From Adversity to Vaping: Differential Effects of ACE Subtypes on Adolescent Electronic Vapor Product Use

Background and Objectives: Electronic vapor product (EVP) use has emerged as the most prevalent form of nicotine consumption among adolescents in the United States, raising significant concerns for long-term health and addiction trajectories. While adverse childhood experiences (ACEs) are consistently linked to substance use, much of the literature has focused on cumulative ACE exposure, potentially obscuring the unique contributions of specific adversity types. Moreover, limited research has simultaneously considered psychosocial stressors and protective factors, such as parental monitoring, in shaping adolescent vaping behaviors. This study examined the association between specific ACE subtypes and current EVP use among U.S. adolescents, while accounting for co-occurring psychosocial stressors and parental monitoring.

Methods: Data were drawn from the 2023 Youth Risk Behavior Survey (YRBS), a nationally representative, school-based survey of U.S. high school students. The analytic sample included 19,928 adolescents aged 14–18 years. Current EVP use (past 30 days) was assessed as a binary outcome. Nine ACE subtypes—including interpersonal, household, and community-level adversities—were examined alongside psychosocial stressors (bullying, cyberbullying, and persistent sadness or hopelessness) and parental monitoring. Multivariable logistic regression models were estimated using survey weights to account for the complex sampling design. Adjusted odds ratios (AORs) with 95% confidence intervals were reported.

Results: Overall, 18.0% of adolescents reported current EVP use, indicating that nearly one in five youth engage in vaping. In fully adjusted models, several ACE subtypes were independently associated with higher odds of EVP use. Emotional abuse (AOR = 1.41, 95% CI: 1.13–1.77), sexual abuse (AOR = 1.48, 95% CI: 1.18–1.84), household substance use (AOR = 1.42, 95% CI: 1.14–1.77), household incarceration (AOR = 1.41, 95% CI: 1.08–1.85), and exposure to neighborhood violence (AOR = 1.66, 95% CI: 1.35–2.03) were all significantly associated with increased likelihood of vaping. These findings highlight the importance of both interpersonal and structural forms of adversity. Psychosocial stressors were also significant correlates: cyberbullying (AOR = 1.61, 95% CI: 1.24–2.09) and persistent sadness or hopelessness (AOR = 2.10, 95% CI: 1.79–2.47) were associated with substantially higher odds of EVP use, with emotional distress emerging as one of the strongest predictors. In contrast, high parental monitoring was associated with significantly lower odds of vaping (AOR = 0.57, 95% CI: 0.46–0.70), underscoring its protective role in adolescent health behaviors.

Conclusions: Findings indicate that specific ACE subtypes—particularly interpersonal abuse, household dysfunction, and neighborhood violence—are associated with adolescent EVP use, even after accounting for psychosocial stressors. For practice, social workers should screen for ACE subtypes, emotional distress, and vaping behaviors, while promoting protective factors such as parental monitoring. Integrated, trauma-informed approaches that address both mental health and substance use are essential. At the policy level, reducing community-level risks and supporting vulnerable families are important priorities.