Electronic Nicotine Delivery System Use and Weight-Related Intentions Among High School Students in the United States

Electronic nicotine delivery system (ENDS) use remains the most commonly used nicotine product among adolescents in the United States (U.S). Reasons for ENDS use vary, but emerging evidence suggests weight control may be a common motive for initiation and increased use. Therefore, better understanding around the association between ENDS use and weight-related intentions among adolescents, particularly in relation to potential differences by sex and sexual minority (SM) identity, is needed.

Analyses used data from the 2021 Youth Risk Behavioral Surveillance System (YRBSS) survey. The sample included 16,077 students in grades 9-12. Bivariate analyses examined associations between past 30-day ENDS use, weight-related intentions, sex, SM identity, and relevant covariates. Logistic regression models assessed adjusted associations of weight-related intentions, SM identity, and covariates with current ENDS use in the overall sample and stratified by sex.

In the adjusted logistic regression models, intentions to lose, gain, and maintain weight, relative to no intention to manage weight, were associated with increased odds of ENDS use. When stratified by sex, similar associations were observed among female participants, whereas among male participants, only weight gain intentions were associated with higher odds of ENDS use.

ENDS use was significantly associated with intentions to lose, gain, and maintain weight among adolescents, with notable sex differences in these associations. Prevention and intervention efforts should consider addressing weight-related motivations, particularly among groups who may be at a higher risk for ENDS use.