E-cigarette Use Trend and Pattern among Texas High School Students: Considering the Inverse Relationship with Cigarette Smoking

Purpose: Over the last decade, e-cigarettes have grown in popularity, surpassing cigarettes as the most widely used tobacco product among adolescents in the United States. Current evidence suggests that using e-cigarettes (vaping) may be less harmful than smoking cigarettes; however, while the long-term effects of vaping are still being studied, it has been linked to chronic lung and cardiovascular diseases and an increased likelihood of transitioning to cigarettes. Despite the association between smoking and vaping, the upward trend of vaping among young people is infrequently studied in concert with the prevalence of cigarette smoking. The objectives of this study are to explore the prevalence of e-cigarette use and socio-demographic factors that influence this behavior, and to examine the trend of e-cigarette use and potential associations with cigarette smoking among Texas high school students. Methods: This study analyzed and presented data on the prevalence of current and frequent use of e-cigarette products and cigarette smoking among high school students from the 2019 Texas Youth Risk Behavior Survey (YRBS), a biennial cross-sectional survey with a sample size of 2032. Previous Texas YRBS data were referenced to report relevant trends. Analysis was conducted using the YRBS online interactive data tool which utilized SAS (version 9.4) and SUDAAN (version 11.0.1). The pairwise t-test and Wald chi-square tests were used to determine significant differences and associations between estimates. Results: Nearly one in five respondents (18.7%) reported e-cigarette use during the 30 days before the survey and a quarter of e-cigarette users reported vaping almost every day. Non-Hispanic White students were significantly more likely to report current use of e-cigarettes than Hispanic and non-Hispanic Black adolescents (P< 0.001). Students who identified as bisexual were also more likely to report vaping than students who identified as heterosexual (P=0.03). The likelihood of reporting electronic vapor product use also appeared to increase with high school grades. Overall, the prevalence of cigarette smoking appeared to be on the decline from a reported 17.4% in 2011 to 4.9% in 2019. On the contrary, e-cigarette use has been on the increase, achieving a peak prevalence of 18.7% in 2019. Conclusions: Current public health anti-tobacco strategies appear to be effective in reducing cigarette smoking but not vaping among adolescents. The popularity of e-cigarettes among high school students has increased steadily over the last 10 years; however, a remarkable decline was observed between 2015 and 2017. It is important to further investigate the causes of this reported decline as this may inform future public health strategies. Halting the upward trend of e-cigarette use is a priority as these products put adolescents at risk of significant morbidity.