Concurrent Use of E-Cigarette, Alcohol, and Marijuana in Adolescents: An Ecological Approach to Assess Family, School, and Community Risk Factors

Background The use of e-cigarettes, alcohol, and marijuana is highly prevalent among US adolescents, with concurrent use of these substances as a growing public health concern. Despite this trend, contextual and environmental factors contributing to concurrent substance use remain understudied.Purpose This study examined family, school, and community factors associated with adolescents’ concurrent use of e-cigarettes, alcohol, and marijuana.Methods Data collected in 2023 from a national sample (N = 18,149) were analyzed using multinomial logistic regression models.Results About 7.0% of adolescents reported past-month concurrent use of all three substances. Multiple factors across family, school, and community contexts were significantly associated with higher odds of concurrent use, including parental physical abuse (aOR = 5.67, 95% CI = 3.80–8.46), exposure to domestic violence (aOR = 9.96, 95% CI = 5.78–17.18), parental substance abuse (aOR = 4.11, 95% CI = 3.00–5.63), perceived racism at school (aOR = 2.31, 95% CI = 1.84–2.90), unfair school discipline (aOR = 2.89, 95% CI = 2.23–3.75), and exposure to community violence (aOR = 4.35, 95% CI = 3.43–5.53).Discussion Concurrent substance use is common among adolescents and influenced by multilevel contextual factors.Translation to Health Education Practice Findings may assist Health Educators to develop comprehensive interventions that address family, school, and community risk factors to reduce adolescents’ concurrent substance use.