E-cigarette use among college students is rising, intersecting the realms of substance use prevention and mental health support. A recent study sheds light on this issue, offering valuable insights that could shape future interventions and the road to new research.

The study revealed that sole e-cigarette use is rare among college students. Instead, nearly all college students who use e-cigarettes (95%) also use other substances. The substances most often reported were marijuana, alcohol and tobacco. When evaluating multiple substance use, approximately 6 out of every 10 college students reported using marijuana, which was unexpectedly more frequent than the 4 of every 10 who reported using tobacco. The use of marijuana among college students more than doubled between 2017 and 2019. These findings point out the ever-growing popularity of marijuana among college students and highlights the need for interventions addressing multiple substances rather than e-cigarettes alone.

Understanding the motivations behind multiple substance use and its health impacts is crucial for developing effective prevention strategies. The researchers also found that while psychological distress alone was not linked to sole e-cigarette use, both psychological distress and recent mental health treatment were positively associated with using e-cigarettes alongside other substances. This aligns with the increasing evidence connecting e-cigarette use with mental health issues, emphasizing the need for integrated care that addresses both mental health and substance use. Further research into the physiological effects and the number and amount of harmful substances in mixed use (e.g., e-cigarettes with alcohol or tobacco) can inform more targeted interventions.

The researchers also discovered that certain demographic groups showed distinct patterns in e-cigarette use. Males were more likely to use e-cigarettes, both alone and with other substances, compared to females. Additionally, racial and ethnic minority students had lower odds of e-cigarette use versus no substance use, possibly reflecting later substance use initiation in these groups. Interestingly, bisexual students, particularly bisexual women, showed higher e-cigarette use, when compared to both heterosexual and other sexual minority groups, indicating a need for culturally appropriate interventions tailored to this group.

This study underscored the complexity of e-cigarette use among college students, highlighting the need for comprehensive, multifaceted approaches. By addressing both substance use and mental health and tailoring strategies to specific demographic groups, we can better support college students in reducing substance use and improving their overall well-being. Campus-wide policies, such as bans on tobacco and vaping products and restrictions on alcohol outlet density, could be effective in reducing substance use among college students. Despite recommendations, fewer than 40% of campuses have adopted e-cigarette-free policies, indicating significant room for policy action. Moreover, existing evidence-based interventions for alcohol could be adapted to address e-cigarette, marijuana, and other substance use among college students.


Kava, C.M., Watkins, S., Gilbert, P., Villhauer, T., Afifi, R. (2024). E-cigarettes in college: Associations between mental health and e-cigarette use with other substances. Tobacco Prevention & Cessation, 10(May), 24. https://doi.org/10.18332/tpc/188712