Exploring the Relationship Between Racial Bullying Victimization and Adolescent E-cigarette Use in California

INTRODUCTION: Higher prevalence of adolescent e-cigarette use among racially marginalized communities remains an issue in the United States. Experiences of racial bullying victimization may contribute to increased vulnerability to e-cigarette use and initiation. Although previous studies have looked at bullying and traditional tobacco products, fewer studies have examined the relationship between bullying and e-cigarette use, especially within racial and ethnic groups. METHODS: We used data from the 2021-2022 California Healthy Kids Survey, a survey of 7th, 9th, and 11th-grade public school adolescents (ages 12-17) in California. Lifetime and current e-cigarette use were self-reported outcomes. Racial bullying victimization was assessed by self-report of harassment or bullying due to race or ethnicity. We used multivariable logistic regressions stratified by race and ethnicity to examine associations between racial bullying victimization and e-cigarette use, controlling for grade, gender identity, parental education, and clustering within schools. RESULTS: Across all races and ethnic groups in the full analytic sample, adolescents had higher odds of lifetime and current e-cigarette use when exposed to racial bullying. Elevated odds were most pronounced among Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native, and Asian adolescents, though confidence intervals overlapped with non-Hispanic White adolescents. Non-Hispanic White and Hispanic adolescents exhibited lower but still increased odds. CONCLUSION: Racial bullying victimization is consistently associated with increased likelihood of adolescent e-cigarette use across racial and ethnic groups. These findings highlight the potential importance of addressing race-based bullying to reduce disparities in adolescent e-cigarette use.