E-cigarette use by adolescents has reached epidemic proportions. This study's purpose was to explore adolescent e-cigarette use and dual use of e-cigarettes with other tobacco products and the relationships between socio-contextual variables (in-school/electronic bullying, threats with a weapon), psychological variables (sadness, suicide attempts) and problem behaviors (alcohol/marijuana use, sexual risk behavior, weapon carrying).

Cross-sectional descriptive study using secondary data from the 2019 Youth Risk Behavior Survey. Multiple logistic regression was used to examine the relationship between socio-contextual variables, psychological variables, problem behaviors and current adolescent e-cigarette use or dual use. E-cigarette users and dual users were examined in separate regression equations.

Most adolescent e-cigarette users (59 %) and dual users (63 %) were white with e-cigarette only users being majority female (55 %) and dual users majority male (57 %). E-cigarette use was significantly correlated with experiencing electronic bullying, sadness, threats with a weapon, alcohol use, marijuana use, and sexual risk behaviors. Dual use was significantly correlated with experiencing electronic bullying, sadness, alcohol use, marijuana use, sexual risk behaviors, and weapon carrying.

Problem behaviors, psychological variables, and socio-contextual variables are associated with e-cigarette use. It is imperative that adolescents are screened for use in addition to other behaviors.

E-cigarette use and dual use of e-cigarettes and other tobacco products is linked to other problem behaviors and feelings of sadness, with dual users being at significantly higher risk. Adolescents should be screened for e-cigarette use and dual use at every health care visit.