# Associations Between Electronic Vapor Product Use and Prescription Opioid Misuse Among High School Students in the United States; A Retrospective Cross-Sectional Analysis

## TL;DR

Adolescents who use electronic vapor products are more likely to misuse prescription opioids, with higher use linked to higher risk.

## Contribution

This study identifies a dose-dependent association between electronic vapor product use and prescription opioid misuse in high school students.

## Key findings

- 17.2% of high school students reported current electronic vapor product use.
- EVP users had an 80% higher prevalence of opioid misuse compared to non-users.
- The association remained significant after adjusting for multiple variables like age, sex, and substance use.

## Abstract

What are the main findings?
•The use of electronic vapor products (EVPs) in adolescents was found to be correlated with increased current opioid misuse•This relationship had a dose-dependent effect, with an increased frequency of EVP use correlating with an increased prevalence of current opioid misuse

The use of electronic vapor products (EVPs) in adolescents was found to be correlated with increased current opioid misuse

This relationship had a dose-dependent effect, with an increased frequency of EVP use correlating with an increased prevalence of current opioid misuse

What is the implication of the main finding?
•Adolescents with EVP use may be at increased risk for opioid misuse and should be identified for targeted screening and education•Public health measures aiming to reduce EVP use in adolescents may want to highlight an increased risk of opioid misuse as a potential sequela of EVP use initiation

Adolescents with EVP use may be at increased risk for opioid misuse and should be identified for targeted screening and education

Public health measures aiming to reduce EVP use in adolescents may want to highlight an increased risk of opioid misuse as a potential sequela of EVP use initiation

Study objective: Electronic vapor product (EVP) use remains prevalent among adolescents in the United States. EVP use may be associated with high-risk substance use behaviors. This study investigates the association between current EVP use and current opioid misuse in high school students. Methods: We conducted a secondary analysis of the 2021 Youth Risk Behavior Survey (YRBS) (n = 7471). We first examined the prevalence rates of current prescription opioid misuse between participants ages 14 to 19 who reported any EVP use compared to those who did not report any EVP use. We conducted an adjusted Poisson regression analysis to determine whether EVP use was associated with prescription opioid misuse after controlling for multiple variables, including age, biological sex, race, ethnicity, alcohol use, other tobacco use, marijuana use, and depressive symptoms. Results: Among participants, 17.2% (95% confidence interval (CI): 15.4–19.1%) reported current EVP use. The prevalence of current opioid misuse was higher in the group of students who use EVPs (13.3%) as compared to students who do not use EVPs (3.2%) (p < 0.0001). Compared to participants who did not use EVPs, those with EVP use had an 80% greater prevalence of opioid misuse, after adjusting in regression analyses (adjusted prevalence rate ratio: 1.8, 95% CI: 1.4–2.3, p < 0.0001). Conclusions: Our findings highlight the significantly increased prevalence of opioid misuse among this population and the need to educate adolescents about the additional risks associated with nicotine and EVP use. Longitudinal studies are needed to test causal relationships and better understand the biobehavioral mechanisms that connect EVP use and opioid misuse.