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Trends in Weight Status and E-Cigarette Use Among U.S. Youth From 2017 to 2023
Tyler B Mason1, Adam M Leventhal2, Alyssa F Harlow2
1Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California.
Introduction:
e-cigarette use and obesity are often studied independently, yet emerging evidence suggests that obesity and e-cigarette use may occur together and can exacerbate health risks. The objective of this study was to examine trends in U.S. adolescent e-cigarette use by weight status and sex from 2017 to 2023 using data from the Monitoring the Future study, an annual nationally representative cross-sectional study.
Methods:
U.S. 8th-, 10th-, and 12th-grade students completed self-report measures of demographics, height, weight, and e-cigarette use at school (results pooled across grades, N=85,383). Piecewise log-binomial regression models were applied, and interactions between sex and weight status were examined within each time segment to assess subgroup differences in e-cigarette use trends.
Results:
Time trends in lifetime e-cigarette use differed by sex and weight status. From 2020 to 2021, declines were not significant among females with overweight (adjusted risk ratio=0.88; 95% CI=0.74, 1.05) or obesity (adjusted risk ratio=0.87; 95% CI=0.72, 1.07), whereas females with a healthy weight and males regardless of weight status showed significant reductions. From 2021 to 2023, declines were observed among males with healthy weight (adjusted risk ratio=0.93; 95% CI=0.88, 0.98) and obesity (adjusted risk ratio=0.90; 95% CI=0.81, 0.98) but not among females across any weight category. In 2023, lifetime e-cigarette use remained highest among females with overweight or obesity than among females with a healthy weight. Similar trends were observed for past 12-month and 30-day e-cigarette use.
Conclusions:
Overall adolescent e-cigarette use declined after 2020; however, this downward trend was primarily driven by males and those with a healthy weight. Declines were not significant among female adolescents, particularly those with overweight or obesity. Findings highlight sex-specific risks for the association of obesity with e-cigarette use and underscore the need for dual prevention efforts.
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