E-cigarette use and concurrent risk behaviors among adolescents

•Adolescent who use e-cigarette had a higher likelihood of using other substances including cigarettes, smokeless tobacco, cigars, alcohol, and marijuana.•E-cigarette use is also a significant factor of participation in other risk behaviors among adolescents including sexual activity-, driving-, and violence-related risky behaviors.•Age and sex moderate the relationship between e-cigarette use and risk behaviors. Although electronic cigarette (e-cigarette) use is on the rise among adolescents, its relationship with risk behaviors is unclear. This study aimed to examine whether e-cigarette use was related to other risk behaviors and whether age and sex play a role in those associations. Data from the 2017 Youth Risk Behavior Surveillance System was used. Weighted logistic regression analysis was conducted to examine the relationships among variables of interest. The results showed that e-cigarette users, compared to nonusers, had higher odds of using other types of substances, as well as being involved in other risk behaviors including driving-related behaviors, sexual activity-related behaviors, and violence-related behaviors. Furthermore, some of these relationships are moderated by age and sex. Our findings suggest that e-cigarette use is linked to other risk behaviors among adolescents. Policy makers and educators should address multiple risk behaviors as part of comprehensive tobacco-free policies and youth substance use prevention programs.