E-cigarette initiation predicts subsequent academic performance among youth: Results from the PATH Study

Prev Med. 2021 Dec:153:106781. doi: 10.1016/j.ypmed.2021.106781. Epub 2021 Sep 3.


Research shows cigarette smoking is associated with lower academic performance among youth. This study examines how initiating e-cigarette use is associated with subsequent academic performance. Data from Waves 2-4 youth and parent surveys of the Population Assessment of Tobacco and Health (PATH) Study were analyzed. Youth (12-15 years old) who reported never using any tobacco products at Wave 2 were included in the analysis (n = 4960). Initiation of e-cigarettes and cigarettes was assessed at Wave 3. Weighted multivariable linear regression models were tested to assess the association between e-cigarette and cigarette initiation at Wave 3 and academic performance at Wave 4, controlling for covariates at Wave 2. At Wave 3, 4.3% and 1.9% of youth initiated e-cigarette and cigarette use, respectively. Youth who initiated e-cigarette use at Wave 3 had lower academic performance at Wave 4, compared to those who did not initiate e-cigarette use (adjusted regression coefficient [ARC] -0.22, 95% confidence interval [CI] -0.43, -0.02). Initiating cigarettes was also associated with lower academic performance (ARC -0.51, 95% CI -0.84, -0.18). Results indicate that e-cigarette use initiation is associated with lower subsequent academic performance, independent from the association between cigarette use initiation and lower academic performance among U.S. youth. Future research needs to examine whether preventing youth e-cigarette and cigarette use can lead to improvement in academic performance.

Keywords: Academic achievement; Adolescents; E-cigarettes; Longitudinal analysis; Tobacco initiation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Academic Performance*
  • Adolescent
  • Child
  • Cigarette Smoking* / epidemiology
  • Electronic Nicotine Delivery Systems*
  • Humans
  • Tobacco Products*
  • Vaping* / epidemiology