New studies examine teen vaping association with sexual risk behavior and drug usage

BALTIMORE – Electronic vapor product (EVP) usage among U.S. high school students is associated with a higher likelihood of engagement in nine out of 10 sexual risk behaviors, according to a new study which analyzed data from the 2017 National Youth Risk Behavior Survey. A related study found that adolescent EVP use is associated with a higher likelihood of engagement in several substance-use behaviors. Findings from the studies will be presented during the Pediatric Academic Societies (PAS) 2019 Meeting, taking place on April 24 – May 1 in Baltimore.

According to the Centers for Disease Control, EVPs remain the most popular tobacco product among U.S. high school students, and current EVP usage in this population increased nonlinearly since 2016.

“Vaping has reached epidemic proportions among U.S. youth,” said Andrew Adesman, MD, senior investigator of the study. “Our study not only expanded upon previous studies examining teen vaping and drug use, but we also investigated novel associations between vaping and various sexual risk behaviors. In this analysis of a nationally representative sample of U.S. teens, we found that vaping was associated with engagement in sexual risk behaviors such as early sexual debut and alcohol use before sex.”

In 2017, 6.5% of U.S. high school students used only EVPs in the past 30 days, 2.8% used only cigarettes, and 6.5% used both products. EVP use only and dual use were associated with a greater likelihood of engagement in nine of 10 sexual risk behaviors compared to non-users. Prevalence proportions did not significantly differ between EVP-only users and dual-users for seven of 10 behaviors. Past 30-day EVP use at any frequency was also associated with a higher likelihood of engaging for nearly all risk behaviors examined. Occasional EVP users were similarly likely as frequent and daily users to engage in all 10 risk behaviors.

Past research has shown that high school EVP users are more likely to engage in certain risk behaviors. However, the association of current EVP usage and EVP usage frequency with specific alcohol and drug-related risk behaviors has not been studied using a recent national sample.

The study found that cigarette, EVP and dual use were associated with greater likelihood of engaging in 12 of 13 substance-use behaviors compared to non-users. Dual-users were more likely than EVP-only users to engage in 12 of 13 behaviors. Past 30-day EVP use at any frequency was also associated with higher likelihood of engaging in nearly all risk behaviors examined. Occasional EVP users were similarly likely as frequent and daily users to engage in 11 of 13 behaviors.

“We found that vaping was associated with a wide variety of substance-use risk behaviors, ranging from prescription pain medicine misuse to binge drinking,” said Devyn Rigsby, principal investigator of the study. “Somewhat surprisingly, for the majority of substance-use risk behaviors examined, we found no difference in the likelihood of engagement in these behaviors when comparing teens who vaped occasionally, frequently or daily.”

Dr. Adesman added, “Although vaping was strongly associated with many substance-use and sexual risk behaviors, we were surprised that, in general, teens who vape only occasionally were no less likely to engage in these risk behaviors than teens who vape frequently. Initiatives to reduce youth substance use and youth engagement in risky sexual behaviors should include efforts to reduce teen vaping at all frequency levels.”

Rigsby will present findings from “Electronic Vapor Product Usage and Sexual Risk Behavior in U.S. Adolescents: Data from the 2017 National Youth Risk Behavior Survey” on Saturday, April 27 at 1:15 p.m. EDT. Findings from “Electronic Vapor Product Usage and Alcohol- & Drug-Related Risk Behaviors in U.S. Adolescents: Data from the 2017 National Youth Risk Behavior Survey” will be presented on Saturday, April 27 at 5:45 p.m. EDT. Reporters interested in an interview with Dr. Adesman or Ms. Rigsby should contact [email protected] Please note that only the abstracts are being presented at the meeting. In some cases, the researchers may have additional data to share with media.

The PAS 2019 Meeting brings together thousands of pediatricians and other health care providers to improve the health and well-being of children worldwide. For more information about the PAS 2019 Meeting, please visit http://www.pas-meeting.org.

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About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting brings together thousands of pediatricians and other health care providers united by a common mission: to improve the health and well-being of children worldwide. This international gathering includes pediatric researchers, leaders in pediatric academics, clinical care providers and community practitioners. Presentations cover issues of interest to generalists as well as topics critical to a wide array of specialty and sub-specialty areas. The PAS Meeting will be the premier North American scholarly child health meeting. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit http://www.pas-meeting.org. Follow us on Twitter @PASMeeting and #PAS2019, and like us on Facebook.

