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Trends in Use and Perceptions of Nicotine Vaping Among US Youth From 2017 to 2020
Abstract
Importance
US adolescent nicotine vaping increased at a record pace from 2017 to 2019, prompting new national policies to reduce access to flavors of vaping products preferred by youth.
Objective
To estimate prevalence, perceived harm, and accessibility of nicotine vaping products among US adolescents from 2017 to 2020.
Design, Setting, and Participants
This survey study includes data from Monitoring the Future, which conducted annual, cross-sectional, school-based, nationally representative surveys from 2017 to 2020 of 10th- and 12th-grade students (results pooled grades, n = 94 320) about vaping and other topics.
Main Outcomes and Measures
Prevalence of self-reported nicotine vaping; vaping brand and flavor used most often; perceived risk of nicotine vaping; and perceived ease of getting vaping devices, nicotine solutions for vaping, and flavored solutions.
Results
In 2020, Monitoring the Future surveyed 8660 students in 10th and 12th grade, of whom 50.6% (95% CI, 47%-54%) were female, 13% (95% CI, 8%-21%) were non-Hispanic Black, 29% (95% CI, 21%-40%) were Hispanic, and 53% (95% CI, 42%-63%) were non-Hispanic White. Nicotine vaping prevalence in 2020 was 22% (95% CI, 19%-25%) for past 30-day use, 32% (95% CI, 28%-37%) for past 12-month use, and 41% (95% CI, 37%-46%) for lifetime use; these levels did not significantly change from 2019. Daily nicotine vaping (use on ≥20 days of the last 30 days) significantly declined from 9% (95% CI, 8%-10%) to 7% (95% CI, 6%-9%) over 2019 to 2020. JUUL brand prevalence in the past 30 days decreased from 20% (95% CI, 18%-22%) in 2019 to 13% (95% CI, 11%-15%) in 2020, while use of other brands increased. Among youth who vaped in the past 30 days in 2020, the most often used flavor was fruit at 59% (95% CI, 55%-63%), followed by mint at 27% (95% CI, 24%-30%) and menthol at 7% (95% CI, 5%-9%); significantly fewer reported easy access to vaping devices and nicotine solutions compared with 2019; and 80% (95% CI, 75%-84%) reported they could easily get a vaping flavor other than tobacco or menthol. Among all youth, perceived risk of both occasional and regular nicotine vaping increased from 2019 to 2020.
Conclusions and Relevance
Increasing US adolescent nicotine vaping trends from 2017 to 2019 halted in 2020, including a decline in daily vaping. Decreases in perceived accessibility of some vaping products, as well as increases in perceived risk of nicotine vaping, occurred from 2019 to 2020. Yet, adolescent nicotine vaping remains highly prevalent, flavors remain highly accessible, and declines in JUUL use were countered by increased use of other brands.
... Vaping may also be associated with respiratory and cardiovascular health risks (Treur et al., 2015). Recent federal, state, and local policies in the United States, including restrictions on flavored vapes popular among youth (Oriakhi, 2020;Wang et al., 2020;Miech et al., 2021) and an increase in the minimum age to purchase all tobacco products to 21 years (T21) (Park-Lee et al., 2021), may have affected youth and young adult vapingrelated perceptions and behaviors. In addition, the outbreak of e-cigarette or vaping-related lung illness (EVALI) that occurred primarily in the United States in 2019 and the onset of the COVID-19 pandemic in 2020 may have affected vaping (U.S. Food and Drug Administration, 2019; Kreslake et al., 2022). ...
... Continued youth and young adult vaping amid these regulatory and environmental changes underscores the need for detailed information about vaping-related beliefs and behaviors. Recent studies have documented vaping frequency; nicotine content, flavors, and brands of vapes used; types of vapes used; beliefs about vapes; perceived addiction; and desire to quit vaping and quit attempts among youth (Cai et al., 2021;Miech et al., 2021;Camara-Medeiros et al., 2021;Wang et al., 2021). Our study adds to the literature by including more detailed information on dependence, harm perceptions, and cessation-related outcomes among youth and young adults, which could inform interventions designed to address vaping. ...
... With this study, we sought to present new information on dependence, harm perceptions, and cessation among underaged vapers in New York State. We found high reported use of disposable vaping products, use of flavored vaping products, and use of vaping products with high nicotine concentrations, consistent with prior studies (Dai, 2021;Miech et al., 2021). We also found young adult vapers aged 18 to 20 years reported similar product type, flavor, and nicotine concentration use as vapers aged 15 to 17 years. ...
... Given the significant genetic correlations between CanUD, tobacco smoking, and Scz, the increasing pace of cannabis legalization with emerging increases in CanUD incidence [25], parallel increases in the popularity of nicotine vaping [26], and the consequent potential impact on the course of Scz in those with heavy cannabis and tobacco use [27][28][29][30][31], we investigated the evidence for causal relationships and horizontal pleiotropy between CanUD, tobacco smoking, and Scz. We used the largest genome-wide summary statistics available for Scz [32] (European ancestry N = 161,405; African ancestry N = 15,846), CanUD [17] (European ancestry N = 886,025; African ancestry N = 120,208), and ever-regularly smoking tobacco [33] (Smk; European ancestry N = 805,431; African ancestry N = 24,278) in samples whose genetic ancestry is most similar to those historically from Europe (henceforth referred to as "European ancestry") and samples whose genetic ancestry is most similar to those historically from Africa (henceforth referred to as "African ancestry"). ...
... We demonstrate that the relationship between Smk, CanUD, and Scz may be due to both correlated genetic and reciprocal causal effects. While cigarette use is generally decreasing [84], nicotine exposure through vaping is increasing [26,85] and cannabis legalization and use are becoming more widespread worldwide [86]. As substance use policies and modes of use continue to change, it is important to carefully monitor epidemiologic trends in mental health conditions, especially schizophrenia and other psychotic disorders, and consider targeted interventions that may benefit individuals with heavy cannabis and tobacco use. ...
Individuals with schizophrenia frequently experience co-occurring substance use, including tobacco smoking and heavy cannabis use, and substance use disorders. There is interest in understanding the extent to which these relationships are causal, and to what extent shared genetic factors play a role. We explored the relationships between schizophrenia (Scz; European ancestry N = 161,405; African ancestry N = 15,846), cannabis use disorder (CanUD; European ancestry N = 886,025; African ancestry N = 120,208), and ever-regular tobacco smoking (Smk; European ancestry N = 805,431; African ancestry N = 24,278) using the largest available genome-wide studies of these phenotypes in individuals of African and European ancestries. All three phenotypes were positively genetically correlated (r g s = 0.17–0.62). Genetic instrumental variable analyses suggested the presence of shared heritable factors, but evidence for bidirectional causal relationships was also found between all three phenotypes even after correcting for these shared genetic factors. We identified 327 pleiotropic loci with 439 lead SNPs in the European ancestry data, 150 of which were novel (i.e., not genome-wide significant in the original studies). Of these pleiotropic loci, 202 had lead variants which showed convergent effects (i.e., same direction of effect) on Scz, CanUD, and Smk. Genetic variants convergent across all three phenotypes showed strong genetic correlations with risk-taking, executive function, and several mental health conditions. Our results suggest that both shared genetic factors and causal mechanisms may play a role in the relationship between CanUD, Smk, and Scz, but longitudinal, prospective studies are needed to confirm a causal relationship.
... Most tobacco use begins during adolescence [3]. Whereas teen smoking has declined in the United States within the last decade, the use of electronic cigarettes (e-cigarettes) has escalated [4][5][6]. Clinical studies report that teens are sensitive to withdrawal from cigarette use, showing signs of dependence soon after initiation and before establishing daily use [7,8]. Teens can also become addicted to e-cigarettes with dependence correlating highly with salivary cotinine, a nicotine metabolite [6,9,10]. ...
... Given the recent substantial increase in e-cigarette use by teenagers [4][5][6], it is important to evaluate whether this mode of nicotine delivery produces similar levels of dependence to that of tobacco cigarettes. To date there have been no direct comparisons of the effect of tobacco smoke constituents. ...
The aim of the current study was to determine whether non-nicotine constituents of cigarette smoke contribute to nicotine dependence in adolescent and adult male Sprague Dawley rats. For 10 days animals were given three times daily intravenous injections of nicotine (1.5 mg/kg/day) or cigarette smoke extract (CSE) containing an equivalent dose of nicotine. Both spontaneous and mecamylamine-precipitated withdrawal were then measured. Chronic treatment with CSE induced significantly greater somatic and affective withdrawal signs than nicotine in both adolescents and adults. Mecamylamine-precipitated somatic signs were similar at both ages. In contrast, animals spontaneously withdrawn from chronic drug treatment exhibited significant age differences: whereas adolescents chronically treated with nicotine did not show somatic signs, those treated with CSE showed similar physical withdrawal to those of adults. Mecamylamine did not precipitate anxiety-like behavior at either age. However, both adolescents and adults showed significant anxiety in a light-dark box test 18 h after spontaneous withdrawal. Anxiety-like behavior was still evident in an open field test 1 month after termination of drug treatment, with adolescents showing significantly greater affective symptoms than adults. Our findings indicate that non-nicotine constituents of cigarette smoke do contribute to dependence in both adolescents and adults and emphasize the importance of including smoke constituents with nicotine in animal models of tobacco dependence.
... Given the significant genetic correlations between CanUD, tobacco smoking, and Scz, the increasing pace of cannabis legalization with emerging increases in CanUD incidence 25 , parallel increases in the popularity of nicotine vaping 26 , and the consequent potential impact on the course of Scz in those with heavy cannabis and tobacco use 27-31 , we investigated the evidence for causal relationships and horizontal pleiotropy between CanUD, tobacco smoking, and Scz. We used the largest genome-wide summary statistics available for Scz 32 (European ancestry N = 161,405; African ancestry N = 15,846), CanUD 17 (European ancestry N = 886,025; African ancestry N = 120,208), and ever-regularly smoking tobacco 33 (Smk; European ancestry N = 805,431; African ancestry N = 24,278) in samples whose genetic ancestry is most similar to those historically from Europe (henceforth referred to as "European ancestry") and samples whose genetic ancestry is most similar to those historically from Africa (henceforth referred to as "African ancestry") to identify and characterize pleiotropic signals and conduct causal inference analyses. ...
... Further, we identify executive functioning as a potential phenotype that links genetic liability for CanUD and Scz. While cigarette use is generally decreasing 68 , nicotine exposure through vaping is increasing 26,69 and cannabis legalization and use are becoming more widespread worldwide 70 . As substance use policies and modes of use continue to change, it is important to carefully monitor epidemiologic trends in mental health conditions, especially schizophrenia and other psychotic disorders, and consider targeted interventions that may benefit individuals with heavy cannabis and tobacco use. ...
Individuals with schizophrenia frequently experience co-occurring substance use, including tobacco smoking and heavy cannabis use, and substance use disorders. There is interest in understanding the extent to which these relationships are causal, and to what extent shared genetic factors play a role. We explored the relationships between schizophrenia (Scz), cannabis use disorder (CanUD), and ever-regular tobacco smoking (Smk) using the largest available genome-wide studies of these phenotypes in individuals of African and European ancestries. All three phenotypes were positively genetically correlated (rgs = 0.17 - 0.62). Causal inference analyses suggested the presence of horizontal pleiotropy, but evidence for bidirectional causal relationships was also found between all three phenotypes even after correcting for horizontal pleiotropy. We identified 439 pleiotropic loci in the European ancestry data, 150 of which were novel (i.e., not genome-wide significant in the original studies). Of these pleiotropic loci, 202 had lead variants which showed convergent effects (i.e., same direction of effect) on Scz, CanUD, and Smk. Genetic variants convergent across all three phenotypes showed strong genetic correlations with risk-taking, executive function, and several mental health conditions. Our results suggest that both horizontal pleiotropy and causal mechanisms may play a role in the relationship between CanUD, Smk, and Scz, but longitudinal, prospective studies are needed to confirm a causal relationship.
