Substance use among college students has become a significant public health concern, with both alcohol and e-cigarette use showing high prevalence rates in this population. Previous studies have highlighted that the co-use of alcohol and e-cigarettes can exacerbate risks of dependence and other adverse outcomes. However, while prior research has examined the general association between e-cigarette and alcohol use, limited attention has been given to understanding how specific contexts of e-cigarette use contribute to alcohol use problems among college students. To address this gap, the current study aims to investigate the longitudinal associations between various e-cigarette use contexts and alcohol use problems.
The study involved 377 undergraduate e-cigarette users from three U.S. public universities. Participants were eligible if they reported using e-cigarettes at least once weekly and completed surveys each semester over four semesters, from Fall 2019 to Spring 2023. Alcohol use problems were assessed using the Alcohol Use Disorders Identification Test (AUDIT), while e-cigarette use contexts included daily usage frequency, co-use with alcohol, use for socializing, and addiction tendencies. The analysis employed a linear mixed model (LMM) to identify associations between e-cigarette use contexts and alcohol use problems, controlling for demographic characteristics and substance use behaviors.
The findings revealed significant associations between e-cigarette use contexts and alcohol use problems among college students. Higher daily e-cigarette usage was associated with more severe alcohol-related problems (p < 0.001), and participants who reported being “hooked” on e-cigarettes also exhibited significantly higher levels of alcohol use problems (p < 0.01). Notably, participants who used e-cigarettes for socializing purposes were found to experience greater alcohol-related issues (p < 0.05) and, the frequency of simultaneous use of e-cigarettes and alcohol was strongly linked to increased alcohol use problems (p < 0.001). In fact, approximately 34.25% of e-cigarette use was associated with concurrent alcohol consumption, and 58.6% of participants were classified as hazardous drinkers based on AUDIT criteria. These findings underscore the close interplay between e-cigarette use and alcohol consumption, particularly when social contexts and addiction tendencies are combined, providing critical implications for developing prevention and intervention strategies targeting college students.
Takeaway: E-cigarette use contexts, particularly social settings and addiction tendencies, are closely linked to alcohol use problems among college students, highlighting the need for targeted prevention and intervention strategies.