Bullying, Sexual Assault, and E-Cigarette Use Among High School Students in the United States.

Abstract

Introduction: Adolescent e-cigarette use is a growing public health concern. Emerging evidence suggests that adverse experiences such as bullying and forced sexual intercourse may contribute to its initiation and continuation. This study investigates the associations between these experiences and e-cigarette use, with attention to demographic differences.

Methods: Data from the 2023 Youth Risk Behavior Surveillance System (YRBS) were analyzed using statistical methods in 2025. Logistic regression models examined associations between school-based bullying, electronic bullying, forced sexual intercourse, and e-cigarette use (ever use and past 30-day use), adjusting for demographics. Interaction terms were tested to assess sex-based differences.

Results: Among respondents, 31.1% reported ever using e-cigarettes, and 16.7% reported past 30-day use. School-based bullying was associated with higher odds of ever use (AOR=1.28, 95% CI=1.06-1.54), while electronic bullying showed stronger associations (AOR=2.22, 95% CI=1.85-2.66). Forced sexual intercourse was linked to both ever use (AOR=2.04, 95% CI=1.56-2.66) and past 30-day use (AOR=3.27, 95% CI=2.69-3.97). A significant sex interaction (p=0.011) indicated higher predicted probabilities of ever use for females (62.2%) than males (44.3%) who had experienced forced sexual intercourse. Race/ethnicity and grade level were also significant predictors, with Asian students reporting lower odds of use compared to White students (AOR=0.38, 95% CI=0.25-0.58).

Conclusions: Bullying and forced sexual intercourse are significantly associated with adolescent e-cigarette use, with electronic bullying and forced sexual intercourse showing particularly strong effects. Findings underscore the need for trauma-informed, school-based prevention strategies tailored to demographic risk factors.