... When JUUL was popular with youth, the FDA issued an enforcement policy that significantly reduced the sales of flavored 4th generation pod/cartridge ECs 9 . However, disposable ECs, which were not covered by the enforcement policy, such as Puff Bar, rapidly gained popularity among young vapers 8,10 . In July of 2020, the FDA issued warning letters to 10 companies, including Puff Bar, to remove their flavored disposable EC products from the market 24 , prompting Puff to cease online sales and distribution in the US between July 2020 to January 2021 (Puffbar.com). ...
... Websites hosted by EC manufacturers were not included, as these were biased toward their products. Five websites were included, and each site had [8][9][10][11][12] ECs that fit the inclusion criteria. These sites were: https:// prova pe. ...
The design of popular disposable electronic cigarettes (ECs) was analyzed, and the concentrations of WS-23, a synthetic coolant, in EC fluids were determined for 22 devices from 4 different brands. All products contained WS-23 in concentrations that ranged from 1.0 to 40.1 mg/mL (mean = 21.4 ± 9.2 mg/mL). To determine the effects of WS-23 on human bronchial epithelium in isolation of other chemicals, we exposed EpiAirway 3-D microtissues to WS-23 at the air liquid interface (ALI) using a cloud chamber that generated aerosols without heating. Proteomics analysis of exposed tissues revealed that the cytoskeleton was a major target of WS-23. BEAS-2B cells were exposed to WS-23 in submerged culture to validate the main results from proteomics. F-actin, which was visualized with phalloidin, decreased concentration dependently in WS-23 treated BEAS-2B cells, and cells became immotile in concentrations above 1.5 mg/mL. Gap closure, which depends on both cell proliferation and migration, was inhibited by 0.45 mg/mL of WS-23. These data show that WS-23 is being added to popular EC fluids at concentrations that can impair processes dependent on the actin cytoskeleton and disturb homeostasis of the bronchial epithelium. The unregulated use of WS-23 in EC products may harm human health.
... An increasing trend in the prevalence of e-cigarette use in most countries we report is congruent with other HIC. 8,9,11,[26][27][28] During the previous decade, e-cigarette use among youth has increased manifold in Italy, the United States, Canada, and New Zealand. 6,7,10,27 However, more recent data for the United States and the United Kingdom reported no increase from the preceding years or there was a slight decline 11,28 perhaps an impact of reduced access to e-cigarettes by the implementation of sales restrictions and raising the minimum age for legal purchase. ...
... 8,9,11,[26][27][28] During the previous decade, e-cigarette use among youth has increased manifold in Italy, the United States, Canada, and New Zealand. 6,7,10,27 However, more recent data for the United States and the United Kingdom reported no increase from the preceding years or there was a slight decline 11,28 perhaps an impact of reduced access to e-cigarettes by the implementation of sales restrictions and raising the minimum age for legal purchase. 29 In most of the 10 countries, both "ever e-cigarette use" and "current e-cigarette use" had increased by two-fold (Romania, Georgia, Latvia, and San Marino) or three-fold (Italy, Paraguay, and Peru). ...
Introduction:
The increasing use of e-cigarettes among the youth is a public health problem that needs surveillance. We report changes in e-cigarette use, cigarette smoking, and 'dual use' among youth in 10 countries.
Methods:
Global Youth Tobacco Surveys from Georgia, Iraq, Italy, Latvia, Montenegro, Paraguay, Peru, Qatar, Romania, and San Marino were analyzed. Changes in prevalence of 'awareness of e-cigarettes', 'ever use' (even tried a few puffs) and 'current use' (during last 30 days) of e-cigarettes and cigarette smoking, and 'dual use' (both e-cigarette and cigarette smoking) between baseline (2013/2014) and most recent (2017-2019 ) surveys were estimated.
Results:
'Awareness of e-cigarettes' and 'ever e-cigarette use' significantly increased (p<0.001). 'Ever e-cigarette use' was highest in Italy, 93% (95%CI 90.9, 94.4). 'Current e-cigarette use' significantly (p<0.05) increased by >50% in most countries. During the most recent surveys, 'current e-cigarette' use was >10% in five countries Italy (18.3%) and Latvia (18.5%) being the highest. Cigarette smoking significantly declined in Italy, Latvia, Peru, and San Marino (p<0.05) but remains unchanged in other countries. 'Dual use' (both electronic and conventional cigarettes) significantly increased in all countries (p<0.001). During the most recent surveys 'dual use' was highest in Italy (10%, 95%CI 8.1, 12.2) and Latvia (8.6%, 95%CI 7.2, 10.2). Youth aged 14 and ≥ 15 years the smokers, were more likely to be e-cigarette users.
Conclusions:
Awareness and use of e-cigarettes and 'dual use' among youth have increased. Closer monitoring of tobacco use among youths and comprehensive tobacco control policies inclusive of e-cigarettes are needed.
Implications:
Secondary data analyses of serial Global Youth Tobacco Surveys in 10 countries showed that both awareness of e-cigarette and e-cigarette use has increased among school-going youth aged 13-15 years. A concurrent increase in 'dual use' of e-cigarettes and cigarette smoking during the last 30 days in all 10 countries indicates continued cigarette smoking in the absence of e-cigarettes due to the common risk construct of tobacco product use. Results call for continued surveillance of both e-cigarettes and cigarette smoking among school-going youth. Comprehensive tobacco control measures inclusive of e-cigarettes should be implemented to reduce tobacco use among the youth.
... Several issues remain unresolved with respect to SAM and overall patterns of alcohol and marijuana use, however, due to changing trends in other substances. The public health successes of reduced cigarette use have been partially offset by increases in nicotine use and nicotine use disorder among adolescents through vaping devices (Miech et al., 2021 since approximately 2015. Vaped nicotine use, like cigarette use, is associated with increased risk and frequency of subsequent alcohol and marijuana use (Evans-Polce et al., 2020;Park et al., 2020;Silveira et al., 2018). ...
... Thus, variation in trends examining SAM use, alcohol use without simultaneous marijuana use, and marijuana use without simultaneous alcohol use may exhibit heterogeneous trends by cigarette and vaped nicotine use. Overall, changes in more recent years when nicotine use has increased due to vaping (Miech et al., 2021), remain understudied. ...
Background:
Simultaneous alcohol and marijuana (SAM) use is associated with adverse consequences for youth. While SAM use is overall declining among youth, prior studies indicate increasing marijuana use among US adolescents who ever used cigarettes, suggesting possible moderation of the alcohol-marijuana relationship by cigarette use.
Methods:
We included 43,845 12-th grade students participating in Monitoring the Future data (2000-2020). A 5-level alcohol/marijuana measure was used, including past-year SAM, alcohol-only, marijuana-only, non-simultaneous alcohol and marijuana, or no use. Multinomial logistic regressions estimated associations between time periods (categorized based on sample size: 2000-2005, 2006-2009, 2010-2014, 2015-2020) and the 5-level alcohol/marijuana measure. Models adjusted for sex, race, parental education and survey mode and included interactions of time periods and lifetime cigarette or vaped nicotine use.
Results:
While overall SAM among 12th graders decreased from 23.65% to 18.31% between 2000 and 2020, SAM increased among students who never used cigarettes or vaped nicotine (from 5.42% to 7.03%). Among students who ever used cigarettes or vaped nicotine, SAM increased from 39.2% in 2000-2005-44.1% in 2010-2014 then declined to 37.8% in 2015-2020. Adjusted models controlling for demographics indicated that among students with no lifetime cigarette or vaped nicotine use, students in 2015-2020 had 1.40 (95% C.I. 1.15-1.71) times the odds of SAM, and 5.43 (95% C.I. 3.63-8.12) times the odds of marijuana-only (i.e., no alcohol use) compared to students who used neither in 2000-2005. Alcohol-only declined over time in both students who ever and never used cigarettes or nicotine vape products.
Conclusion:
Paradoxically, while SAM declined in the overall adolescent US population, the prevalence of SAM increased among students who have never smoked cigarettes or vaped nicotine. This effect arises because of a substantial decline in the prevalence of cigarette smoking; smoking is a risk factor for SAM, and fewer students smoke. Increases in vaping are offsetting these changes, however. Preventing adolescent use of cigarettes and nicotine vaped products could have extended benefits for other substance use, including SAM.
... On the other hand, caffeineinduced increase in emotional reactivity could trigger tobacco smoking. [27][28][29] Despite the worldwide reduction in tobacco consumption over the past decades, the rapid increase in use of electronic nicotine delivery systems (ENDS), particularly during adolescence, [30][31][32] has renewed the relevance of studies that investigate nicotine and caffeine interactions. ...
... 6 Adolescence is also when nicotine use typically begins and, despite the gradual decrease in consumption of combustible tobacco products, ENDS use among adolescents had a fast increase in the last few years. [30][31][32] Despite the well-established epidemiological association between caffeine and nicotine, 67,68 the underlying causes and neurobiological mechanisms are still poorly understood. Besides, most studies in animal models focus on a particular period of caffeine exposure (e.g. ...
Caffeine consumption occurs throughout life, while nicotine use typically begins during adolescence, the period when caffeine-nicotine epidemiological association begins in earnest. Despite that, few studies in animal models parallel the pattern of coexposure that occurs in humans. Therefore, the neurobehavioral consequences of the association between these drugs remain unclear. Here, we exposed Swiss mice to lifetime caffeine. Caffeine solutions of 0.1 g/L (CAF0.1), 0.3 g/L (CAF0.3), or water (CTRL) were used as the sole liquid source, being offered to progenitors until weaning and, after that, directly to the offspring until the last day of adolescent behavioral evaluation. The open field test was used to evaluate acute effects of nicotine, of lifetime caffeine and of their interaction on locomotion and anxiety-like behavior, while the conditioned place preference test was used to assess the impact of caffeine on nicotine (0.5 mg/Kg, i.p.) reward. Frontal cerebral cortex dopamine content, dopamine turnover, and norepinephrine levels, as well as hippocampal serotonin 1A receptor expression were assessed. CAF0.3 mice exhibited an increase in anxiety-like behavior when compared to CAF0.1 and CTRL ones, but nicotine coexposure mitigated the anxiogenic-like caffeine-induced effect. Distinctively, caffeine had no effect on locomotion and failed to interfere with both nicotine-induced hyperactivity and place preference. There were no significant effects on dopaminergic and serotonergic markers. In conclusion, although caffeine did not affect nicotine reward, considering the strong association between anxiety disorders and tobacco consumption, caffeine-induced anxiety-like behavior advises limiting its consumption during development, including adolescence, as caffeine could be a risk factor to nicotine use.
... Since their introduction, the use of electronic cigarettes, commonly referred to as e-cigarettes, has surged [5,6]. Within the United States, vaping has surpassed traditional cigarette smoking as the predominant form of tobacco consumption among adolescents and young adults [7]. ...
Introduction
E-cigarettes smoking is a global health concern due to its associated risks and unexpected rise in e-cigarette smoking among adults and nonsmokers. This study aims to investigate gender differences in e-cigarette knowledge, attitude, and practice among adults in Bahrain.
