Youth Healthy Behaviors and E-Cigarette and Tobacco Use

Youth Healthy Behaviors and E-Cigarette and Tobacco Use

This paper explores the relationship between the big three healthy lifestyle behaviors of physical activity, nutrition and specifically breakfast eating, and sleep with e-cigarette and regular cigarette use among US high school students.  In addition, published research examining these associations was examined. 

First, it’s important to recognize that the majority of American adolescents are at risk for chronic disease development due to their health habits, or lack thereof.  

Looking at the latest Youth Risk Behavior Survey data (2019) shows that only a third (33%) of US high school students eat breakfast every morning, only 29% eat two servings of fruit a day, and only 14% eat three or more vegetable servings every day.  In addition, only 23% get an hour of physical activity each day and only 22% get eight or more hours of sleep. 

These data show that most American adolescents are not meeting basic health recommendations for nutrition, physical activity and sleep: 

US Adolescent Health Behavior Associations 

Now, let’s look at the relationships between these key healthy behaviors and both e-cigarette and combustible cigarette consumption measures.  Using the Youth Online YRBS data analysis tool (CDC, 2019) for all high school students in the country, cross-tabs were run comparing each of the big-three healthy behaviors (one-hour physical activity, eating breakfast, eight-hours of sleep per day: yes/no) against various measures of cigarette and e-cigarette use (yes/no): 

Youth eating breakfast every morning and getting eight or more hours of sleep each night were significantly less likely to ever and currently smoke combustible cigarettes, use smokeless tobacco, and ever, currently, frequently and daily vape e-cigarettes compared to those adolescents who did not eat breakfast or get regular sleep (p’s =.0000-.02). 

Eating breakfast every day was also associated with less likelihood of smoking regular cigarettes before age 13 years old (p=.0000) and frequent cigarette smoking (p=.001). 

However, youth getting one or more hours of physical activity every day were more likely to use smokeless tobacco and currently, frequently and daily vape e-cigarettes than less physically active adolescents (p’s =.0003-.03). 

These results indicate that promoting daily breakfast consumption could enhance tobacco use prevention among adolescents while promoting breakfast eating and sleep behaviors may influence e-cigarette use.  However, highly active adolescents may be at greater risk for smokeless tobacco and e-cigarette use and therefore are in greater need of prevention programs by teachers, coaches and parents. 

Research on Youth Physical Activity and E-Cigarette Use 

A study published in Nicotine and Tobacco Research (2019) examined how sport participation and activity levels among high school-aged youth differ between e-cigarette users and smokers.

Results indicated that e-cigarette users are more likely to participate in intramural, competitive, and team sports compared to non-users. Youth e-cigarette users are also more likely than non-users to meet the physical activity guidelines:

A study published in Tobacco Use Insights (2022) evaluated the relationship between electronic vapor product (EVP) use and physical activity among high school students in Georgia. 

Study findings showed that the prevalence of EVP use was higher among physically active adolescents: 

Yet another study published in the American Journal of Preventive Medicine (2020) examined whether physical activity is associated with lower levels of cigarette and e-cigarette use, both cross-sectionally and prospectively, among young adults. 

Higher physical activity at baseline was associated with increased e-cigarette use at follow-up, adjusting for baseline e-cigarette use, sensation seeking, BMI, and demographic variables: 

Together, these studies support the YRBS data shown earlier indicating a greater risk of e-cigarette use among physical active and sports participating young people and indicate the need for e-cigarette use prevention programs especially for adolescents in physical education and youth sports. 

Research on Youth Sleep, Breakfast Consumption and Cigarette Use 

A study in the Journal of Adolescence (2019) examined whether exclusive e-cigarette, exclusive combusted cigarette, and dual-product use are associated with sleep-related complaints among adolescents. 

Findings included that e-cigarette and dual-product use are significantly associated with greater odds of reporting sleep-related complaints among adolescents: 

Another study published in Scientific Reports (2022) explored the impact of e-cigarette, conventional tobacco, and dual use on sleep quality, sleep latency, cough, and drug use.  

Results showed that dual use of e-cigarettes and conventional tobacco was associated with increased sleep latency relative to non-smokers/non-vapers: 

A third study published in Preventive Medicine Reports (2022) explored whether sleep deprivation is associated with adolescents’ self-reported susceptibility to initiating electronic nicotine devices (ENDS) use in the next month.  

Findings indicated that adolescents who reported getting less than six hours of sleep per night were associated with greater odds of reporting any likelihood to try a vape in the next 30 days: 

Together, these studies illustrate that e-cigarette use alone and with regular cigarette smoking negatively impacts sleep health and indicate the need to promote youth sleep and address sleep quantity and quality in cigarette use prevention programs. 

Very few published studies were found examining the association between breakfast consumption and cigarette consumption. 

One paper published in the Journal of the American College of Cardiology (2018) examined clinical studies from Japan and Spain exploring the associations among breakfast consumption, social eating, cigarette smoking and cardiovascular health. 

Results indicated that in each of the studies the prevalence of current smoking among the patients who skipped eating breakfast was significantly higher than those who ate breakfast:,%2C%20respectively%2C%20in%20Spain). 

While there is a lack of research examining the association between e-cigarette use and breakfast consumption, it appears that greater cigarette smoking may be related to missing breakfast and therefore cigarette use prevention programs might wish to promote the physical and mental health and academic benefits of regular breakfast consumption among youth. 

Learn more about programs that integrate cigarette use prevention with healthy behavior promotion among youth and young adults: 

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