Adverse School Outcomes and Risky Sexual Health Behaviors among High School Students with E-Cigarette and Marijuana Use

Background: While several health risks of e-cigarette and marijuana use have been described, little is known about their associations with school-related outcomes and risky sexual behaviors in adolescents. Objectives: To determine the odds of adverse school outcomes and risky sexual behaviors among youth with single or dual use of e-cigarettes and marijuana. Methods: We used data from the 2015 and 2017 waves of the Youth Risk Behavior Survey, a nationally representative survey of high school students in the US. Participants (N = 30,389) were divided into four exposure groups for single or dual use of e-cigarettes and marijuana. We compared rates of e-cigarette and/or marijuana use for different demographic characteristics using chi-square tests and performed multivariate logistic regressions exploring associations among e-cigarette and marijuana use and adverse school outcomes and risky sexual behaviors adjusting for confounding factors. Results: Participants reported e-cigarette-only (7.7%), marijuana-only (8.5%), and dual e-cigarette/marijuana (9.2%) use. Youth in all three use categories had higher odds of reporting grades that were mostly C's or lower than youth with no use, but no difference was found between youth with e-cigarette-only vs marijuana-only use. Increased odds of having sex without a condom were seen in youth with marijuana-only use (vs. e-cigarette-only use or no use) but not in youth with e-cigarette-only use or dual use. Conclusions: We found increased odds of adverse school-related outcomes and contrasting sexual risk profiles among youth with single or dual e-cigarette and marijuana use.