Methods
The data was collected using an online questionnaire covering demographics, knowledge, attitude, and practice. Data were analyzed using SPSS software, reporting mean and SD for continuous variables, frequencies, and percentages for categorical variables. A chi-square test was conducted to assess the association between variables and gender with a significance level of p < 0.05.
Results
A total of 555 participants completed the questionnaire, with the majority being females (66.8%), with a mean age of 31 (SD 8.5). Among respondents, 23.2% were smokers with a higher percentage of male smokers 58.7% compared to female smokers 5.7%. E-cigarette smoking was prevalent among 18% of participants, with 86% of them being male e-cigarette smokers compared to 14% of female e-cigarette smokers. The chi-square test showed that there was statistical significance between males and females when it comes to knowledge and attitudes toward e-cigarette smoking (p = 0.000). Males have inadequate knowledge and positive attitudes toward e-cigarette smoking compared to females. There was no statistical difference in the analysis of practice between both genders.
Conclusion
E-cigarette smoking is very prevalent among adults in Bahrain, especially among males. Educational interventions and robust laws and policies should be implemented to address this issue and contribute to improving community health.
... The U.S. Surgeon General declared youth e-cigarette use an epidemic, as current electronic cigarette (e-cigarette) use in the past 30 days among high school students more than doubled between 2017 (9.5%) and 2019 (22.5%). 1,2 Although use decreased to 14% in 2022, e-cigarettes are still the most used tobacco product among youth. 3 Among current e-cigarette users, 85% of high school students reported a preference for flavored e-cigarettes. ...
Introduction
Factors that impact flavored tobacco sales restriction (flavor restrictions) effectiveness on youth e-cigarette behavior are unclear. Tobacco retailer density (retailer density) is a health equity issue with greater retailer density in high-minority, low-income areas. We examined the association between flavor restrictions and youth e-cigarette behavior by retailer density across diverse communities in the California Bay Area.
Aims and Methods
We analyzed data from the California Healthy Kids Survey using a difference-in-differences (DID) strategy. We compared pre- and post-policy changes in e-cigarette access and use one-year post-implementation among high school students in the Bay Area with a flavor restriction (n = 20 832) versus without (n = 66 126). Separate analyses were conducted for students in cities with low and high retailer density, with a median cutoff of 3.3 tobacco retailers/square mile.
Results
Students with high retailer density were more likely to identify as a minority and have parents with lower education. Among students with low retailer density, flavor restrictions were associated with 24% lower odds in the pre- to post-policy increase in ease of access relative to unexposed students (DID = 0.76, 95% CI: 0.58, 0.99). Among students with high retailer density, flavor restrictions were associated with 26% higher odds in ease of access (DID: 1.26, 95% CI: 1.02, 1.56) and 57% higher odds of current use (DID = 1.57, 95% CI: 1.31, 1.87).
Conclusions
Flavor restrictions had positive impacts on youth e-cigarette access in low, but not high retailer density cities. From a health equity perspective, our results underscore how flavor restrictions may have uneven effects among vulnerable groups.
Implications
In diverse communities in the California Bay Area, our results suggest a protective association between flavored tobacco sales restrictions and youth access to e-cigarettes in low, but not high tobacco retailer density cities one-year post-implementation. These results underscore how flavor restrictions may have uneven effects, and when implemented in high retailer density areas, may disproportionately place already vulnerable groups at heightened exposure to e-cigarette use and access. In high retailer density areas, additional tobacco control efforts may need to be included with flavor restriction implementation, such as increased education, youth prevention and cessation programs, policies to reduce tobacco retailer density, or stronger tobacco retailer enforcement or compliance monitoring.
... Some have hypothesized that shifts in social network preferences to digital formats may underlie general declines in youth unsupervised social time (Twenge, 2020), yet it is incomplete; these shifts began prior to the widespread use of digital technology for engagement, and the association between digital technology in recent trends in youth behavior and mental health is generally of small magnitude (Ferguson et al., 2021;Orben, 2020). Further, declines in drug use are not universal; cannabis use prevalence has remained relatively invariant Patrick et al., 2020), and novel drug products such as e-cigarettes and vapes surged in prevalence in the late 2010s (Miech et al., 2021). (Carnevale & Rose, 2003;NCES, 2003), thus future orientations and academic pressure (Högberg, 2021) associated with college preparation may reduce the desire for social/recreational activities with alcohol involved due to concerns about academic performance and potential punitive consequences of underage drinking. ...
Background
Alcohol use is declining among US adolescents/early young adults and increasing among other adults, with increases in adult binge drinking more concentrated in females than males. Reasons for drinking are historically patterned by age and sex, and if historically variant, could suggest that changes over time could in part explain age‐ and sex‐differential cohort effects.
Methods
We analyzed longitudinal Monitoring the Future data for individuals born from 1958 to 1990. These individuals were aged 29/30 from 1987 to 2020, and first surveyed at age 18 from 1976 to 2008 (N = 14,190). Five reasons for drinking were analyzed (social, enhancement, avoid problems, relax, boredom). Drinking for social reasons and to relax were most prevalent. Total effects of birth cohort predicting past‐2‐week binge drinking were estimated with polynomial regression models by age; indirect effects through mediators were estimated.
Results
Drinking reasons exhibited dynamic time trends across birth cohort and sex. Notable increases were observed in social reasons: among women aged 29/30, social reasons increased from 53% to 87% from 1987 to 2020. Social reasons to drink had prominent positive indirect effects at adult ages (age 23/24 and above among men; age 19 and above among women), indicating that binge drinking would have increased less were it not for the increase in social reasons for drinking. Social reasons also mediated adult male/female differences, indicating that part of the reason sex differences are diminishing is the more rapid increases in social reasons for drinking among women. Indirect effects were also observed for drinking to relax and for boredom, and limited indirect effects were observed for enhancement and to avoid problems.
Conclusion
Changing endorsement of drinking reasons, especially social reasons, among US adult drinkers mediate cohort effects in binge drinking in the US adult population and explain in part why binge drinking is converging by sex.
... However, adolescent nicotine use has changed markedly since the time of this study. Nationally, nicotine vaping rose rapidly in the late 2010s (Miech et al., 2019(Miech et al., , 2021. On the other hand, post-pandemic prevalence for all types of nicotine use fell (Miech et al., 2023). ...
... One major factor that has contributed to a recent decline in e-cigarette use among US adolescents is an increase in perceived risk of e-cigarettes. 46 However, several studies have indicated that US adolescents still hold onto e-cigarette-related risk misperceptions, lack knowledge of e-cigarette devices, and consider e-cigarette products to be safe. 10,20,47,48 Recent studies have reported a positive association of e-cigarette harm perception with intention to quit and past-year quit attempts among youth/young Remained Stagnant (PC to PC and C/P to C/P), Progressed (PC to C/P, PC to A and C/P to A), Regressed (C/P to PC), where PC -Pre-contemplation, C/P-Contemplation/Preparation, and A -Action stages of changes for quitting e-cigarettes; CI: Confidence interval; Percentage (%) estimates calculated using sample weights, frequencies (n) based on unweighted data. ...
Purpose
To identify predictive factors associated with US adolescents’ transition through the stages of change for potentially quitting e-cigarettes using the Trans-theoretical model of behavior change.
Design
Prospective cohort study.
Setting
United States.
Subjects
We utilized data from adolescents (12-17 years) in Wave 3 of the Population Assessment of Tobacco and Health study who used e-cigarettes exclusively over the past 30 days (n = 177) and were followed up with in Wave 4.
Measures
Outcome variables were 3 transition categories: those who remained stagnant, those who progressed, and those who regressed in their stage of quitting e-cigarettes. Predictor variables were socio-demographics, e-cigarette harm perception, e-cigarette use at home or by important people, social norms, e-cigarette and anti-tobacco advertisements, and e-cigarette health warnings.
Analysis
Weighted-adjusted multinomial regression analysis was performed to determine the association between predictor and outcome variables.
Results
From Wave 3 to Wave 4, 19% of adolescents remained stagnant; 73.3% progressed; and 7.7% regressed. Adolescents were less likely to progress in their stage of change if they perceived nicotine in e-cigarettes to be “not at all/slightly harmful” (AOR = .26 [95% CI: .25, .27], P < .001); reported important people’s use of e-cigarettes (AOR = .18 [95% CI: .05, .65, P = .009); and “rarely” noticed e-cigarette health warnings (AOR = .28 [95% CI: .08, .98, P = .054).
Conclusion
Intervention efforts must target specific predictive factors that may help adolescents quit e-cigarettes.
... Furthermore, research on risk and protective factors for e-cigarette use among rural adolescents is sparse, though research has identified differences in prevalence rates among urban and rural high school-aged youth (Noland et al., 2017). Increasing rates of adolescent e-cigarette use (Johnston et al., 2020;Miech et al., 2021) coupled with e-cigarettes' developmental consequences (McCabe et al., 2018), necessitate further consideration of e-cigarette initiation, particularly among rural youth. The current study addresses these gaps in the literature by examining the timing of risk for e-cigarette initiation and considers multiple sources of socialization (i.e., peers, siblings, and parents) for e-cigarette initiation among rural middle school students. ...
Research has considered the role of social learning in substance use and determined that social influences are powerful determinants of substance initiation. However, the relationships between peer, sibling, and parent behaviors and e-cigarette initiation among early adolescents, and rural youth in particular, have yet to be examined. The present study investigated how peer delinquency, sibling substance use, and parental approval contribute to risk of e-cigarette initiation across middle school while also examining these associations with alcohol use initiation. Adolescents (N = 663) self-reported perceptions of peer delinquency, sibling substance use, parental approval about substance use, and their own e-cigarette and alcohol use. Multilevel survival analyses were conducted to model the risk of initiation and predictors of this risk. Results indicate that the risk of e-cigarette initiation increased by 75% annually as youths progressed through middle school. All social factors were significant predictors of e-cigarette initiation, while perceived peer delinquency and parental approval predicted alcohol initiation. Results emphasize the importance of early intervention for preventing e-cigarette initiation and the influence of peers and parents on alcohol initiation and the influence of peers, siblings, and parents on e-cigarette use.
... The popularity of cannabis vaping has increased rapidly (Croker, Werts, Couch, & Chaffee, 2023;Knapp et al., 2019;Miech et al., 2021). While the prevalence of overall cannabis use did not change much, past 12-month cannabis vaping among adolescents nearly doubled from 2017 to 2020 (7.2 % to 13.2 %) (Lim et al., 2022). ...
Introduction
The popularity of cannabis vaping has increased rapidly, especially among adolescents and young adults. We posit some possible explanations and, to evaluate them, examine whether cannabis vapers differ from non-vaping cannabis users in other substance use.
Methods
Using nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study wave 5 (Dec. 2018-Nov. 2019), we assessed the association between cannabis vaping and other substance use. A total of 1,689 adolescents and 10,620 adults who reported cannabis use in the past 12 months were included in the study. We employed multivariable logistic regressions to assess the association between cannabis vaping and other substance use.
Results
Among past 12-month cannabis users, compared with those who do not vape cannabis, participants who vape cannabis had higher risks of using alcohol (adjusted relative risk [aRR] = 1.04, 95 % CI, 1.01–1.07), cigarettes (aRR = 1.09, 95 % CI, 1.02–1.15), cigars (aRR = 1.17, 95 % CI, 1.06–1.30), other tobacco products (aRR = 1.29, 95 % CI, 1.14–1.45), electronic nicotine products (aRR = 4.64, 95 % CI, 4.32–4.99), other illicit drugs (aRR = 1.53, 95 % CI, 1.29–1.80), and misuse of prescription drugs (aRR = 1.43, 95 % CI, 1.19–1.72). Compared to older cannabis vapers, younger cannabis vapers were at risk of using more other substances. Cannabis vaping was associated with all seven measures of substance use among young adults.
