Examining the Association Between Perceived School Safety and Adolescent Electronic Cigarette Use in Washington State High School Students: 2023 Washington State Healthy Youth Survey

In the United States, adolescent substance use continues to be an important factor in negative health outcomes in adolescents. While previous research has established an association between school climate and adolescent use of alcohol, marijuana, and tobacco, minimal research has been conducted on the influences of school safety on adolescent electronic cigarette (e-cigarette) use in school settings. We assessed the association between perceived school safety and current e-cigarette use amongst 10th and 12th grade students in Washington State, and whether this association was different in migrant adolescents compared to other students. Methods: This study used cross-sectional data from the 2023 Healthy Youth Survey. The study sample included grade 10th and 12th adolescents. Survey-weighted Poisson regression models adjusting for race, ethnicity, sexual orientation, experienced bullying, and socioeconomic status were used to determine the association between perceived school safety and current e-cigarette use in the past 30 days. A second model was fit with an interaction term between school safety and adolescent migrant status to determine if there was a difference in burden between migrant adolescents and all other students. Results: 8,499 10th and 12th-grade students from the 2023 HYS were included in the analyses, with 9.0% reporting current e-cigarette use and 91.0% reporting no current e-cigarette use. The adjusted prevalence ratio of current e-cigarette use was 1.38 (95% CI: 1.18, 1.60) in students who perceived feeling unsafe at school compared to students who felt safe at school. When stratified by migrant status, the observed adjusted prevalence ratio for the association between feeling unsafe at school and current e-cigarette use in both migrant adolescents and non-migrant adolescents was 1.38 (p = 0.89). Conclusion: Feeling unsafe at school was associated with current e-cigarette use in the past 30 days. There was no significant difference in the prevalence of current e-cigarette use when stratified by migrant adolescent status. Future research in Washington state should determine what established factors of safety cause students to perceive feeling unsafe at school, and the influence this has on e-cigarette use in students. While there was no difference in observed adjusted prevalence ratios between migrant and non-migrant adolescents, migrant adolescents should still be considered a high-priority population due to their high-risk status from frequent mobility and discrimination faced in the school system.