Objectives: Adolescent e‑cigarette use is a growing public health concern, yet the influence of family context and risk perceptions on usage patterns remains poorly understood. Material and Methods: This cross-sectional study investigated relationships between family context, risk perceptions, and e‑cigarette use patterns among a nationally representative sample of 4797 Polish adolescents aged 15–18 years who were current e‑cigarette users (defined as use in the past 30 days). Using computer-assisted web interviews, the authors assessed family factors (parental awareness, attitudes, and nicotine use), risk perceptions, and e‑cigarette use behaviors. Results: Among adolescent e‑cigarette users, 92.6% engaged in poly-nicotine use (i.e., used ≥1 other nicotine product) with only 7.4% reporting exclusive e‑cigarette use. Notably, 46.7% of participants reported extensive multiple product use (concurrent use of ≥5 products). Structural equation modeling demonstrated that family context significantly influenced e‑cigarette use patterns, both directly (β = 0.31, p < 0.001) and indirectly through risk perceptions (β = 0.12). Risk perception emerged as the strongest direct predictor of e‑cigarette use patterns (β = 0.41, p < 0.001). Parental e‑cigarette use was associated with a 70% increase in adolescents’ likelihood of intensive e‑cigarette use (≥10 times daily) (OR = 1.70, 95% CI: 1.39–2.07, p < 0.001). Traditional cigarette initiation (compared to e‑cigarette initiation) was associated with almost twice the likelihood of multiple nicotine product use (OR = 1.89, 95% CI: 1.67–2.13, p < 0.001). Conclusions: These findings highlight the significant influence of family context and risk perceptions on adolescent nicotine use behaviors, suggesting that family-based interventions addressing these factors could be effective prevention strategies. Int J Occup Med Environ Health. 2025;38(5)