Patterns and Correlates of Disposable E-Cigarette Use Among US Youth

Introduction: While research has documented the rapid rise in youth disposable e-cigarette use, understanding of the distinct characteristics and behaviors of youth who use these devices remains limited.Methods: This cross-sectional study analysed data from the 2023 National Youth Tobacco Survey, a nationally representative survey of U.S. students grades 6-12 (N=22,069).Analyses were conducted in 2025.Participants were classified into six mutually exclusive groups based on their current tobacco product use: predominantly disposable e-cigarettes and no cigarettes, predominantly non-disposable e-cigarettes and no cigarettes, cigarettes only, concurrent use of cigarettes with disposable e-cigarettes, concurrent use of cigarettes with non-disposable ecigarettes, or no use.Measures included e-cigarette use patterns, nicotine dependence indicators, exposure to e-cigarette content on social media, social norms, and psychological distress.Weighted analyses and multinomial logistic regression were performed.Results: Youth who predominantly used disposable e-cigarettes reported significantly higher rates of nicotine-containing product use (81.9% vs 49.6%) and fruit flavour preference compared to those who use non-disposable e-cigarettes.Those who predominantly used disposable e-cigarettes without cigarettes reported fewer smoking peers but similar numbers of e-cigarette-using peers compared to those who use cigarettes and e-cigarettes concurrently.'Getting high from nicotine' was more commonly reported than flavour availability as a motivation across all e-cigarette use groups.Relative to non-use, predominant disposable ecigarette use without cigarettes was significantly associated with daily social media exposure (Relative Risk Ratio [RRR]=2.1),peer e-cigarette use (RRR=1.2),home e-cigarette exposure (RRR=1.2),and severe psychological distress (RRR=2.3).Concurrent use of cigarettes and ecigarettes showed the strongest associations with dependence indicators and social exposure across multiple domains.Conclusions: Youth who predominantly used disposable e-cigarettes were characterised by nicotine-seeking behaviour and social media influence, while those who concurrently used cigarettes and disposable e-cigarettes showed elevated risk indicators across multiple domains.Prevention strategies should be differentiated to address the specific risk profiles of groups with different use patterns.