Conclusions
Compared to non-vaping cannabis users, cannabis vapers have higher likelihood of using other substances. Research is needed to understand why, as well as the implications of the association.
... COVID-19 disrupted in-school data collection in 2020, but a sensitivity analysis of previous years supported use of the available data from the first part of that year. 48 We report data from 1991 to 2022. ...
Objective
To compare trends in cigarette smoking and nicotine vaping among US population aged 17–18 years and 18–24 years.
Methods
Regression analyses identified trends in ever and current use of cigarettes and e-cigarettes, using three US representative surveys from 1992 to 2022.
Results
From 1997 to 2020, cigarette smoking prevalence among those aged 18–24 years decreased from 29.1% (95% CI 27.4% to 30.7%) to 5.4% (95% CI 3.9% to 6.9%). The decline was highly correlated with a decline in past 30-day smoking among those aged 17–18 years (1997: 36.8% (95% CI 35.6% to 37.9%; 2022: 3.0% (95% CI 1.8% to 4.1%). From 2017 to 2019, both ever-vaping and past 30-day nicotine vaping (11.0% to 25.5%) surged among those 17–18 years, however there was no increase among those aged 18–24 years. Regression models demonstrated that the surge in vaping was independent of the decline in cigarette smoking. In the 24 most populous US states, exclusive vaping did increase among those aged 18–24 years, from 1.7% to 4.0% to equivalent to 40% of the decline in cigarette smoking between 2014–15 and 2018–19. Across these US states, the correlation between the changes in vaping and smoking prevalence was low (r=0.11). In the two US states with >US$1/fluid mL tax on e-cigarettes in 2017, cigarette smoking declined faster than the US average.
Conclusions
Since 1997, a large decline in cigarette smoking occurred in the US population under age 24 years, that was independent of the 2017–19 adolescent surge in past 30-day e-cigarette vaping. Further research is needed to assess whether the 2014–15 to 2018–19 increase in exclusive vaping in those aged 18–24 years is a cohort effect from earlier dependence on e-cigarette vaping as adolescents.
... For estimating nicotine-specific and cannabis-specific vaping, data were primarily drawn from the MTF survey, the only such survey to assess substances vaped every year since 2017, using raw data from 2021 (Miech et al., 2021(Miech et al., , 2022. ...
Background:
Youth use of electronic cigarettes ("e-cigarettes") is an ongoing concern. Vaping is usually assumed to be of nicotine, but survey responses may also include vaping of non-nicotine substances (particularly cannabis), which can impose different risks. The current study quantifies the proportions of nicotine-specific and cannabis-specific vaping among adolescents.
Methods:
Data from the Monitoring the Future (MTF) 2021 survey were analyzed with respect to the substance vaped: nicotine, cannabis, or flavoring only. Past-30-day (P30D) nicotine-specific vaping (exclusively, or also having vaped other substances) and cannabis-specific vaping were calculated. Results were also broken down by grade level, cigarette smoking history (current, former, or never), and frequency of e-cigarette use (<20 vs. 20+ days in P30D).
Results:
Among 4706 P30D e-cigarette users, 84.2% vaped nicotine; the remaining 15.8% reported not vaping any nicotine in P30D. Cannabis vaping was reported by 48.4% of P30D vapers. Vaping both nicotine and cannabis in P30D was more common in current and former smokers than in never-smokers, and in frequent vapers (of any substance). Conversely, never-smokers were more commonly vaping cannabis but not nicotine, compared to current and former smokers. Supplementary NYTS 2022 analyses were consistent with these findings.
Conclusions:
A notable proportion of self-reported P30D vapers reported not vaping nicotine; nearly half vaped cannabis. Capturing the variety of substances used in vaping devices is imperative for accurate public health surveillance of both nicotine and cannabis vaping among US adolescents, considering their different respective harms and regulatory frameworks.
... The use Frontiers in Medicine 07 frontiersin.org of e-cigarettes was associated with an increased incidence of combustible cigarette smoking, regarded as a gateway to combustible cigarette smoking (28,29). In the US, 22% of teenagers smoked e-cigarettes in 2020 (30), and the number of smokers in early adulthood (ages 18-23 years) has doubled between 2002 and 2018 (10). Furthermore, adolescent smokers could have significant airflow limitations, and lung function impairments might be long-term and irreversible later in life (31,32). ...
Background
Cigarette smoking is an important risk factor for developing chronic obstructive pulmonary disease (COPD). However, the effect of smoking on the development of COPD in young individuals remains unclear. We aimed to evaluate the effect of smoking on COPD development in young individuals.
Methods
Using the Korean National Health Information Database, we screened individuals aged 20–39 years who participated in the national health check-up between 2009 and 2012. We defined physician-diagnosed COPD based on health insurance claims and searched the database until December 2019. We identified 6,307,576 eligible individuals, and 13,789 had newly developed COPD. We used multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD.
Results
The incidence rate for developing COPD was 0.26/1000 person-year. The risk of developing COPD was significantly higher in current smokers [aHR 1.46, 95% confidence interval (CI) 1.39–1.53] and former smokers (aHR 1.21, 95% CI 1.14–1.29) than in non-smokers. Furthermore, the risk increased with increasing smoking amounts (≥20 pack-years, aHR 2.24; 10–20 pack-years, aHR 1.55; <10 pack-years, aHR 1.27). Female participants had a higher relative risk of developing COPD due to smoking, compared with their male counterparts.
Conclusion
Cigarette smoking increased the risk of developing COPD in young individuals. Current and heavy smokers had higher risks of developing COPD than non-smokers. Female smokers were more likely to develop COPD than male smokers.
... The FDA and the U.S. Surgeon General have characterized the widespread use of vape products (e-cigarettes) among U.S. adolescents as an epidemic 1,2 In the early stages of the Covid-19 pandemic, a reduction of e-cigarette use occurred. 3 During that time, although most adolescents continuing to vape at the same level (39%) or less (44%), the remaining 17% increased use representing a concerning minority at greater risk for nicotine dependence and frequent use. 4 Yet the early pandemic reduction in adolescent vaping proved to be a temporary reprieve as use returned to pre-pandemic levels in 2021/22. 5 It is currently estimated that 14.1% of U.S. high schoolers vape at least once in the past 30 days, and more than a quarter (27.6%) of current users use daily. ...
Introduction
Understanding adolescent perceptions of vaping and roles it plays in their lives is needed to design effective interventions to help adolescents quit. We explored vaping experiences of 11 adolescents from initiation through quit attempts.
Methods
A convenience sample of students who vaped in the last 90 days was recruited from one suburban high school in Massachusetts. Qualitative interviews were transcribed and coded. An inductive thematic analysis approach was employed. Areas of agreement and range of responses in code reports were summarized.
Results
Eleven open-ended semi-structured interviews were conducted (mean = 32.5 minutes each). Vaping initiation often occurred when socializing with friends who also supplied vaping devices. Vaping was “something to do” and new flavors engaged adolescents further. Solitary activities coupled with vaping included video gaming, getting ready for school, talking on the phone, or studying. Peak hours for vaping included morning, before and after school, before parents returned from work, and after parents went to bed. Several vaped to address anxiety/stress. For some, anxiety control was a main reason for vaping. Participants were concerned about health effects and nicotine dependence. Cost and health effects were drivers of quitting. Quit strategies relied on willpower and distraction.
Conclusions
Peers have powerful influences on the initiation and maintenance of adolescent vaping. Vaping habits can become routinized into adolescent lives. Addiction is a concern although nicotine’s anxiolytic effects were valued by many. Social connection was enhanced by communal vaping, sharing, and common vernacular, secrecy and rule-breaking. We describe the context in which adolescents vape nicotine, their reasons for vaping, and reasons to quit. This information can inform the development of interventions to better address adolescents’ triggers to vape, and social and psychosocial barriers to quitting. Our findings suggest a desire to quit vaping but a limited awareness of quitting strategies.
... Indeed, these characteristics vary greatly from one country to another. For example, the United States has a relatively low smoking prevalence (8.7%) 21 and a relatively high vaping prevalence among adolescents (11%-21%) 22,23 , the majority of whom prefer using JUUL vaping devices with high nicotine content 24 . By contrast, in France, the smoking prevalence is relatively high (24% in 2020) 25 , with little published data on the prevalence of adolescent vaping or on the most popular vaping technologies. ...
Introduction:
We describe the vaping and smoking habits of French adolescents aged 15-16 years in the Loire department with a view to assess the impact of e-cigarette experimentation and use on their smoking behavior.
Methods:
This quantitative, cross-sectional, single-center and observational study conducted from January to July 2019 targeted 6622 students aged 15-16 years attending public high school in the Loire department, France.
Results:
A total of 4937 (74.6%) adolescents were included. Of these, 73.2% were non-vapers and 72.2% non-smokers; 66.0% of adolescents were non-vapers and non-smokers. Slightly less than half of adolescents had experimented with e-cigarettes (44.6%), more than half of whom (26.8%) continued to use vaping products, with 6.02% vaping daily. Likewise, a little less than half of adolescents had experimented with smoked tobacco (42.4%), more than half of whom (27.8%) continued to use smoking products, with 10.3% smoking daily. Vapers and smokers (20.6%) tended to begin with the use of smoked tobacco and to progress to the dual use of vaping and smoked tobacco products. Vaping had a positive effect, as 71.8% of vapers who smoked tobacco before initiating vaping stopped or reduced smoking following their progression to this double use. More than half of tobacco users are daily users while this daily use affects only 1/3 boys and 1/6 girls for vape. Finally, nearly 80.7% of adolescents who had never smoked before vaping did not smoke at the time of the study.
Conclusions:
Our data suggest that vaping has a rather marginal impact on smoking initiation among French adolescents aged 15-16 years in the Loire department. They therefore neither confirm nor completely disprove the gateway effect theory, relating to use of tobacco subsequent to vaping.
... Nicotine is one of the most reported substances used among U.S. youth (Johnston et al., 2022;Walley et al., 2019). In 2020, nearly 22% of U.S. 10th-and 12th-grade students reported vaping nicotine in the past month and 7% reported vaping nicotine daily (Miech et al., 2021). More frequent nicotine vaping has been associated with greater nicotine dependence and continued use (Boykan et al., 2019;Dobbs et al., 2020;Lanza & Vasilenko, 2015;Sidani et al., 2019;Vogel et al., 2019). ...
E-cigarette use has increased among young adults, and emerging research suggests a subset of young adults report using e-cigarettes for appetite control/weight loss. The current article examined the association of e-cigarette weight control beliefs with subsequent e-cigarette initiation. Data were collected via online surveys from a prospective cohort study of young adults in Southern California (N = 1,368) at baseline (May-October 2020; M [SD]age = 21.2 [0.4]) and 6 months later (January-May 2021). Binary logistic regression models were used to evaluate the association of e-cigarette weight control beliefs (i.e., perceptions that e-cigarettes help people lose weight and satisfy hunger and desire to eat unhealthy foods) with new onset e-cigarette use at follow-up. All models were adjusted for sociodemographic characteristics. Among individuals who had never used e-cigarettes at baseline, those who agreed (vs. disagreed) that e-cigarettes help people lose weight had more than three times the odds of initiating e-cigarette use by follow-up (OR [95% CI]: 3.24 [1.52, 6.62]). Similarly, those who agreed (vs. disagreed) that vaping certain e-cigarette flavors help satisfy hunger and desire to eat unhealthy foods had more than twice the odds of initiating e-cigarette use by follow-up (OR [95% CI]: 2.40 [1.15, 4.82]). Findings highlight that e-cigarette weight control beliefs are an important risk factor for vaping initiation. Future interventions and policies aiming to prevent vaping among young adults should address e-cigarette weight control beliefs and long-term health consequences from related use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... 24 The JUUL and Puff tobacco products were included due to their popularity among young adults and adolescents. [25][26][27][28] ...
