Date of Award

Summer 8-11-2020

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Monica Swahn, PhD, MPH

Second Advisor

Dr. Rachel Culbreth, PhD, MPH, RRT



Young adults have high rates of alcohol and tobacco use relative to any other age group. However, levels of use vary by race and education. This study aimed to examine the association between alcohol use and Electronic Nicotine Devices (ENDS) in a representative sample of young adults and to determine if any associations vary by race or education.


Data utilized in this study originated from the 2015-2016 National Health and Nutrition Examination Survey (NHANES). Records were restricted to those aged 18–35 years (n = 1145), with the primary outcome, ENDS use in the past 12 months. Multivariable logistic regression was performed to assess the association between the primary outcome, and alcohol use and socio-demographic variables. Further assessment was completed to determine if the association between the primary outcome and alcohol use while controlling for cigarette use varied by race or educational level.


The overall prevalence of ever ENDS use was 38.29%. Prevalence was highest among young adults 26-30 (31.01%), those reporting heavy alcohol use (44.93%), Non-Hispanic Whites (58.53%), those with some college or Associate of Arts degree (34.04%) and income range of $25,000 to $54,999 (35.59%). Traditional cigarette use (aOR=12.62; 95% CI 12.60 - 12.64), Income $25,000 to $54,999 (aOR=1.60; 95% CI 1.59 – 1.60), higher collegiate education (aOR=0.41; 95% CI 0.41 – 0.41), moderate and high alcohol use (aOR=1.76; 95% CI 1.76 – 1.77, aOR=1.89; 95% CI 1.88 – 1.89 respectfully) was associated with ENDS. The association between alcohol usage level and ENDS use also varied by education when adjusting for traditional cigarette use. The effect that alcohol usage has in predicting ENDS use is different for various education status when controlled for traditional cigarette use (p-vale: <0.0001).


ENDS use is common among young adults in the U.S. and is associated with socioeconomic status as well as alcohol use. Prevention efforts need to factor in these demographic characteristics when targeting interventions, and also factor in that moderate and heavy alcohol use are associated with ENDS use, which likely will exacerbate health concerns among ENDS users.


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