TOPLINE:

Over 76% of US adolescents aged 12-13 years said they would not use vapes or cigarettes, but 11.0% were susceptible to using both. Older age, female sex, history of substance use, and impulsivity traits were each associated with increased odds of susceptibility to the use of e-cigarettes and cigarettes.

METHODOLOGY:

• Researchers analyzed data from the Adolescent Brain Cognitive Development study to assess susceptibility to e-cigarette and cigarette use among US adolescents.
• About 9326 adolescents aged 12-13 years were included, with data collected during a follow-up between 2019 and 2021.
• Participants were categorized into four groups on the basis of their responses to questions about curiosity and willingness to try e-cigarettes and cigarettes: not susceptible, susceptible to e-cigarettes only, susceptible to cigarettes only, or susceptible to both.
• Data collection included surveys of adolescents and their primary caregivers, with a focus on psychosocial factors (measuring internalizing and externalizing behaviors), environmental factors (including school and neighborhood), self-reported use of substances (such as alcohol or other drugs), and youth impulsivity (assessing traits such as sensation seeking).
• Associations between susceptibility to e-cigarettes or cigarettes and factors such as demographics, impulsivity, and parental influence were assessed, with the nonsusceptible group as reference.

TAKEAWAY:

• Among the 9326 US adolescents, 76.8% were not susceptible to tobacco use, 6.1% were susceptible to vape use only, 6.1% to cigarette use only, and 11% to both.
• Older adolescents had increased odds of being susceptible to vaping (adjusted odds ratio [aOR], 1.05; P < .001) and to the use of both vapes and cigarettes (aOR, 1.03; P < .001). Female adolescents were also more likely to be susceptible to vape use and dual use than male adolescents (aOR, 1.75; P < .001 and aOR, 1.61; P < .001, respectively).
• Youth with a history of substance use had increased odds of susceptibility to e-cigarette use (aOR, 4.03; P = .007) and dual use (aOR, 3.81; P = .007). Traits such as higher negative urgency (aOR, 1.10; P = .005) and sensation seeking (aOR, 1.09; P < .001) were associated with increased odds of susceptibility to e-cigarette use.
• Higher parental monitoring was associated with reduced susceptibility across all groups of tobacco use (P < .01 for all), with the strongest effects for susceptibility to vape use (aOR, 0.59; P < .001) and to dual use (aOR, 0.49; P < .001).

IN PRACTICE:

“The findings underscore the importance of addressing both individual and environmental risk factors in efforts to prevent tobacco use initiation. Public health interventions should focus on preventing youths’ early experimentation with tobacco and other substances, whether influenced by their own behavior or parental use, while also strengthening family and school environments and offering targeted support to adolescents facing mental health challenges or impulsive behaviors,” the authors of the study wrote.

SOURCE:

The study was led by Jiani Zhang, MS, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska. It was published online on November 20, 2025, in the Journal of Adolescent Health.

LIMITATIONS:

The study’s cross-sectional design limited the ability to prove cause-and-effect relationships between factors and susceptibility. Data collected during the COVID pandemic might have affected behaviors and reporting, thereby affecting generalizability to non-pandemic contexts.

DISCLOSURES:

The study was supported by the National Institute on Drug Abuse. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.