The increased popularity of electronic cigarettes (e-cigarettes) has been linked to the abundance of flavoured products that are attractive to adolescents and young adults. E-cigarette devices have significantly evolved in the last decade through four generations. Likewise, e-liquids are evolving in terms of chemical constituents and concentrations. Our objective was to evaluate and compare the evolving composition of tobacco-flavoured e-liquids over the last 10 years.
... Past year e-cigarette usage rates among high school students, which had risen from 2017 to 2019, leveled off but remained high. 21 Among AYA who used e-cigarettes in general prior to the pandemic, more than half changed their patterns of use with roughly one third quitting, and one third reducing use, but nearly 1 in 5 increased their nicotine use, nearly 1 in 12 increased their cannabis use, and the remainder switched to other products. 22 Among AYA who vaped cannabis prior to the pandemic, 6.8% reported increasing cannabis vaping since the pandemic, 37.0% reported quitting or reducing vaping in general, and 42.3% reported no change early in the pandemic. ...
Background:
Vaping is a major health risk behavior which often occurs socially. Limited social activity during the COVID-19 pandemic contributed to worsening social and emotional health. We investigated associations among youth vaping, and reports of worsening mental health, loneliness, and relationships with friends and romantic partners (ie, social health), as well as perceived attitudes toward COVID-19 mitigation measures.
Methods:
From October 2020 to May 2021, a clinical convenience sample of adolescents and young adults (AYA) reported on their past-year substance use, including vaping, their mental health, COVID-19 related exposures and impacts, and their attitudes toward non-pharmaceutical COVID-19 mitigation interventions, via a confidential electronic survey. Multivariate logistic regressions were used to estimate associations among vaping and social/emotional health.
Results:
Of 474 AYA (mean age = 19.3 (SD = 1.6) years; 68.6% female), 36.9% reported vaping in the prior 12 months. AYA who self-reported vaping were more likely than non-vaping AYA to report worsening: anxiety/worry (81.1%; P = .036), mood (78.9%; P = .028), eating (64.6%; P = .015), sleep (54.3%; P = .019), family discord (56.6%; P = .034), and substance use (54.9%; P < .001). Participants who vaped also reported easy access to nicotine (63.4%; P < .001) and cannabis products (74.9%; P < .001). No difference in perceived change in social wellbeing was seen between the groups. In adjusted models, vaping was associated with symptoms of depression (AOR = 1.86; 95% CI = 1.06-3.29), less social distancing (AOR = 1.82; 95% CI = 1.11-2.98), lower perceived importance of proper mask wearing (AOR = 3.22; 95% CI = 1.50-6.93), and less regular use of masks (AOR = 2.98; 95% CI = 1.29-6.84).
Conclusions:
We found evidence that vaping was associated with symptoms of depression and lower compliance with non-pharmaceutical COVID-19 mitigation efforts among AYA during the COVID-19 pandemic.
... First, e-cigarette use appears to have increased dramatically over this 2017 and 2019 time period using OSDUHS, as well as in other Canadian surveys (Canadian Broadcasting Corporation, 2021;Cole et al., 2021;Government of Canada, 2018Statistics Canada, 2020) and in the U.S. (Cooper et al., 2022;CDC, 2016CDC, , 2019CDC, , 2021Singh et al., 2020;Wang et al., 2020). Since 2019, e-cigarette use among youth appears to have decreased in the U.S. (e.g., Gaiha et al., 2020;Wang et al., 2021) or plateaued (e.g., Miech et al., 2021) and stabilized in Canada (e.g., Statistics Canada, 2022b). For example, the Canadian Tobacco and Nicotine Survey found past-30-day vaping prevalence among youth aged 15 to 19 , 14% in 2020and 13% in 2021(Statistics Canada 2020, 2022a. ...
This project examined e-cigarette use among Elementary School (ES) (grades 7 and 8) and Secondary School (SS) (grades 9-12) students in Ontario, Canada, for 2017 and 2019 and relationships with sociodemographic variables and traditional cigarette use. The data came from the Ontario Student Drug Use and Health Survey OSDUHS (2017, 2019). Socio-demographics included grade, school performance, sex, race, years in Canada, living arrangements and language spoken at home. E-cigarette use and cigarette smoking were any past year use. For 2017, there are a greater percentage of ES males than females who used e-cigarettes, older students, those living in more than one home and those smoking cigarettes. For SS students a greater percentage for those of older age, higher grades, living in Canada all their lives, using only English language at home, self-identified as white, with lower school performance, those with multiple household living arrangements and who reported smoking traditional cigarettes reported using e-cigarettes. Use was lower among females in 2017 (OR = 0.63, 95% CI = 0.46, 0.86, p = 0.002), but by 2019 use was higher among females, which resulted in a non-significant difference between males and females (OR = 0.91, 95% CI = 0.77, 1.09). Greater use of e-cigarettes was found among students who smoked traditional cigarettes compared to those who did not smoke in both years. Monitoring the trends, patterns and trajectories of use and variables related to use needs to be continued which may help inform the development of further legislative and educational measures.
... 3-5 The possible reasons behind the reported decline in e-cigarette use among adolescents and young adults might be a result of tobacco regulatory policies that restrict youth access to e-cigarettes (e.g., Tobacco-21 Legislation), 6 the ban on flavored e-cigarettes, 7 or the increase in the perceived harm of nicotine vaping. 8 Despite the decline in the prevalence of e-cigarette use among adolescents, their use is still widespread, with approximately 11.3% of high school students and 2.8% of middle school students reporting past-30-day e-cigarette use in 2021. 4 Most e-cigarettes contain nicotine, which is highly addictive and can harm the developing brain of adolescents. ...
Among adolescents, sole use is the most common pattern of e-cigarette use. However, concurrent use of e-cigarettes with other tobacco products is not uncommon and may be associated with high-risk behaviors. We used data from 12,767 participants in the 2019 Youth Risk Behavior Survey to examine the patterns of tobacco product use among youth in the US. First, we examined the prevalence of e-cigarette-specific patterns of tobacco use (nonuse[no tobacco product use], sole use[sole e-cigarette use], dual-use[e-cigarette and one other tobacco product], and poly use[e-cigarette and two or more other tobacco products]). Then, using multivariable Poisson regression, we assessed how the tobacco use patterns were associated with the misuse of nine substances of abuse (alcohol, marijuana, cocaine, ecstasy, hallucinogens, heroin, inhalants, injectables, and methamphetamines). 62.9% of youth reported nonuse of any tobacco product. The weighted prevalence of sole e-cigarette use, dual use, and poly use was 23.2%, 4.2%, and 3.3%, respectively. Across all the substances explored, the prevalence was highest among poly users, followed by dual users, sole users, and non-users. Compared to non-users, sole, dual, and poly users had 7.8(95 %CI:6.1-10.0), 14.3(95 %CI:10.8-18.8), and 19.7(95 %CI:15.0-25.9) times higher adjusted prevalence of reporting past-30-day binge drinking, after adjusting for age, sex, race/ethnicity, sexual orientation, and depressive symptoms. This pattern was seen across all the different substances explored. These findings highlight the high prevalence of substance misuse among youth who use tobacco products and the need to educate and counsel on substances of abuse among this population, particularly among poly-tobacco users.
Introduction
We examined youth and young adult access to flavored vaping products following New York’s (NY’s) flavored vaping product sales restriction in 2020.
Method
In 2021, we conducted an online survey (N = 493) and focus groups (N = 33) with NY youth and young adults who vaped in the past year (ages 15–24). We summarize findings and use logistic regression to assess associations with access to flavored vaping products.
Results
Most youth and young adults who vaped in the past year (64%) had obtained flavored vaping products. Among them, 49% purchased in a store, 47% got them from social sources, and 11% bought online. Focus group participants reported restricted products were available on store shelves or behind the counter. Those under age 21 were less likely to buy flavored vaping products in store than those aged 21–24, but age was unrelated to online purchases. Focus group participants reported websites did not require age verification, or they found ways to circumvent it. Most believed buying flavored vaping products was easy (77%) and had gotten easier or stayed the same in the past year (70%).
Discussion
Most NY youth and young adults who vaped in the past year obtained flavored vaping products and found it easy to buy them after the statewide sales restriction, suggesting that implementation has not occurred as intended. Findings also raise questions about retailer compliance and highlight enforcement challenges with online purchases. Continued retailer education and enforcement efforts, including for online sales, may help flavored vaping product sales restrictions achieve intended outcomes.
Introduction
On April 20, 2020, New Jersey (NJ) implemented a comprehensive ban on the sale of flavored e-cigarettes. This study compares sales of e-cigarettes, cigarettes, and cigars before and after the law.
Aims and Methods
Data were biweekly retailer scanner sales in NJ convenience stores for e-cigarettes, cigarettes, and cigars between August 2019 and December 2020. We used Joinpoint regression to assess sales trends for cigarettes (non-menthol and menthol), cigars (unflavored and flavored), and e-cigarettes (unflavored, fruit or sweet or concept flavor, and menthol flavor) in the 36 weeks before and 36 weeks after a statewide ban on flavored e-cigarettes.
Results
Flavored e-cigarette sales, not including menthol, significantly decreased over the study period while menthol e-cigarette sales significantly increased until the e-cigarette flavor ban took effect, after which these sales rapidly declined through May 2020, then slowed. Unflavored e-cigarette sales declined through September 2019, then grew modestly until the flavored e-cigarette ban, after which sales significantly increased. Flavored cigar sales increased between March and May 2020, then declined; non-flavored cigar sales increased between mid-February and early July 2020, then declined. Cigarette sales were decreasing before the flavored e-cigarette ban but after, significantly increased until June 2020. Overall, there was no significant trend in the average biweekly percent change for cigarette sales.
Conclusions
Flavored e-cigarette sales were declining prior to the ban but the pace of the decline accelerated following federal and state restrictions on flavored e-cigarette sales, then slowed by the second half of 2020, with a brief period of increased cigarette and cigar sales immediately following the ban.
Implications
NJ’s 2020 statewide e-cigarette flavor ban offered the opportunity to observe how sales of e-cigarette, cigarette, and cigar products shifted after the change. The effect of the state law, at least in the short-term, was decreased sales of flavored e-cigarettes and increased sales of unflavored e-cigarettes. Research on long-term policy effects is needed.
Objective:
The current study used U.S. national data to examine trends in cannabis use from 2013-2021, focusing on changes in cannabis prevalence during young and middle adulthood, and whether trends differed by sociodemographic characteristics.
Method:
Data from 2013-2021 from 21,133 respondents aged 19-30 and 29,898 aged 35-55 in the national Monitoring the Future panel study (followed since they were in 12th grade in 1976-2020) were used to model historical trends in cannabis prevalence (any 12-month use, any 30-day use, and near-daily use [20+ occasions in the past 30 days]).
Results:
Prevalence of 12-month, 30-day, and near-daily cannabis use significantly increased from 2013-2021 for both young and middle adults. Trends for all three behaviors indicated either consistent linear increases or two-slope increases where the slope estimate was larger in more recent years. Historical increases in 12-month and 30-day use were similar for young and middle adulthood; the historical increase in near-daily use among middle adults had some evidence for a possible pandemic-related deviation. Historical trends did not differ by race/ethnicity or college degree. Trends for 12-month and 30-day use differed by sex, with females increasing more than males over time, especially during middle adulthood.
