Secondhand E-cigarette and Tobacco Smoke Exposure and Stages of E-cigarette Use in U.S 6th-12th Graders.

Abstract

Introduction: Studies examining the association of secondhand exposures with e-cigarette use behaviors have been limited by indirect or incomplete measures of exposure. This study reports the prevalence of secondhand e-cigarette and tobacco smoke exposure among U.S youth and examines how robust measures of secondhand exposure correlate with e-cigarette susceptibility, ever use, daily use, and quit attempts.

Methods: A cross-sectional analysis of 21,946 U.S. 6th-12th graders from the 2023 National Youth Tobacco Survey was conducted. Participants' past 30-day secondhand exposure status was classified as: no secondhand exposure, secondhand e-cigarette only, secondhand tobacco smoke only, or dual secondhand exposure. Multivariate, weighted logistic regression evaluated secondhand exposure status as a predictor of four binary e-cigarette use outcomes in separate models: susceptibility, ever use, daily use, and past 12-month serious quit attempt.

Results: The estimated prevalence of past 30-day secondhand e-cigarette or tobacco smoke exposure was 64.2% (18.18 million). Secondhand exposure to e-cigarettes (AOR 2.14 95% CI [1.54-2.98]), tobacco smoke (AOR 1.62 [1.32-2.00]), and dual exposure (AOR 2.44 [2.10-2.84]) were each associated with greater e-cigarette susceptibility. Secondhand e-cigarette (AOR: 2.45 [1.69-3.56]) and dual exposure (AOR: 1.55 [1.23-1.94]), but not secondhand tobacco smoke exposure, were positively associated with e-cigarette ever use. There were no significant associations between secondhand exposure and daily e-cigarette use or serious quit attempts.

Conclusions: Secondhand e-cigarette and tobacco smoke exposure remains highly prevalent among U.S 6th-12th graders and is strongly associated with early stages of e-cigarette use, but not later stages. Minimizing youth secondhand exposure could have important public health benefits.

Implications: This study uses the latest data from the 2023 National Youth Tobacco Survey to highlight how the prevalence of secondhand e-cigarette and tobacco exposure among U.S 6-12 graders remains quite high (64.2%, 18.18 million) despite decreases in youth tobacco and e-cigarette use since 2019. Further, unlike prior studies limited to examining a single stage of e-cigarette use, this study examines how robust measures of secondhand exposure correlate with outcomes spanning the stages of e-cigarette use: susceptibility, ever use, daily use, and quit attempts. Ultimately, it reinforces secondhand exposure among U.S youth as an important and timely public health challenge.