Patterns and Correlates of Disposable E-Cigarette Use Among U.S. Youth.

INTRODUCTION

Although research has documented the rapid rise in youth disposable E-cigarette use, understanding of the distinct characteristics and behaviors of youth who use these devices remains limited.

METHODS

This cross-sectional study analyzed data from the 2023 National Youth Tobacco Survey, a nationally representative survey of U.S. students Grades 6-12 (N=22,069). Analyses were conducted in 2025. Participants were classified into 6 mutually exclusive groups on the basis of their current tobacco product use: predominantly disposable E-cigarettes and no cigarettes, predominantly nondisposable E-cigarettes and no cigarettes, cigarettes only, concurrent use of cigarettes with disposable E-cigarettes, concurrent use of cigarettes with nondisposable E-cigarettes, or no use. Measures included E-cigarette use patterns, nicotine dependence indicators, exposure to E-cigarette content on social media, social norms, and psychological distress. Weighted analyses and multinomial logistic regression were performed.

RESULTS

Youth who predominantly used disposable E-cigarettes reported significantly higher rates of nicotine-containing product use (81.9% vs 49.6%) and fruit flavor preference than those who use nondisposable E-cigarettes. Those who predominantly used disposable E-cigarettes without cigarettes reported fewer smoking peers but similar numbers of E-cigarette-using peers than those who use cigarettes and E-cigarettes concurrently. Getting high from nicotine was more commonly reported than flavor availability as a motivation across all E-cigarette use groups. Relative to nonuse, predominant disposable E-cigarette use without cigarettes was significantly associated with daily social media exposure (RRR=2.1), peer E-cigarette use (RRR=1.2), home E-cigarette exposure (RRR=1.2), and severe psychological distress (RRR=2.3). Concurrent use of cigarettes and E-cigarettes showed the strongest associations with dependence indicators and social exposure across multiple domains.

CONCLUSIONS

Youth who predominantly used disposable E-cigarettes were characterized by nicotine-seeking behavior and social media influence, whereas those who concurrently used cigarettes and disposable E-cigarettes showed elevated risk indicators across multiple domains. Prevention strategies should be differentiated to address the specific risk profiles of groups with different use patterns.