Conclusions:
Significant increases in the prevalence of cannabis use have occurred over the past decade for young and middle adults across sociodemographic groups, with some indication that near-daily use increased among middle adults at the onset of the pandemic. Although males continue to have higher prevalence than females, the gap has narrowed with greater increases in cannabis use among women.
Introduction
Electronic cigarettes (e-cigarettes) are the most widely used tobacco product by youth and young adults in the United States. Effective prevention campaigns require the identification of appropriate content focus for message construction.
Aims and Methods
A sample of 2622 youth and young adults ages 15–24 were recruited through social media advertisements and completed an online survey. Respondents reported current e-cigarette use or intention to use if not currently using. They also indicated agreement or disagreement with 75 e-cigarette-related beliefs representing 16 themes. The relative promise of each theme/belief for campaign messaging was investigated by examining its association with the behavior/intention outcomes and the opportunity for positive change in its distribution (room to move).
Results
All themes showed significant associations with the behavior (ORs = 2.49–19.04) and intention (ORs = 2.21–6.11) outcomes. Room to move for themes ranged from 32.9% to 96.3% in behavior analysis and 15.6–93.9% in intention analysis. A normed relative promise index (M = 50, SD = 17) showed flavors (72), comparison to cigarettes (69), and relaxation and mental health (68) as the top ranked themes. Subgroup analyses by demographics revealed few differences. Results on the belief level were largely consistent with those on the theme level.
Conclusions
Data from this study provide timely evidence for the relative value of various themes/beliefs as potential targets for message development in e-cigarette prevention campaigns. The final selection of target themes/beliefs requires consideration of openness to persuasion, which may be informed by additional testing.
Implications
Electronic cigarettes (e-cigarettes) are the most widely used tobacco products among youth and young adults in the United States. This study adds new evidence on the relative promise of a wide range of e-cigarette beliefs and belief clusters (themes) as potential targets for message development in educational campaigns. This evidence is important to consider in future campaign efforts directed at the youth and young adult populations in the United States.
Importance
Pregnant adolescents sometimes use cigarettes; however, little is known about e-cigarette use among pregnant adolescents, a population with increased health vulnerability.
Objective
To examine yearly trends, sociodemographic and pregnancy-related determinants, and the association with small-for-gestational-age (SGA) birth of e-cigarette and/or cigarette use during late pregnancy among adolescents.
Design, Setting, and Participants
This cohort study used existing data from the 2016-2021 Pregnancy Risk Assessment Monitoring System on 10 428 US adolescents aged 10 to 19 years who had a singleton birth with complete data on e-cigarette or cigarette use and SGA birth.
Exposure
Adolescents reported e-cigarette and cigarette use during the last 3 months of pregnancy.
Main Outcomes and Measures
SGA birth (birth weight below the 10th percentile for the same sex and gestational duration) was determined from birth certificates. Multivariable logistic regression was used to compare the odds of SGA birth across pregnant adolescents who exclusively used e-cigarettes, exclusively used cigarettes, used e-cigarettes and cigarettes, or did not use either.
Results
Of the 10 428 pregnant adolescents, 72.7% were aged 18 or 19 years; 58.9% self-identified as White and 23.3% as Black; and 69.8% were non-Hispanic. The weighted prevalence of exclusive e-cigarette use during late pregnancy increased from 0.8% in 2016 to 4.1% in 2021, while the prevalence of exclusive cigarette use decreased from 9.2% in 2017 to 3.2% in 2021. The prevalence of dual use fluctuated, ranging from 0.6% to 1.6%. White pregnant adolescents were more likely than those who self-identified as another race and ethnicity to use e-cigarettes (2.7% vs 1.0% for American Indian or Alaska Native adolescents, 0.8% for Asian or other race adolescents, 0.6% for Black adolescents, and 0.7% for multiracial adolescents). Compared with those who did not use either product, adolescents who exclusively used e-cigarettes (16.8% vs 12.9%; confounder-adjusted odds ratio [AOR], 1.68 [95% CI, 0.89-3.18]) or who used cigarettes and e-cigarettes (17.6% vs 12.9%; AOR, 1.68 [95% CI, 0.79-3.53]) had no statistically significant difference in risk of SGA birth. However, adolescents who exclusively used cigarettes had a more than 2-fold higher risk of SGA birth (24.6% vs 12.9%; AOR, 2.51 [95% CI, 1.79-3.52]).
Conclusions and Relevance
This cohort study suggests that pregnant adolescents increasingly used e-cigarettes, with the highest use among White adolescents. Results from this analysis found that, unlike cigarette use, e-cigarette use during late pregnancy was not statistically significantly associated with an increased risk of SGA birth among adolescents. Due to the uncertainty of this nonsignificant association, future research could benefit from a larger sample size.
Vaping nicotine and marijuana have been increasing among adolescents in the past 5 years. Tetrahydrocannabinol is the psychoactive cannabinoid in marijuana. The COVID-19 pandemic created gaps in healthcare access and visits, making it difficult to collect accurate data on adolescent vaping, willingness to quit and methods used to quit. In addition, the literature lacks information regarding effective evidence-based treatment measures for adolescents who vape. In this report, we seek to address this using two patient cases and detailing the interventions a managed care organisation enacted during this timeframe. Our investigation revealed a relationship between social stressors and vaping among teens. Addressing these underlying stressors and eliciting and treating mental health symptoms and polysubstance use appears to be critical to curbing vaping.
Purpose
We examined awareness and perceptions of the US FDA JUUL marketing denial order (MDO) that occurred in June 2022 among a nationally representative sample of US adolescents.
Methods
Data were collected in August 2022 via an online survey (n=1,603). Adolescents were asked whether they had heard about the JUUL MDO, and, if yes, where they heard the news. Those who had heard were asked about the MDO’s impact on their harm beliefs about JUUL and vape products in general. We examined correlates of awareness of the MDO and of increased JUUL and vape harm perceptions.
Results
Twenty-seven percent of adolescents had heard about the MDO. Older adolescents (aOR=1.13) and LGBTQ+ adolescents (aOR=2.05) had significantly higher odds of having heard the news, while those who identified as Black/African American had significantly lower odds of having heard (aOR=0.56). Most participants who were aware of the MDO indicated that they had higher harm perceptions about JUUL itself (77.9%) and vapes in general (79.6%). Youth susceptible to vaping and current users were less likely to report increased harm perceptions about JUUL (B=-0.34 and -0.46, respectively) and vapes in general (B=-0.27 and -0.43) compared with youth not susceptible to vaping.
Conclusions
The results of this nationally representative survey demonstrate that over one-quarter of US youth heard about the JUUL MDO and the vast majority of those indicated increased harm perceptions about vapes. Large-scale news events about vaping can reach youth audiences and may impact what youth think about the harms of vaping.
Implications
Analysis of a nationally representative survey of adolescents aged 13-17 revealed that more than 25% had heard about the marketing denial order issued to JUUL Labs by the FDA in June of 2022. We also found that the vast majority of adolescents reported increased JUUL and vape harm perceptions in response to hearing about the MDO. This indicates that news coverage about vaping – including coverage of regulatory actions – can reach and potentially impact adolescents. It is therefore important to monitor news coverage about vaping, how it is framed and discussed across media platforms, and its reach among priority populations.
Aims
The aims of this study were to measure whether household bans on vaping were associated with lower odds of youth past‐month vaping when compared with (1) otherwise similar youth whose households did not have a vaping ban (using coarsened exact matching); and (2) themselves in waves when their household did not have a ban (using hybrid panel models). We used the same analytical strategies to examine cross‐sectional associations between household smoking bans and adolescents’ past‐month cigarette smoking.
Design
This was a longitudinal study using data from a nationally representative sample of youth (age 12–17 years) in the Population Assessment of Tobacco and Health Study.
Setting
United States of America.
Participants
A total of 16 214 adolescents followed over 48 103 total observations (approximately three waves).
Measurements
Measurements comprised youth past‐month e‐cigarette and cigarette use and parent‐reported household bans on vaping and smoking. Potential confounders were prior adolescent smoking, vaping, and other nicotine product use; parent current smoking, vaping, and other nicotine use; adolescent peer e‐cigarette/cigarette use; parental monitoring; and demographic characteristics.
Findings
Before matching, smoking bans were associated with 46% lower odds of youth smoking [odds ratio (OR) = 0.54; 95% confidence interval (CI) = 0.41–0.70] and vaping bans with 37% lower odds of youth e‐cigarette use (OR = 0.63; 95% CI = 0.50–0.80). However, households with and without bans differed significantly on all confounders before matching. After matching, household vaping bans were associated with 56% lower odds of youth vaping (OR = 0.44; 95% CI = 0.33–0.58). Results from hybrid panel models also revealed 37% lower odds of vaping in waves when youth lived in a vape‐free household compared to waves when they did not (OR = 0.63; 95% CI = 0.50–0.78). Associations between smoking bans and youth smoking were not statistically significant after matching or when using hybrid panel models.
Conclusions
Household vaping bans appear to be associated with lower odds of past‐month vaping among US adolescents, compared with similar youth whose households did not have a ban and to themselves in waves when their households did not have a ban.
Introduction:
There is considerable controversy about the development of dependence among e-cigarette users. This study describes the average amount of time using e-cigarettes before dependence milestones emerge and the differences in developing dependence between e-cigarette users who smoke cigarettes compared to those who do not.
Methods:
Adolescents and young adults aged 16-25 living in Canada were recruited into an online survey in 2021. Current (past-month) e-cigarette users completed 15 items assessing dependence from the Penn-State Electronic Cigarette Dependence Index and the E-cigarette Dependence Scale for a total of 12 behavioural (e.g., difficulty refraining from vaping) and 3 frequency (e.g., using e-cigarette daily, weekly, or monthly) indicators of dependence milestones. Number of years after e-cigarette onset at which the cumulative probability of attaining each milestone was 25 % was computed.
Results:
Among 1205 participants, most (80.6 %) were female, 73.7 % were Caucasian, and 49.7 % resided in Ontario. Ten of the 12 e-cigarette use milestones were attained by 25 % of respondents 2 years after starting vaping except for daily cigarette use (2.5 years after onset) and waking at night to vape (5.6 years after onset). Within the entire study population, frequency milestones (weekly, monthly, daily e-cigarette use) were attained faster by ever-smokers (hazard ratio compared to attainment by never-smokers: 1.12, 1.21, and 1.28 respectively), whereas for at least monthly users, behavioural milestones were attained faster by never-smokers.
Discussion:
Many current e-cigarette users developed symptoms of e-cigarette dependence between two and five years since onset. Never smokers may be at higher risk of becoming e-cigarette dependent since they attained e-cigarette dependence milestones faster than smokers.
