{
  "abstract": "Background\n\nThe dual use of traditional cigarettes and e-cigarettes is common among adolescents. Dual use is likely more harmful than smoking traditional cigarettes or using e-cigarettes alone. However, few studies have explored the behavioral and psychological factors associated with this pattern of tobacco use among Chinese adolescents.Methods\n\nWe surveyed high school students in all 31 provincial-level administrative divisions (PLADs) in mainland China. Tobacco use was categorized as current dual use, exclusive traditional cigarette use, exclusive e-cigarette use, and non-use. We collected 11 behavioral and psychological variables potentially associated with current tobacco use, including physical activity, screen time, sleep duration, diet, alcohol use, fighting, social self-control, self-esteem, self-efficacy, stress, and depression. Multinomial logistic regression adjusted for PLAD fixed effects was employed to analyze the associations.Results\n\nThe weighted sample included 15,000 students with an equal distribution of sex and a median age of 17 years (IQR: 16-18). About 6.9% (95% confidence interval: 6.5%-7.3%) reported current dual use. Several behavioral and psychological factors, including excessive screen time (OR = 0.70, 95% CI = 0.61-0.80; appropriate screen time as the reference group), unhealthy dietary habits (OR = 1.34, 95% CI = 1.15-1.56; healthy diet as the reference group), alcohol use (occasional: OR = 5.53, 95% CI = 4.27-7.17; habitual: OR = 12.71, 95% CI = 9.24-17.47; never use as the reference group), fighting (occasionally: OR = 1.69, 95% CI = 1.41-2.03; habitual: OR = 1.83, 95% CI = 1.18-2.82; never fight as the reference group), strong social self-control (OR = 0.69, 95% CI = 0.57-0.82; moderate as the reference group), strong self-esteem (OR = 1.62, 95% CI = 1.36-1.94; moderate as the reference group), self-efficacy (strong: OR = 1.61, 95% CI = 1.38-1.88; weak: OR = 0.78, 95% CI = 0.62-0.97; moderate as the reference group), and strong stress (OR = 0.78, 95% CI = 0.64-0.95; moderate as the reference group), were found to be associated with the current dual use. Some of the above factors were also associated with the current exclusive use of traditional cigarettes or e-cigarettes.Conclusions\n\nThis study reports on the phenomenon of current dual use and its behavioral and psychological associated factors among high school students in China. Families and schools should pay attention to adolescents' health risk behaviors and psychological health, as these factors were found to be associated with tobacco use.Clinical trial number\n\nNot applicable.",
  "abstract_shown": true,
  "affiliations": [
    "State Key Laboratory of Common Mechanism Research for Major Diseases, Institute of Basic Medical Sciences & School of Basic Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.",
    "School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.",
    "School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. liqing@pumc.edu.cn.",
    "State Key Laboratory of Common Mechanism Research for Major Diseases, Institute of Basic Medical Sciences & School of Basic Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. yangjt@pumc.edu.cn."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Kaiyuan Min"
    },
    {
      "affs": [
        1
      ],
      "name": "Runping Ma"
    },
    {
      "affs": [
        1
      ],
      "name": "Lewen Fu"
    },
    {
      "affs": [
        1
      ],
      "name": "Ziyan Meng"
    },
    {
      "affs": [
        2
      ],
      "name": "Qing Li"
    },
    {
      "affs": [
        3
      ],
      "name": "Juntao Yang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c4kezwaas3ec0.bib",
  "cited_by": 0,
  "doi": "10.1186/s13690-026-02032-9",
  "fulltext_url": "https://europepmc.org/articles/PMC13721673",
  "id": "c4kezwaas3ec0",
  "issns": [
    "0778-7367",
    "2049-3258"
  ],
  "landing_url": "https://europepmc.org/article/MED/42963804",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2737|Smoking Behavior and Cessation"
    ]
  ],
  "openalex": "W7172446709",
  "pdf_url": "https://europepmc.org/articles/PMC13721673?pdf=render",
  "pmcid": "PMC13721673",
  "pmid": "42963804",
  "published": "2026-08-04",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/c4kezwaas3ec0.ris",
  "sources": [
    {
      "first_seen": "2026-11-02T03:21:43Z",
      "native_id": "MED:42963804",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42963804"
    },
    {
      "first_seen": "2026-11-03T12:22:19Z",
      "native_id": "PMC13721673",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s13690-026-02032-9"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Smoking Behavior and Cessation",
      "subfield": "physiology"
    }
  ],
  "title": "The dual use of traditional cigarettes and e-cigarettes and behavioral and psychological associated factors among Chinese adolescents.",
  "title_text": "The dual use of traditional cigarettes and e-cigarettes and behavioral and psychological associated factors among Chinese adolescents.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:22:19Z",
  "url": "https://research.draconitic.com/paper/c4kezwaas3ec0",
  "venue": "Archives of public health = Archives belges de sante publique",
  "versions": []
}