Use and Perceived Risk of Electronic Cigarettes Among North Carolina Middle and High School Students.

Purpose: Electronic cigarette (e-cigarette) use continues to rise among adolescents, but little is known regarding their risk perceptions of e-cigarette use. We aimed to describe the lifetime use and perceived risk of e-cigarette use in the context of other risk-taking behaviors among adolescents in North Carolina.

Methods: Data were derived from the 2015 North Carolina Youth Risk Behavior Survey, which was administered to 503 middle school and 444 high school students in the Chapel Hill-Carrboro public school district. Survey participants self-reported their sex; ethnicity; school grade; ever-use of cigarettes, e-cigarettes, alcohol, and other illicit substances; perceived risk of harm of these products; and perceived view of their parents' and friends' perceptions of these products. Logistic regression analyses were used to assess associations between student-reported characteristics, risk behaviors, perceived product risk, and ever-use of e-cigarettes.

Results: This study found that 4.6% of middle school students and 37.2% of high school students reported ever-use of e-cigarettes. E-cigarette use increased and perception of e-cigarette risk decreased with advancing grade. Ever-use of e-cigarettes surpassed ever-use of combustible cigarettes at all grades; 49.4% of e-cigarette users had never smoked cigarettes. The perception that friends view e-cigarette use as "wrong" correlated negatively with e-cigarette use (adjusted odds ratio = 0.43; 95% confidence interval, 0.19-0.97).

Limitations: Self-reported results from students in one school district have limited generalizability to larger groups.

Conclusion: E-cigarette use among adolescents in North Carolina correlates positively with perceived friends' views of e-cigarettes, and use correlates negatively with personal perception of the risk of e-cigarettes. Based on our survey results, education and public health intervention regarding e-cigarette use may be best targeted at youth prior to their transition to high school.