E-cigarettes (electronic cigarettes) have been the most used tobacco product among US youth since 2014, reaching a plateau during the COVID-19 pandemic. Youth e-cigarette use is associated with negative health consequences such as impaired cognitive functioning. For many, the COVID-19 pandemic altered social interactions, harm perceptions, and product availability. This changed the frequency and locations in which youth use e-cigarettes. To better understand youth e-cigarette use, we need more information on factors that can alter e-cigarette use, specifically, how the pandemic changed e-cigarette use among youth. In 2020-2021, we conducted online, individual interviews with 19 youth (aged 13-17) e-cigarette users living in the US to explore how COVID-19 impacted their e-cigarette use. Youth described a progression of e-cigarette use from initial experimentation, regular social use, and ultimately to nicotine addiction demonstrated by individual use in isolation. Many youth initiated e-cigarette use due to influences by friends or family members. Youth discussed progression to social use, with social interactions as an important reason for use and an avenue for expanding one’s knowledge of e-cigarettes. After a period of time, youth began to recognize that the social interactions mattered less, suggesting to them that they had become addicted. This realization became more apparent during COVID-19, which changed how youth used e-cigarettes, especially around where use was occurring, health concerns, and use behavior and frequency. In our interviews, youth trajectory began with an initiation with family and friends, progressed to social use, and eventually developed to addiction, at which point social use was no longer the primary motivation for e-cigarette use. Understanding the trajectory of e-cigarette use will allow for effective interventions that reduce harm to youth from e-cigarette use.
Vaping and electronic cigarette (e-cigarette) use have grown exponentially in the past decade, particularly among youth and young adults. Cigarette smoking is a risk factor for both cardiovascular and pulmonary disease. Because of their more limited ingredients and the absence of combustion, e-cigarettes and vaping products are often touted as safer alternative and potential tobacco-cessation products. The outbreak of e-cigarette or vaping product use-associated lung injury in the United States in 2019, which led to >2800 hospitalizations, highlighted the risks of e-cigarettes and vaping products. Currently, all e-cigarettes are regulated as tobacco products and thus do not undergo the premarket animal and human safety studies required of a drug product or medical device. Because youth prevalence of e-cigarette and vaping product use was as high as 27.5% in high school students in 2019 in the United States, it is critical to assess the short-term and long-term health effects of these products, as well as the development of interventional and public health efforts to reduce youth use. The objectives of this scientific statement are (1) to describe and discuss e-cigarettes and vaping products use patterns among youth and adults; (2) to identify harmful and potentially harmful constituents in vaping aerosols; (3) to critically assess the molecular, animal, and clinical evidence on the acute and chronic cardiovascular and pulmonary risks of e-cigarette and vaping products use; (4) to describe the current evidence of e-cigarettes and vaping products as potential tobacco-cessation products; and (5) to summarize current public health and regulatory efforts of e-cigarettes and vaping products. It is timely, therefore, to review the short-term and especially the long-term implications of e-cigarettes and vaping products on cardiopulmonary health. Early molecular and clinical evidence suggests various acute physiological effects from electronic nicotine delivery systems, particularly those containing nicotine. Additional clinical and animal-exposure model research is critically needed as the use of these products continues to grow.
Background:
Compared to single substance use, adolescents' use of multiple substances is associated with more severe dependence, cessation outcomes, and health risks. This study examined correlates of use and co-use of e-cigarettes, combusted tobacco, and cannabis among high school-aged (9th-12th grade, approximately aged 14-18) adolescents.
Methods:
We analyzed the 2019 Massachusetts Youth Health Survey (MYHS) data to calculate the weighted means of any past 30-day sole-use of e-cigarettes, sole-use of combusted tobacco, sole-use of cannabis, dual-use of two of the above substances, and poly-use of all three substances. We then used weighted multinomial logistic regression to examine the associations between demographic, social and behavioral factors and sole-, dual-, and poly-use (vs. no use) of these substances.
Results:
Among N = 1614 respondents, any past 30-day dual-use of e-cigarettes and cannabis was the most prevalent (17.2%, SE: 1.3%). Sole-use of combusted tobacco was less than 1%, whereas 4.5% (SE: 0.7%) of respondents reported poly-use of e-cigarettes, cannabis, and combusted tobacco. Lower academic grades and self-reported depression (1 item on persistent feelings of sadness or hopelessness) were associated with increased odds of dual-use of e-cigarettes and cannabis and poly-use (vs. sole-use of any substance). Adolescents who self-reported having "any long-term emotional problems or learning disabilities" had greater odds of poly-use.
Conclusion:
Different sets of correlates were associated with sole-, dual-, and poly-use, suggesting that certain adolescents may be more vulnerable than others to multiple substance use. Future research should examine potentially modifiable upstream influences, such as the home environment and socioeconomic factors that may affect the relationship between adolescent mental health, school performance, and multiple addictive substance use.
Purpose:
To examine if the record declines in adolescent substance use after the onset of the COVID-19 pandemic resulted from reduced levels of initiation, defined as any lifetime use.
Methods:
We analyzed data from the nationally representative, cross-sectional, annual Monitoring the Future surveys of eighth, 10th, and 12th grade students from 2019 to 2022. Measures included past 12-month use of cannabis, nicotine vaping, and alcohol as well as self-reported grade of initiation of each substance. Analyses are based on randomly selected subsamples of students who received questions on both prevalence and grade of first use, resulting in a total sample size of 96,990 students.
Results:
Levels of the past 12-month substance use were markedly lower after the onset of the pandemic, in 2021 and 2022. In eighth and 10th grade, levels were at least one-third lower for cannabis and nicotine vaping and 13%-31% lower for alcohol. In 12th grade, the decreases ranged from 9% to 23%. Lower levels of initiation in seventh grade in 2020-2021 accounted for half or more of the overall prevalence decreases in eighth grade in 2021- 2022. Lower levels of initiation in ninth grade in 2020-2021 accounted for 45% or more of the overall prevalence decreases in 10th grade in 2021-2022. Declines in 12th grade substance use prevalence were not consistently linked to lower initiation in earlier grades.
Discussion:
Much of the declines in overall prevalence of adolescent substance use after the onset of the COVID-19 pandemic trace back specifically to declines in substance use initiation in seventh and ninth grades.
Introduction:
Youth use of electronic nicotine delivery systems (ENDS) is a continuing concern, making it important to assess evolving patterns, especially as non-tobacco, non-menthol (NTM) flavors were withdrawn for pod-based (but not disposable) ENDS in February 2020.
Methods:
Trends in past-30-day (P30D) ENDS use and smoking prevalence, usual device type, flavor (tobacco, mint/menthol, or fruit/sweet/other), and regular/last-used brand in PATH Waves 4 (2017), 4.5 (2018), 5 (2019), and 5.5 (2020) were examined. Shifts between 2019 and 2020 in flavor use for pods and disposables were examined.
Results:
P30D ENDS use peaked in 2019 at 8.6 % of all youth, subsequently declining by nearly half to 4.5 % in 2020. Meanwhile, P30D cigarette smoking declined to an all-time low (1.3 %) in 2020. Within this overall decline, consumption shifted to disposable ENDS, which increased nearly 10-fold (from 5.0 % to 49.2 % of P30D ENDS users). Relatedly, use of fruit/sweet/other flavors remained similar overall between 2019 and 2020 (approximately 75-80 % of P30D ENDS users), but the use of these flavors became concentrated in disposable ENDS in 2020 (a 12-fold increase from 4.4 % to 58.4 % of fruit/sweet/other-flavor users).
Conclusions:
PATH results show similar trends to other US national surveys in youth ENDS trends. The removal of non-tobacco, non-menthol flavors in pod-based ENDS (while remaining available in disposables) has likely driven youth towards disposable devices, resulting in continued high use of fruit/sweet/other flavors, which are now predominant in users of disposable ENDS. Wave 5.5 is uninformative regarding brand use because common disposable brands were not queried.
Background:
The prevalence of e-cigarette and vaping products has increased in the past decade, especially among adolescents. To provide data that will inform identification of youth at high risk, the goals of this study are to determine the social, educational, and psychological health outcomes associated with e-cigarette use distinct from combustible cigarettes.
Methods:
Annual samples of adolescents in grade 12 (years: 2015-2021, N = 24,015) were analyzed from Monitoring the Future cross-sectional data. Students were categorized based on vaping and smoking patterns (no use, vape only, combustible cigarette smoking only, or both). Survey-weighted prevalence and logistic regression were used to assess associations.
Results:
Between 2015 and 2021, 78.7% of students used neither e-cigarettes nor combustible cigarettes, 13.2% used e-cigarettes only (vape-only), 3.7% used combustible cigarettes only (smoke-only), and 4.4% used both. Students who vaped-only (OR:1.49, CI:1.28-1.74), smoked-only (OR:2.50, CI:1.98-3.16), or both (OR:3.03, CI:2.43-3.76) had worse academic performance than non-smoking, non-vaping peers after demographic adjustment. There was no significant difference in self-esteem between the "neither" group and the other groups, though the "vaping-only", "smoking-only" and "both" groups were more likely to report unhappiness. Inconsistent differences emerged regarding personal & family beliefs.
Conclusions:
Generally, adolescents who reported e-cigarette-only use had better outcomes than their peers who smoked cigarettes. However, students who vape-only reported poorer academic performance compared to those who did not vape or smoke. Vaping and smoking were not significantly related to self-esteem, but were linked to unhappiness. Still, vaping does not follow the same patterns as smoking, despite frequent comparisons in the literature.
Purpose:
Perceived harm is associated with substance use. Changes in product and policy landscapes may impact perceived harms of tobacco and cannabis. This study aimed to examine changes in young adults' perceived harms of tobacco and cannabis and their associations with use behavior during a period including both before and after legalization of cannabis.
Methods:
We conducted a panel survey of California Bay Area young adults (mean age = 23.5 years old, 64.4% female) in 2014 and 2019-2020. Participants (N = 306) reported past 30-day use and perceived harms of tobacco and cannabis at both waves. Perceived harms to health of cannabis and tobacco (cigarettes, e-cigarettes, hookah, smokeless tobacco, and secondhand tobacco smoke) were measured from 1-"Not at all harmful" to 7-"Extremely harmful." Mixed-effects logistic regressions examined associations between perceived harms and use of tobacco and cannabis, controlling for demographics.
Results:
Participants perceived lower harm for cannabis than for tobacco products. Perceived harms of e-cigarettes, hookah, and smokeless tobacco significantly increased over time; while perceived harms of cigarettes, secondhand tobacco smoke, and cannabis did not change. Increased perceived harm of e-cigarettes was associated with lower odds of any tobacco use (OR = 0.72, 95%CI = 0.56, 0.92), and increased perceived harm of cannabis was associated with lower odds of any cannabis use (OR = 0.51, 95%CI = 0.42, 0.62).
Conclusions:
Findings suggest that perceived harms of e-cigarettes and cannabis play important roles in driving young adult use behaviors. Risk communication efforts that increase perceptions of health harms related to e-cigarettes and cannabis may decrease use of tobacco and cannabis among young people.
Background: The use of electronic cigarettes (or "vaping") among adolescents remains a public health concern given exposure to harmful substances, plus potential association with cannabis and alcohol. Understanding vaping as it intersects with combustible cigarette use and other substance use can inform nicotine prevention efforts. Methods: Data were drawn from 51,872 US adolescents (grades 8, 10, 12, years: 2017-2019) from Monitoring the Future. Multinomial logistic regression analyses assessed links of past 30-day nicotine use (none, smoking-only, vaping-only, and any smoking plus vaping) with both past 30-day cannabis use and past two-week binge drinking. Results: Nicotine use patterns were strongly associated with greater likelihood of cannabis use and binge drinking, particularly for the highest levels of each. For instance, those who smoked and vaped nicotine had 36.53 [95% CI:16.16, 82.60] times higher odds of having 10+ past 2-week binge drinking instances compared to non-users of nicotine. Discussion: Given the strong associations between nicotine use and both cannabis use and binge drinking, there is a need for sustained interventions, advertising and promotion restrictions, and national public education efforts to reduce adolescent nicotine vaping, efforts that acknowledge co-occurring use.
