A major youth electronic cigarette increase in use prevalence was seen in the early 2010s up to its 2019 peak, according to a new analysis, and the subsequent decline in use was not as sharp from 2021 - 2022 among youths who are Hispanic and non-Hispanic Black.¹

This new research was led by Delvon T. Mattingly, PhD, from the Center for Health Equity Transformation at the University of Kentucky, Lexington College of Medicine. Mattingly and colleagues noted that while prior data highlighted prevalence of youth e-cigarette use, new updates on trends in use with key socio-demographic data were necessary.²

“Electronic cigarettes (e-cigarettes) are the most used tobacco products among youths in the US1 and may facilitate progression into use of more harmful products, such as cigarettes, which are associated with premature morbidity and mortality,” Mattingly and colleagues wrote.

Background and Findings

The investigators implemented a cross-sectional study design, making use of publicly accessible and de-identified data. The research team drew their 2013 - 2022 data from the National Youth Tobacco Survey (NYTS), a survey conducted each year among American middle and high schoolers.

Over the course of a decade, the team found that 199,113 survey respondents had been recorded. Among these students, 186,555 were found to have complete information each year on age, use of e-cigarettes, sex, race, and ethnicity.

The NYTS did, however, have slight delivery mode adjustment for the survey beginning in 2021, due to the COVID-19 pandemic. The survey was switched to an online format, thereby helping students included as respondents to continue taking part from any location.

The investigators did urge caution among readers comparing estimates from 2021 - 2022 with those of other years, given the potential for introduction of information bias. To address this, the trends they looked into were evaluated separately for the periods 2013 - 2020 and 2021 - 2022.

Although the 2021 and 2022 surveys given out by the team were still held online, they found that methodological disparities restricted any direct comparisons. The research team had noted that there had not been any conclusions on e-cigarette behavior between 2020 - 2021.

The team defined use as having smoked using these devices within the past 30 days, and used this as their assessment. They looked at sociodemographic information such as age, race, sex, and ethnicity, having participants self-report and categorize based upon the NYTS investigators' parameters.

The investigators also looked into the weighted prevalence rates of e-cigarette smoking, both overall and then stratified by sex, age, and race and ethnicity. They looked at shifts that took place over time and assessed overlaps of confidence intervals (2-sided; significance level of .05).

Overall, the research team found that 44.82% of the respondents were aged 13-15 years and 50.65% were male. The team also reported that 51.75% were identified as non-Hispanic White, 12.68% as non-Hispanic Black, 24.44% as Hispanic, and 5.68% were categorized as other races or ethnicities.

When looking at use trends among smokers, the investigators noted that 3.10% reported use in 2013 and the peak of use was shown to be 20.18% in 2019. Stability in use was seen from 2021 - 2022, with rates of 7.50% and 9.44% among respondents, respectively.

The research team noted higher e-cigarette prevalence rates among older youths aged 16 - 18, with their peak being 30.01% in 2019 and stability trends from 2021 - 2022 also being observed. Trends in smoking with e-cigarettes were not particularly distinct in terms of sex differences until 2015 when males overtook females (13.23% versus 9.28%, respectively), though by 2019 prevalence became fairly equal between both sexes.

Hispanic, non-Hispanic White, and non-Hispanic multiracial respondents generally were shown by the team to have used e-cigarette more from 2013 - 2020 compared to non-Hispanic Black respondents. In 2019, there were significant differences, with Hispanic (18.64%) and non-Hispanic White (23.37%) respondents reporting greater use compared to non-Hispanic Black individuals (13.32%).

However, alarming prevalence trends were then observed from 2021 - 2022, with use rising among Hispanic (5.78%-8.51%) and non-Hispanic Black (4.23%-8.04%) respondents.

“Overall, these findings update the literature on youth e-cigarette use trends in the US and complement previous research detailing disparities in e-cigarette use by providing a temporal component,” they wrote. “Future research will benefit from examining trends using additional measures of e-cigarette use, such as frequency and flavorings.”

References

1. ^{Mattingly DT, Hart JL. Trends in Current Electronic Cigarette Use Among Youths by Age, Sex, and Race and Ethnicity. JAMA Netw Open. 2024;7(2):e2354872. doi:10.1001/jamanetworkopen.2023.54872.}
2. ^{Meza R, Jimenez-Mendoza E, Levy DT. Trends in tobacco use among adolescents by grade, sex, and race, 1991-2019. JAMA Netw Open. 2020;3(12):e2027465. doi:10.1001/jamanetworkopen.2020.27465.}