Electronic and Conventional Cigarette Use and Academic Achievement Among Predominantly Low-Income Black High School Students.

BACKGROUND

Tobacco use remains a major public health concern among adolescents, particularly as electronic cigarette (e-cigarette) use has increased in recent years. While academic performance has been linked to health-risk behaviors, less is known about its specific relationship to tobacco use among predominantly Black youth in urban settings. Understanding this association is essential for informing targeted prevention strategies.

OBJECTIVE

To examine the association between academic performance (self-reported grades from A to F) and use of tobacco products-including conventional cigarettes, e-cigarettes, and other forms-among predominantly Black high school students in Baltimore, a city marked by socioeconomic and health disparities.

METHODS

A cross-sectional analysis was conducted using survey data from 604 public high school students in Baltimore. The main predictor was self-reported average school grades. Outcomes included ever use of (1) combustible tobacco products, (2) e-cigarettes, and (3) any tobacco product. Logistic regression models estimated associations between academic performance and each tobacco outcome, adjusting for age, sex, race, parental education and employment, and household structure.

RESULTS

Among participants (mean age = 16.1 years), 20.2% reported using e-cigarettes, 7.1% used cigarettes, and 25.2% had used any tobacco product. Academic performance was inversely associated with all forms of tobacco use. Students with A, B, or C grades had significantly lower odds of e-cigarette use compared to those with D or F grades. Students with A grades had lower odds of cigarette use and any tobacco use.

CONCLUSIONS

Lower academic achievement was consistently associated with higher odds of tobacco use among predominantly Black adolescents. Academic performance may help identify youth at higher risk of tobacco use and guide school-based prevention and intervention strategies in similar urban settings.