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J Adolesc Health. 2014 Oct;55(4):588-91. doi: 10.1016/j.jadohealth.2014.06.016. Epub 2014 Jul 29.

Alternate tobacco product and drug use among adolescents who use electronic cigarettes, cigarettes only, and never smokers.

Author information

  • 1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut. Electronic address:
  • 2Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
  • 3Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York.
  • 4Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.



To determine whether use of alternative tobacco products (i.e., cigars, blunts, hookah, smokeless tobacco), alcohol, and marijuana differs among adolescents who currently use (1) electronic cigarettes (e-cigarettes); (2) cigarettes only; and (3) never smokers.


Analysis of a self-reported survey from four high schools in 2010-2011 (n = 3,102) with a subsample (n = 1,556) surveyed on alcohol and marijuana. Analyses were conducted with multinomial logistic regression models accounting for clustering by schools.


The sample contained 2.4% (n = 76) e-cigarette users, 12.4% (n = 386) cigarette smokers, and 85.1% (n = 3,197) never smokers. E-cigarette users were more likely than cigarette-only smokers to report blunt (adjusted odds ratio, 1.81; 95% confidence interval, 1.21-2.71) and hookah use (adjusted odds ratio, 3.12; 95% confidence interval, 1.90-5.13), but not cigar, smokeless tobacco, alcohol, or marijuana use.


E-cigarette users are more likely than cigarette smokers to use hookah and blunts.

Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.


Adolescent; Alcohol; Marijuana; Tobacco products

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