Background
The Tobacco Products Directive (2014/40/EU) partially harmonised the regulation of electronic cigarettes (e-cigarettes) in Europe, but individual countries maintain jurisdiction over bans on use in public places, domestic advertising, taxation and flavour regulations. Their association with youth e-cigarette use has not been examined.
Methods
We used the cross-sectional 2019 European School Survey Project on Alcohol and Other Drugs data from 32 countries with 98 758 students aged 15–16 years and the 2020 WHO’s assessment of the e-cigarette regulations. Multilevel logistic regression models on ever (vs never) and current (vs non-current) exclusive e-cigarette use, exclusive cigarette use and dual use by e-cigarette regulations’ composite score were adjusted for age, gender, parental education, perceived family’s financial well-being, perceived difficulty of obtaining cigarettes, country income level and general progress in tobacco control.
Results
Of the respondents, 13.3% had ever used cigarettes, 10.6% e-cigarettes and 27.3% both; 13.0% currently used cigarettes, 6.0% e-cigarettes and 6.4% both. Higher composite country score in the e-cigarette regulations was associated with lower current exclusive e-cigarette use (OR=0.78; 95% CI 0.65 to 0.94) and current dual use (OR=0.80; 95% CI 0.67 to 0.95). Youth perceiving more difficulties in obtaining cigarettes were less likely to use cigarettes, e-cigarettes and both ever and currently (OR from 0.80 (95% CI 0.76 to 0.85) to 0.94 (95% CI 0.92 to 0.96)).
Conclusions
More comprehensive e-cigarette regulations and enforcement of age-of-sale laws may be protective of e-cigarette and dual use among adolescents.
Menthol and tobacco flavors are available for almost all tobacco products, including electronic cigarettes (e-cigs). These flavors are a mixture of chemicals with overlapping constituents. There are no comparative toxicity studies of these flavors produced by different manufacturers. We hypothesized that acute exposure to menthol and tobacco-flavored e-cig aerosols induces inflammatory, genotoxicity, and metabolic responses in mouse lungs. We compared two brands, A and B, e-cig flavors (PG/VG, menthol, and tobacco) with and without nicotine for their inflammatory response, genotoxic markers, altered genes and proteins in the context of metabolism by exposing mouse strains, C57BL/6J (Th1-mediated) and BALB/cJ (Th2-mediated). Brand A nicotine-free menthol exposure caused increased neutrophils and differential T-lymphocyte influx in bronchoalveolar lavage fluid (BALF) and induced significant immunosuppression, while brand A tobacco with nicotine elicited an allergic inflammatory response with increased Eotaxin, IL-6, and RANTES levels. Brand B elicited a similar inflammatory response in menthol flavor exposure. Upon e-cig exposure, genotoxicity markers, significantly increased in lung tissue. These inflammatory and genotoxicity responses were associated with altered NLRP3 inflammasome and TRPA1 induction by menthol flavor. Nicotine decreased surfactant protein D and increased PAI-1 by menthol and tobacco flavors, respectively. Integration of inflammatory and metabolic pathway gene expression analysis showed immunometabolic regulation in T-cells via PI3K/Akt/p70S6k-mTOR axis associated with suppressed immunity/allergic immune response. Overall, this study showed comparative toxicity of flavored e-cig aerosols, unraveling potential signaling pathways of nicotine and flavor-mediated pulmonary toxicological responses, and emphasized the need for standardized toxicity testing for appropriate premarket authorization of e-cigarette products.
Objective
Determine longitudinal tobacco product discontinuation rates among youth (ages 12–17 years) in the USA between 2013 and 2019.
Methods
The Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study, was used to determine annual/biennial rates of tobacco product discontinuation behaviours among youth across 2013–2019: (1) discontinuing product use (transition from past 30-day use to no past 30-day use), (2) attempting to quit product use and (3) discontinuing product use among those who attempted to quit. Discontinuing use was evaluated separately for cigarettes, electronic nicotine delivery systems (ENDS), cigars, hookah, smokeless tobacco and any tobacco. Attempting to quit and discontinuing use among those who attempted were each evaluated for cigarettes and ENDS. Generalised estimating equations were used to evaluate linear and non-linear trends in rates across the study period.
Results
Between 2013 and 2019, biennial rates of discontinuing tobacco product use among youth increased for cigarettes from 29% to 40%, increased for smokeless tobacco from 39% to 60%, and decreased for ENDS from 53% to 27%. By 2018/2019, rates of discontinuing use among attempters were 30% for those who used ENDS and 30% for those who smoked cigarettes.
Conclusions
Findings show decreasing rates of discontinuing ENDS use among youth in the USA alongside the changing ENDS marketplace and increasing rates of discontinuing cigarette smoking and smokeless tobacco use. Findings will serve as benchmarks against which future tobacco product discontinuation rates can be compared with evaluating impacts of subsequent tobacco regulatory policies, ENDS product development and public education campaigns.
Purpose of review:
E-cigarettes have been long purported to be a mechanism of harm reduction in current smokers. However, market expansion to adolescents has been aggressive, despite government interventions. Research examining the adverse effects of e-cigarettes in teens with asthma has been limited. We discuss the most recent data on the pulmonary manifestations of e-cigarettes use and exposure in adolescents with asthma.
Recent findings:
Adolescents with asthma are more likely to be e-cigarette users than those without asthma and more likely to have asthma exacerbations. Increased pulmonary inflammatory cytokines have been seen in e-cigarette users and mouse models. Yet, providers are not confident in e-cigarette screening and counselling despite acknowledging adolescents are using e-cigarettes regularly.
Summary:
Since the introduction of e-cigarettes into the United States market in 2007, adolescents use of these products has risen, even after a brief decline during the height of the COVID-19 pandemic. This review will describe the most recent studies on e-cigarette use trends, cytotoxicity of e-cigarette aerosol and associations with the diagnosis and symptoms of asthma. Knowledge gaps, advocacy efforts, evidence on e-cigarette cessation will be highlighted.
Objectives. To describe the evolution of flavored e-cigarette sales since the expansion of the JUUL brand, and to describe the effect of JUUL’s November 2018 decision to self-regulate the flavors it sold in stores on flavored e-cigarette sales.
Methods. We used Scantrack data on sales of e-cigarettes in the United States from January 2015 to October 2019 provided by The Nielsen Company. National sales values were aggregated monthly in 5 flavor categories (fruit, menthol/mint, sweet, tobacco, and other).
Results. The expansion of JUUL sales coincided with an expansion in fruit-flavor sales through October 2018. Once JUUL withdrew fruit and sweet flavors from stores, menthol/mint came to dominate the e-cigarette market, but through 2019, a new surge in fruit-flavor sales by non-JUUL brands was observed.
Conclusions. After a decline in sales following JUUL’s decision to withdraw some flavored products from stores, JUUL sales recovered within weeks and surpassed their previous maximum in those same channels, as consumption shifted to the menthol/mint and tobacco flavors that remained on shelves.
Public Health Implications. These trends suggest shortcomings of self-regulation and highlight the utility of government regulation. (Am J Public Health. Published online ahead of print April 16, 2020: e1–e3. doi:10.2105/AJPH.2020.305667)
Since August 2019, CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders have been investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). This report updates patient demographic characteristics, self-reported substance use, and hospitalization dates for EVALI patients reported to CDC by states, as well as the distribution of emergency department (ED) visits related to e-cigarette, or vaping, products analyzed through the National Syndromic Surveillance Program (NSSP). As of January 14, 2020, a total of 2,668 hospitalized EVALI cases had been reported to CDC. Median patient age was 24 years, and 66% were male. Overall, 82% of EVALI patients reported using any tetrahydrocannabinol (THC)-containing e-cigarette, or vaping, product (including 33% with exclusive THC-containing product use), and 57% of EVALI patients reported using any nicotine-containing product (including 14% with exclusive nicotine-containing product use). Syndromic surveillance indicates that ED visits related to e-cigarette, or vaping, products continue to decline after sharply increasing in August 2019 and peaking in September 2019. Clinicians and public health practitioners should remain vigilant for new EVALI cases. CDC recommends that persons not use THC-containing e-cigarette, or vaping, products, especially those acquired from informal sources such as friends, family members, or from in-person or online dealers. Vitamin E acetate is strongly linked to the EVALI outbreak and should not be added to any e-cigarette, or vaping, products (2). However, evidence is not sufficient to rule out the contribution of other chemicals of concern, including chemicals in either THC- or non-THC-containing products, in some reported EVALI cases.
Adolescent e-cigarette use has increased substantially since 2016.¹ To counteract such trends, public health agencies are considering regulatory restrictions of e-cigarettes in flavors popular among youths.²,3 Whether certain flavors warrant inclusion or exemption from regulatory policies is unclear because recent estimates of the specific e-cigarette flavors adolescents use are lacking.
Importance
The prevalence of e-cigarette use among US youth increased from 2011 to 2018. Continued monitoring of the prevalence of e-cigarette and other tobacco product use among youth is important to inform public health policy, planning, and regulatory efforts.
Objective
To estimate the prevalence of e-cigarette use among US high school and middle school students in 2019 including frequency of use, brands used, and use of flavored products.
Design, Setting, and Participants
Cross-sectional analyses of a school-based nationally representative sample of 19 018 US students in grades 6 to 12 participating in the 2019 National Youth Tobacco Survey. The survey was conducted from February 15, 2019, to May 24, 2019.
Main Outcomes and Measures
Self-reported current (past 30-day) e-cigarette use estimates among high school and middle school students; frequent use (≥20 days in the past 30 days) and usual e-cigarette brand among current e-cigarette users; and use of flavored e-cigarettes and flavor types among current exclusive e-cigarette users (no use of other tobacco products) by school level and usual brand. Prevalence estimates were weighted to account for the complex sampling design.
Results
The survey included 10 097 high school students (mean [SD] age, 16.1 [3.0] years; 47.5% female) and 8837 middle school students (mean [SD] age, 12.7 [2.8] years; 48.7% female). The response rate was 66.3%. An estimated 27.5% (95% CI, 25.3%-29.7%) of high school students and 10.5% (95% CI, 9.4%-11.8%) of middle school students reported current e-cigarette use. Among current e-cigarette users, an estimated 34.2% (95% CI, 31.2%-37.3%) of high school students and 18.0% (95% CI, 15.2%-21.2%) of middle school students reported frequent use, and an estimated 63.6% (95% CI, 59.3%-67.8%) of high school students and 65.4% (95% CI, 60.6%-69.9%) of middle school students reported exclusive use of e-cigarettes. Among current e-cigarette users, an estimated 59.1% (95% CI, 54.8%-63.2%) of high school students and 54.1% (95% CI, 49.1%-59.0%) of middle school students reported JUUL as their usual e-cigarette brand in the past 30 days; among current e-cigarette users, 13.8% (95% CI, 12.0%-15.9%) of high school students and 16.8% (95% CI, 13.6%-20.7%) of middle school students reported not having a usual e-cigarette brand. Among current exclusive e-cigarette users, an estimated 72.2% (95% CI, 69.1%-75.1%) of high school students and 59.2% (95% CI, 54.8%-63.4%) of middle school students used flavored e-cigarettes, with fruit, menthol or mint, and candy, desserts, or other sweets being the most commonly reported flavors.
Conclusions and Relevance
In 2019, the prevalence of self-reported e-cigarette use was high among high school and middle school students, with many current e-cigarette users reporting frequent use and most of the exclusive e-cigarette users reporting use of flavored e-cigarettes.
FDA expands youth e-cigarette prevention campaign to include stories from teenagers addicted to nicotine. Press release. US Food and Drug Administration
- Fda In Brief