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Background <p>The dual use of traditional cigarettes and e-cigarettes is common among adolescents. Dual use is likely more harmful than smoking traditional cigarettes or using e-cigarettes alone. However, few studies have explored the behavioral and psychological factors associated with this pattern of tobacco use among Chinese adolescents.</p> Methods <p>We surveyed high school students in all 31 provincial-level administrative divisions (PLADs) in mainland China. Tobacco use was categorized as current dual use, exclusive traditional cigarette use, exclusive e-cigarette use, and non-use. We collected 11 behavioral and psychological variables potentially associated with current tobacco use, including physical activity, screen time, sleep duration, diet, alcohol use, fighting, social self-control, self-esteem, self-efficacy, stress, and depression. Multinomial logistic regression adjusted for PLAD fixed effects was employed to analyze the associations.</p> Results <p>The weighted sample included 15,000 students with an equal distribution of sex and a median age of 17&#xa0;years (IQR: 16–18)<b>.</b> About 6.9% (95% confidence interval: 6.5%–7.3%) reported current dual use. Several behavioral and psychological factors, including excessive screen time (OR = 0.70, 95% CI = 0.61–0.80; appropriate screen time as the reference group), unhealthy dietary habits (OR = 1.34, 95% CI = 1.15–1.56; healthy diet as the reference group), alcohol use (occasional: OR = 5.53, 95% CI = 4.27–7.17; habitual: OR = 12.71, 95% CI = 9.24–17.47; never use as the reference group), fighting (occasionally: OR = 1.69, 95% CI = 1.41–2.03; habitual: OR = 1.83, 95% CI = 1.18–2.82; never fight as the reference group), strong social self-control (OR = 0.69, 95% CI = 0.57–0.82; moderate as the reference group), strong self-esteem (OR = 1.62, 95% CI = 1.36–1.94; moderate as the reference group), self-efficacy (strong: OR = 1.61, 95% CI = 1.38–1.88; weak: OR = 0.78, 95% CI = 0.62–0.97; moderate as the reference group), and strong stress (OR = 0.78, 95% CI = 0.64–0.95; moderate as the reference group), were found to be associated with the current dual use. Some of the above factors were also associated with the current exclusive use of traditional cigarettes or e-cigarettes.</p> Conclusions <p>This study reports on the phenomenon of current dual use and its behavioral and psychological associated factors among high school students in China. Families and schools should pay attention to adolescents’ health risk behaviors and psychological health, as these factors were found to be associated with tobacco use.</p> Clinical trial number <p>Not applicable.</p>

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The dual use of traditional cigarettes and e-cigarettes and behavioral and psychological associated factors among Chinese adolescents

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Kaiyuan Min,
  • Runping Ma,
  • Lewen Fu,
  • Ziyan Meng,
  • Qing Li,
  • Juntao Yang

摘要

Background

The dual use of traditional cigarettes and e-cigarettes is common among adolescents. Dual use is likely more harmful than smoking traditional cigarettes or using e-cigarettes alone. However, few studies have explored the behavioral and psychological factors associated with this pattern of tobacco use among Chinese adolescents.

Methods

We surveyed high school students in all 31 provincial-level administrative divisions (PLADs) in mainland China. Tobacco use was categorized as current dual use, exclusive traditional cigarette use, exclusive e-cigarette use, and non-use. We collected 11 behavioral and psychological variables potentially associated with current tobacco use, including physical activity, screen time, sleep duration, diet, alcohol use, fighting, social self-control, self-esteem, self-efficacy, stress, and depression. Multinomial logistic regression adjusted for PLAD fixed effects was employed to analyze the associations.

Results

The weighted sample included 15,000 students with an equal distribution of sex and a median age of 17 years (IQR: 16–18). About 6.9% (95% confidence interval: 6.5%–7.3%) reported current dual use. Several behavioral and psychological factors, including excessive screen time (OR = 0.70, 95% CI = 0.61–0.80; appropriate screen time as the reference group), unhealthy dietary habits (OR = 1.34, 95% CI = 1.15–1.56; healthy diet as the reference group), alcohol use (occasional: OR = 5.53, 95% CI = 4.27–7.17; habitual: OR = 12.71, 95% CI = 9.24–17.47; never use as the reference group), fighting (occasionally: OR = 1.69, 95% CI = 1.41–2.03; habitual: OR = 1.83, 95% CI = 1.18–2.82; never fight as the reference group), strong social self-control (OR = 0.69, 95% CI = 0.57–0.82; moderate as the reference group), strong self-esteem (OR = 1.62, 95% CI = 1.36–1.94; moderate as the reference group), self-efficacy (strong: OR = 1.61, 95% CI = 1.38–1.88; weak: OR = 0.78, 95% CI = 0.62–0.97; moderate as the reference group), and strong stress (OR = 0.78, 95% CI = 0.64–0.95; moderate as the reference group), were found to be associated with the current dual use. Some of the above factors were also associated with the current exclusive use of traditional cigarettes or e-cigarettes.

Conclusions

This study reports on the phenomenon of current dual use and its behavioral and psychological associated factors among high school students in China. Families and schools should pay attention to adolescents’ health risk behaviors and psychological health, as these factors were found to be associated with tobacco use.

Clinical trial number

Not applicable.