E-Cigarette Access Sources, Use Frequency, and Quit Attempts among U.S. High School Students

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Background: Despite federal tobacco 21 (T21) legislation and retail regulations, e-cigarettes remain the most commonly used tobacco product among U.S. adolescents. Purpose: This study examined how U.S. high school students obtain e-cigarettes and how source access pathways are associated with frequency of vaping behavior and cessation efforts. Methods: We conducted a cross-sectional analysis of data from the 2023 national Youth Risk Behavior Survey. Analyses focused on adolescents reporting ever and past 30-day e-cigarette use. Survey-weighted negative binomial modeling examined associations between access source and frequency of past 30-day use, while weighted logistic regression assessed associations with quit attempts in the past year. Nominal logistic regression evaluated demographic correlates of access pathways. Results: Among U.S. high school students, 13.9% reported past 30-day e-cigarette use, with social sources representing the most common access pathway (51.2%). However, adolescents obtaining e-cigarettes from retail/commercial sources reported the highest frequency of use ( M = 18.6 days/month), compared with social sources ( M = 13.0 days/month) or other sources ( M = 13.6 days/month). Access source was not significantly associated with quit attempts. Access pathways varied by sex and grade, but not race/ethnicity. Male and higher-grade students had higher odds of retail/commercial access, while earlier-grade students were more likely to rely on social sources. Conclusions: Although peer-mediated access remains predominant, retail access (e.g., through vape and tobacco shops) is strongly associated with heavier adolescent e-cigarette use. Comprehensive youth vaping prevention efforts should address both retail and social supply chains, with targeted enforcement, school-based prevention, and equity-focused strategies.

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