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

Objective: 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.). Methods: 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. Results: 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. Conclusions: 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.