Does social media and academic performance impact e-cigarette use among adolescents?

In a recent study published in the BMC Public Health Journal, researchers investigated the mediating effects of factors such as academic performance and the tendency of the youth to internalize problems on the longitudinal association between electronic cigarette (e-cigarette) use and social media influence among adolescents.

Study: Longitudinal relationship between social media and e-cigarette use among adolescents: the roles of internalizing problems and academic performance. Image Credit: iama_sing/


The use of e-cigarettes has become more prevalent among the youths in recent years, and reports from the United States (U.S.) Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) indicate that one in every ten students in middle and high schools uses e-cigarettes.

Although the use of tobacco cigarettes among youths has decreased significantly, the increased usage of e-cigarettes has raised significant health concerns.

E-cigarette use has been linked to mental health issues and lung disease in the short term, and the use of e-cigarettes in adolescents is thought to cause long-term nicotine addiction and other profound chronic health issues.

Studies analyzing e-cigarette use among adolescents have explored proximal factors such as attitudes, social norms, and self-efficacy, as well as distal factors such as the influence of schools and social media. Personality and family-associated traits also influence e-cigarette use.

While social media has been found to have a strong influence on prolonged e-cigarette use among adolescents, how other factors, such as academic performance and the tendency to internalize problems, mediate this association remains unclear.

About the study

The present study investigated the longitudinal relationships between e-cigarette usage, use of social media, internalization of problems, and academic performance in adolescents. They also examined the mechanism through which social media influences e-cigarette use, as well as the effect of academic performance on the use of e-cigarettes.

The data for the analysis came from the Population Assessment of Tobacco and Health study, a study carried out by the FDA and National Institutes of Health that longitudinally examines a representative cohort of youths and adults in the United States for tobacco use and associated health problems.

The present study used data from youths between the ages of 12 and 17 who had provided complete information on key variables, including social media use, internalization of problems, and e-cigarette use.

E-cigarette use, the dependent variable in the analysis, was assessed based on the usage frequency and was measured using the number of days in the last month that the participant reported using an e-cigarette. Given the wide variety of e-cigarettes available and the differing reliability and validity of the devices, the quantity of e-cigarettes was not one of the considered measures.

Social media use was one of the independent variables. It was graded on a seven-point Likert scale ranging from one to seven, with one being never and seven being multiple times a day.

The Global Appraisal of Individual Needs-Short Screener was used to measure the internalization of problems and included questions about feelings of loneliness, depression, hopelessness, difficulty sleeping, anxiety, panic, etc.

Academic performance was assessed based on parent-reported grades, with nine categories for rates ranging from A to F.

Sociodemographic factors such as gender, age, race, and average household income were considered covariates, and the analysis was controlled for self-reported physical and mental health and smoke exposure in the family.


The findings suggested that increased frequency of social media use among adolescents was linked to enhanced internalization of problems, which increased e-cigarette usage. Academic performance was negatively linked to e-cigarette use, with adolescents who performed better academically being more resistant to the use of e-cigarettes.

The longitudinal data indicated that adolescents between the ages of 12 and 14 with a higher frequency of using social media had higher odds of exhibiting internalization problems in the following one to three years, which was linked to an increase in e-cigarette usage in the subsequent one to three years.

Adolescents who were not performing well academically also tended to internalize problems, leading to an increase in e-cigarette use, suggesting that better academic performance was also possibly associated with characteristics such as competence in forming valuable judgments, self-confidence, and stronger social values that deter them from using e-cigarettes.


Overall, the findings reported that the association between social media usage frequency and e-cigarette use was mediated by the tendency to internalize problems.

However, academic performance was negatively correlated to e-cigarette use, with adolescents who were performing well academically exhibiting stronger resistance to e-cigarette use.

Journal reference:
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