1.73]) (ptrends <0.001). Conclusion: This study demonstrated significant association between psychosocial stressors and e-cigarette use.