Electronic nicotine delivery systems (ENDS) use and its association with low academic achievement among 9th-12th grade students in the US – 2017 Youth Risk Behavior Survey (YRBS) Open Access
Russell, Olivia (Summer 2020)
Abstract
Objective. In 2018, the United States (US) Surgeon General declared adolescent electronic nicotine delivery systems (ENDS) use an epidemic and called for aggressive steps to reduce ENDS use among adolescents. There is ample evidence how tobacco smoking impacts academic achievement among adolescents; however, there is a need to explore the association of ENDS use with low academic achievement in high school students in the US, to guide translational research on ENDS use and its prevention programs.
Methods. We used self-administered questionnaire response data from the 2017 Youth Risk Behavior Survey (YRBS), a nationally representative cross-sectional survey of 14,765 US high school adolescents (9th-12th grade). Low academic achievement was defined as receiving mostly Cs, Ds, and Fs in the previous 12 months. Multiple logistic regression was performed to estimate crude and adjusted prevalence odds ratios (cPOR and aPOR, respectively) and associated 95% confidence intervals (CI) to examine the association. Adjusted analyses were stratified by gender, and controlled for year in school, race/ethnicity, and cigarette use.
Results. In 2017, 13.2% of adolescents reported current ENDS use in the past 30 days of YRBS survey, 21.5% reported past use, and 65.2% never used ENDS. Our stratified adjusted analysis showed that among females, current ENDS users had 2.3-times (95% CI: 1.5 – 3.4) higher odds for low academic achievement compared to never ENDs users, and among males, past ENDS users had 1.3- times (95% C.I.: 1.1 – 1.5) higher odds of low academic achievement, relative to those who reported never ENDS use.
Conclusions. In our study examining a nationally representative sample of high school adolescents in the US, ENDS use was positively associated with lower academic achievement in both genders, however the association was stronger in females. Prevalence of ENDS use fluctuates in the adolescent population, and hence knowledge of gender’s differential effect on the association between ENDS use and academic achievement should be examined in future analyses.
Table of Contents
Chapter 1: Literature Review 1
Public Health Significance 2
Electronic Nicotine Delivery Systems (ENDS) 3
ENDS 3
ENDS Design 3
ENDS Emission 4
History of ENDS 4
JUUL 6
Health Effects of ENDS 7
Tobacco Use Prevalence 9
Youth Risk Behavior Survey (YRBS) 9
National Youth Tobacco Survey (NYTS) 10
Population Assessment of Tobacco and Health (PATH) 11
Monitoring the Future (MTF) 11
Reasons for Use 12
Trends in Tobacco Use Among Adolescents 12
ENDS Use 12
Cigarette Use 13
Tobacco Dual Use 14
ENDS Risk Factors 14
Age/grade 15
Gender 16
Race/Ethnicity 16
Socioeconomic Status (SES) 16
Academic Achievement 16
Alcohol Use 17
Substance Use 17
Mental Health 18
Sexual Activity 19
Violence and Injury 19
Diet and Physical Activity 19
Psychosocial Characteristics 19
Susceptibility to ENDS use 20
Flavorings 20
ENDS Marketing 21
Perceived Addictiveness and Harmfulness 21
Academic Achievement Trend Data 22
Academic Achievement 23
SAT Scores 23
Drop-out Rates 24
Academic Achievement Risk Factors 24
Gender 24
Race/Ethnicity 25
SES 25
Tobacco Use 26
Alcohol Use 26
Substance Use 27
Mental Health 27
Sexual Activity 27
Violence and Injury 28
TV and Device Use 28
Diet 29
Physical Activity 29
Study Rationale 29
Chapter 2: Manuscript 32
Abstract 33
Introduction 34
Methods 36
Results 39
Tables 46
Table 1 46
Table 2 49
Table 3 53
Table 4 57
Chapter 3: Discussion 57
Findings 58
Recommendations 58
Future Analysis 58
ENDS Prevention Policy 60
References 63
Appendix 76
Tables 77
Table 5 77
Table 6 81
Table 7 84
Table 8 86
Table 9 87
Table 10 90
YRBS Survey Questions 94
ENDS Use 94
Academic Achievement 94
Year in School 95
Gender 95
Race/Ethnicity 95
Cigarette Use 96
Alcohol Risk 97
Substance Use Risk 97
Sexual Activity Risk 100
Mental Health Risk 101
Violence Risk 102
Injury Risk 102
Diet Risk 103
Physical Inactivity Risk 104
Screen Time Risk 105
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