Objectives: The increasing prevalence of electronic cigarettes (e‑cigarette) use among adolescents has raised concerns about potential high‑risk behaviors, particularly the addition of psychoactive substances to e‑cigarette liquid (e‑liquids). This study examines the association between exposure to e‑cigarette marketing and the practice of adding psychoactive substances to e‑liquids among Polish teenagers. Material and Methods: A cross-sectional survey was conducted with 8,344 Polish teenagers aged 15 years and older. The study evaluated exposure to various e-cigarette marketing channels, the prevalence of psychoactive substances added to e-liquids and associated demographic and socioeconomic factors. Results: A cross‑sectional survey was conducted with 8344 Polish teenagers aged ≥15 years. The study evaluated exposure to various e‑cigarette marketing channels, the prevalence of psychoactive substances added to e‑liquids and associated demographic and socioeconomic factors. Conclusions: These findings elucidate the com‑ plex interplay between e‑cigarette marketing exposure, socioeconomic factors, and high‑risk e‑cigarette use among adolescents. The results underscore the necessity for more stringent regulation of e‑cigarette marketing and comprehensive, targeted prevention strategies focusing on urban and higher‑income youth populations. Int J Occup Med Environ Health. 2025;38(2)