Susceptibility to E-Cigarette and Cigarette Use Among U.S. Adolescents.

PURPOSE: This study aimed to assess the risk and protective factors associated with susceptibility to e-cigarette and cigarette use among U.S. adolescents.

METHODS

Data were obtained from the Adolescent Brain Cognitive Development study at year 3 follow-up (2019-2021; ages 12-13 years). Susceptibility to tobacco use was based on self-reported curiosity and willingness to try e-cigarettes and cigarettes. Participants were grouped into four distinct categories: not susceptible, susceptible to e-cigarettes only, cigarettes only, or both. Multinomial logistic regression examined associations between susceptibility and demographics, impulsivity, parental substance use, environment, and psychosocial factors.

RESULTS

Among 9,326 adolescents (mean age = 154.9 months), 7,232 were not susceptible (weighted 76.8%), whereas 526 (6.1%) were susceptible to e-cigarettes only, 566 (6.1%) to cigarettes only, and 1,002 (11.0%) to both. Susceptibility to e-cigarette-only and dual use was associated with being older (closer to age 13 years), female, and having a history of substance use. Impulsivity traits, particularly negative urgency and sensation seeking, were linked to susceptibility across both products, whereas positive urgency and lack of perseverance were more strongly associated with e-cigarette-only and dual use. Protective factors across all susceptibility groups included higher levels of parental monitoring and a supportive school environment. In addition, parental use of other drugs and youth psychopathology were specifically linked to e-cigarette susceptibility, whereas a more favorable perceived neighborhood environment was protective against cigarette susceptibility.

DISCUSSION: Findings emphasize the importance of psychosocial, environmental, and parental factors in adolescent tobacco susceptibility. Prevention should address impulsivity-related risk factors, improve parental involvement, and strengthen school and community interventions.