Young Adult E-Cigarette Use Began Rise in 2017

Wei Bao, MD, PhD

Experts may have pinpointed the concise moment in time when the inflation of electronic cigarette use kicked off in the US.

E-cigarette use among young adults significantly increased between 2017 and 2018, according to new research which also showed a steady overall decrease in use from 2014-2017. The findings, which provide an age-stratified look into the contentious tobacco trend over the past half-decade, add to the growing public health concern circling the limited regulation of e-cigarette products from companies such as Juul.

A team of investigators from the University of Iowa College of Public Health, led by Wei Bao, MD, PhD, followed up a recent US Centers for Disease Control and Prevention (CDC) report showing a “startling rise” in e-cigarette use among middle school and high school students from 2017-2018.

“It is imperative to update the recent changes in e-cigarette use in adults to inform future research and policy,” Bao and colleagues wrote. “We updated data on adult e-cigarette use to include 2018 and examined the changes between 2017 and 2018.”

The team used data from the National Health Interview Survey (NHIS), which since 2014 has included a pair of questions pertaining to one-time or frequent e-cigarette use for adults aged 18 years and older.

Investigators used survey weights to account for unequal probability of selection and non-response, with linear regression models used to estimate prevalence difference between specific years.

Their data pool included 153,177 NHIS participants aged 18 years or older. A majority (n = 84,154 [54.9%]) were women. Weighted e-cigarette use decreased significantly from 2014-2017—from 3.7% (95% CI, 3.3 — 4.1), to 2.8% (95% CI, 2.5 – 3.1).

In the following year, however, it significantly increased to 3.2% (95% CI, 3.0 — 3.5). This increase was most prevalent in 18-24 year-olds, in which a percentage-point increase of 2.4 was observed (P = .002). In 2018, 7.6% (95% CI, 6.1 — 9.1) of young adults used e-cigarettes.

Men also reported a 1.0 percentage-point increase, and non-Hispanic Asian individuals reported a 1.3 increase (P = .03). Similar increases were observed among former conventional cigarette smokers, and individuals with a family income at least 4 times greater than the federal poverty level.

Bao and colleagues concluded their findings echoed the reported trends in high school and middle school students for the same time period. They also observed it the increasing trend coincides with the “sharp” change in e-cigarette marketing and sales.

“Juul sales have surged since its introduction in 2015, with the brand capturing the greatest market share by 2017,” they wrote. “With a discreet design and abundant types of flavors, Juul e-cigarettes are appealing to young people but also concerning because of their high nicotine content.”

In a recent DocTalk podcast interview with MD Magazine®, Albert Rizzo, MD, chief medical officer of the American Lung Association, theorized the common use of e-cigarettes by younger population is the misunderstanding the product is healthier and safer than conventional cigarettes.

“So, a lot of the tactics that the cigarette industry used for many years until they were regulated, are now being used by the e-cigarettes to attract youth to the e-cigarette,” Rizzo said. “And there's been studies showing that individuals who use an e-cigarette are more likely to go on to use a true regular cigarette.”

The Iowa-based investigators echoed Rizzo’s belief that e-cigarette use among young adults and adolescents has evolved into a larger issue of overall health in the US.

“These findings are of public health concern, because nicotine exposure can harm the developing brain, and e-cigarette use may lead to a transition to subsequent cigarette smoking,” they wrote.

The study, “Electronic Cigarette Use Among Young, Middle-Aged, and Older Adults in the United States in 2017 and 2018,” was published online as a research letter in JAMA Internal Medicine.