Physical activity and tobacco use among high school students in the United States, 2015-2021.

Abstract

The relationship between physical activity and tobacco use among adolescents remains unclear. We examined this relationship using nationally representative data from the United States (U.S.). We pooled four years of cross-sectional data from the Youth Risk Behavior Surveillance System (2015-2021). Participants were high school students (n = 49,857) in the U.S. Multivariate logistic regression models examined the association between measures of self-reported days of 60+ minutes of physical activity per week (0-7) and past 30-day use of combustible cigarette, e-cigarette, cigar, and smokeless tobacco. We modeled interactions by sex. Covariates included sex, race/ethnicity, grade, other tobacco use, and survey year. Supplemental analyses examined the association between sports participation and tobacco use. An increase in the number of days of physical activity corresponded with lower odds of cigarette smoking (aOR: 0.93; 95 % CI: 0.90 - 0.95) but greater odds of using e-cigarettes (aOR 1.05; 95 % CI: 1.03-1.06) and smokeless tobacco (aOR: 1.07; 95 % CI: 1.04-1.11). There was no association between days of physical activity and cigar smoking. The association between physical activity and e-cigarette use differed by sex (p < 0.001), with the association observed among males (aOR 1.07; 95 % CI: 1.05-1.10) but not females (aOR 1.02; 95 % CI: 0.99-1.04). Sports participation had similar associations. Findings indicate that physically active youth are using non-combustible products at an alarming rate. Findings suggest the need for intervention to reduce e-cigarette and smokeless tobacco use among youth.