E-cigarette use among US youths climbs, with pandemic years showing slight decline

An article published in JAMA Network Open provides the current prevalence of electronic cigarette (e-cigarette) usage among youths in the United States.

Study: Trends in Current Electronic Cigarette Use Among Youths by Age, Sex, and Race and Ethnicity. Image Credit: Dmytro Tyshchenko / Shutterstock

Background

E-cigarettes, also known as vapes, were originally invented by a Chinese pharmacist in 2003 and are battery-operated nicotine-delivery devices that produce aerosols by heating a liquid mainly containing nicotine or other tobacco products. Users inhale the aerosol to experience a physical sensation and flavor similar to that of inhaled tobacco smoke.

E-cigarettes were initially introduced in the market as a substitute for conventional combustible cigarettes that have more harmful health effects. The aim was to help adult smokers quit their smoking habits. However, several scientific studies have pointed out the adverse health effects of e-cigarettes among users, especially adolescents, young adults, pregnant women, and non-smokers.

In the United States, e-cigarettes are the most commonly used tobacco products among youths. There is a growing concern that habits of e-cigarette use can potentially trigger addiction to more harmful products, such as conventional cigarettes, which are associated with premature morbidity and mortality.

In this study, scientists have evaluated the current trends in e-cigarette use among US youths stratified by key sociodemographic characteristics.     

Study design

The scientists used data from the National Youth Tobacco Survey (NYTS) over a period of ten years (2013 – 2022). NYTS is an annual, repeated cross-sectional survey of US middle- and high-school students. In the current study, a total of 186,555 youths with complete information on e-cigarette use, age, sex, race, and ethnicity were included in the analysis.

The study analysis included self-reported age, sex, race, and ethnicity as sociodemographic characteristics. Current e-cigarette use was defined as past 30-day use. The scientists calculated overall as well as sociodemographic characteristics, stratified the prevalence of e-cigarette use, and assessed the changes in prevalence over time (2013 – 2022).

Important observations

According to the study estimates, the overall prevalence of e-cigarette use was 3.1% in 2013, which increased to 20.1% in 2019. During the period of the coronavirus disease 2019 (COVID-19) pandemic, the prevalence was 7.5% and 9.4% in 2021 and 2022, respectively.

A consistently higher prevalence was observed among older youths compared to that among younger youths. The highest prevalence (30%) among older youths was observed in 2019, which remained stable between 2021 and 2022.

Males showed a slightly higher prevalence of e-cigarette use than females until 2015. In 2019, the prevalence was almost the same between males and females. During the pandemic years, females showed a slightly higher prevalence than males.

Hispanic, non-Hispanic white and non-Hispanic multiracial youths showed a higher prevalence of e-cigarette use between 2013 and 2020 compared to non-Hispanic Black youths. Specifically, the prevalence was higher among Hispanic and non-Hispanic whites in 2019 compared to that among non-Hispanic Black youths. During the pandemic years, the prevalence increased among Hispanic and non-Hispanic Black youths.  

Study significance

The study finds a significant increase in the prevalence of e-cigarette use among US youths between 2013 and 2019. Although a reduction in use has been observed during the pandemic years, the prevalence remains at a concerning level.

Because of the COVID-19 pandemic-related restrictions, the scientists could not examine the trends in e-cigarette use between 2020 and 2021. This is one of the limitations of the study. Another limitation is the inclusion of self-reported information on e-cigarette use and sociodemographic characteristics, which could potentially suffer from recall bias.

Overall, the study provides temporal e-cigarette use trends by age, sex, race, and ethnicity and identifies high-use subgroups that require tobacco prevention support systems. As mentioned by the scientists, future studies estimating the prevalence of e-cigarette use should consider additional measures, such as frequency of use and choice of flavoring agents, for a more comprehensive understanding.