Abstract: Electronic Vapor Product Usage and Sexual Risk Behavior in U.S. Adolescents: Data from the 2017 National Youth Risk Behavior Survey

Background: According to the 2017 National Youth Tobacco Survey, electronic vapor products (EVPs) remain the most popular tobacco product among U.S. high school (HS) students, and current EVP usage in this population increased nonlinearly since 2016. Prior studies have linked adolescent EVP usage with greater likelihood of engagement in other risk behaviors. However, there is a lack of current research regarding the association of EVP usage and EVP usage frequency with specific sexual risk behaviors.

Objective: To examine, in a nationally representative sample of U.S. HS students, how current cigarette, EVP, and dual usage as well as EVP usage frequency are related to specific sexual risk behaviors in U.S. adolescents.

Design/Methods: Respondents (N=12,667) of the 2017 National Youth Risk Behavior Survey (YRBS) were categorized by previous 30-day EVP and cigarette usage into one of four groups: nonuse, cigarette only, EVP only, or dual use. Separately, respondents were categorized by 30-day EVP usage frequency: 0, 1-9, 10-29, or 30 days. Ten sexual risk behaviors were identified as dependent variables. Adjusted prevalence ratios (aPRs) were calculated using multivariable modified Poisson regression to determine associations between sexual risk behaviors and both current EVP/cigarette usage and current EVP usage frequency among U.S. adolescents (Tables 1 & 2). Linear contrasts were conducted to compare aPRs across usage categories.

Results: In 2017, 6.5% of U.S. HS students used only EVPs in the past 30 days, 2.8% used only cigarettes, and 6.5% used both products. EVP use only and dual use were associated with greater likelihood of engagement in 9 of 10 sexual risk behaviors compared to non-users. Prevalence proportions did not significantly differ between EVP-only users and dual-users for 7 of 10 behaviors. Past 30-day EVP use at any frequency was also associated with higher likelihood of engaging for nearly all risk behaviors examined. Occasional EVP users were similarly likely as frequent and daily users to engage in all 10 risk behaviors.

Authors: Devyn Rigsby, Sarah Keim, Ruth Milanaik, Andrew Adesman

Abstract: Electronic Vapor Product Usage and Alcohol- & Drug-Related Risk Behaviors in U.S. Adolescents: Data from the 2017 National Youth Risk Behavior Survey

Background: According to the Centers for Disease Control, electronic vapor products (EVPs) remained the most utilized tobacco product among U.S. high school (HS) students in 2017, and EVP usage in this population increased from 2016. Past research has shown that HS EVP users are more likely to engage in certain risk behaviors. However, association of current EVP usage and EVP usage frequency with specific alcohol- & drug-related risk behaviors has not been studied using a recent national sample.

Objective: To assess how current EVP, cigarette, and dual-product usage as well as EVP usage frequency are related to alcohol- & drug-related risk behaviors in a nationally representative sample of U.S. HS students.

Design/Methods: Respondents (N=12,667) of the 2017 National Youth Risk Behavior Survey (YRBS) were categorized by previous 30-day EVP and cigarette usage into one of four groups: nonuse, cigarette only, EVP only, or dual use. Separately, respondents were categorized by 30-day EVP usage frequency: 0, 1-9, 10-29, or 30 days. Thirteen substance-use behaviors were selected as dependent variables. Adjusted prevalence ratios (aPRs) were calculated using multivariable modified Poisson regression to determine associations between outcome behaviors and both current EVP/cigarette usage and EVP usage frequency (Tables 1 & 2). Linear contrasts were conducted to compare aPRs across usage categories.

Results: In 2017, 6.5% of U.S. HS students used only EVPs in the past 30 days, 2.8% used only cigarettes, and 6.5% used both products. Cigarette, EVP, and dual use were associated with greater likelihood of engaging in 12 of 13 substance-use behaviors compared to non-users. Dual-users were more likely than EVP-only users to engage in 12 of 13 behaviors. Past 30-day EVP use at any frequency was also associated with higher likelihood of engaging in nearly all risk behaviors examined. Occasional EVP users were similarly likely as frequent and daily users to engage in 11 of 13 behaviors.

Conclusions: Adolescent EVP use, with or without concurrent cigarette smoking, is associated with a higher likelihood of engagement in several substance-use behaviors. Prevalence of risk behaviors is generally greater for dual users than EVP-only users, but prevalence proportions do not significantly differ among occasional, frequent, or daily EVP users for most behaviors.

Authors: Devyn Rigsby, Sarah Keim, Andrew Adesman

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