Despite a minor reduction in current use among the youngest adults, daily e-cigarette use is increasing
According to recent research funded by the American Heart Association’s Tobacco Center of Regulatory Science and published today in JAMA Network Open, daily e-cigarette use has been steadily rising among U.S. adults, even though overall current electronic cigarette use (defined as use within the past 30 days) decreased slightly in 2020 compared to prior years.
“We were happy to see a little decrease in overall e-cigarette usage over this time, which this study shows as self-reported e-cigarette use among adults in the U.S. between 2017 and 2020.” “That was primarily caused by a decrease in current e-cigarette use, defined as use within the past 30 days, among our youngest adults, those between the ages of 18 and 20.
” Michael J. Blaha, M.D., M.P.H., director of clinical research at the Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease in Baltimore and senior study author, Michael J. Blaha, M.D., M.P.H. The majority of the increase in daily e-cigarette use among adults was seen among those between the ages of 21 and 24, which was troubling to see overall.
The authors of the study examined e-cigarette usage among more than 429,000 U.S. adults in 2017, more than 280,000 individuals in 2018, and almost 285,000 adults in 2020, using data from the Behavioral Risk Factor Surveillance System for the years 2017 to 2020.
They looked at a variety of things, including national estimates of current (past 30 days) and daily e-cigarette usage; current (past 30 days) e-cigarette use for each state or territory; and changes at the state level between 2017 and 2020.
The researchers found:
- Current e-cigarette use, defined as use in the previous 30 days, fell slightly among US adults, from 5.5 percent in 2018 to 5.1 percent in 2020. The authors noticed that the group affected by the Tobacco-21 Act, which raises the minimum age for e-cigarette sales from 18 to 21 years, was young adults aged 18 to 20 years, who saw drops in their current e-cigarette use. The American Heart Association backed this measure wholeheartedly.
- Not all states experienced the same decrease in e-cigarette use during the previous 30 days between 2018 and 2020. In several states, e-cigarette use has significantly decreased during the last 30 days. In Connecticut, for example, the prior 30-day e-cigarette use rate fell from 5.6% to 4.5 percent. E-cigarette use during the previous 30 days decreased in North Dakota, Massachusetts, and New York. However, e-cigarette use increased in other states and territories, including in Guam, where it rose from 5.9% to 11.4% in the previous 30 days. The use of e-cigarettes increased more rapidly in the last 30 days in Tennessee, Kansas, Utah, and Kansas.
- Daily e-cigarette usage, which signals a shift to greater nicotine dependence, has progressively increased, raising concerns about public health. The proportion of current e-cigarette users who reported using them on a daily basis increased significantly from 34.5 percent in 2017 to 44.4 percent in 2020. The prevalence of daily e-cigarette usage among young adults aged 21 to 24 climbed from 4.4 percent to 6.6 percent between 2018 and 2020, according to the authors.
“Acute exposure studies have revealed that e-cigarettes have negative effects on the cardiovascular system, including elevated heart rate and blood pressure. However, there is insufficient evidence about the long-term cardiovascular effects of using exclusively e-cigarettes.
“More importantly, using e-cigarettes along with traditional cigarettes is a dangerous use pattern that increases the risk of lung and cardiovascular disease,” Blaha, who is the lead researcher on the Cardiovascular Effects of Tobacco Products in Community-based Cohorts project funded by the Tobacco Center of Regulatory Science of the American Heart Association through federal grants, said.
According to earlier research, using these items in addition to combustible cigarettes has been linked to worse tobacco-related health effects than not using them at all.
Blaha noted that in order to assess the efficacy of laws and initiatives aimed at enhancing public health by reducing the use of all nicotine products, including e-cigarettes and combustible cigarettes, it is essential to track how patterns of e-cigarette use are changing among various population subgroups, including youth, those who are tobacco naive, and those who use combustible cigarettes.
“Youth e-cigarette use has dropped, according to recent studies.” This may be an early sign that recently implemented federal and state policies, such as the Tobacco-21 legislation and e-cigarette flavor restrictions, are having an impact, especially when combined with the study’s finding of a modest decline in current use among young adults between the ages of 18 and 20, “said research fellow at the Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease and study co-author Ellen Boakye, M.D., M.P.H. It’s also conceivable that the widespread public education and raised public awareness that went along with the 2019 e-cigarette or vaping product use-associated lung injury (EVALI) outbreak contributed.
However, the authors pointed out that while some of these factors might have helped to influence how people use e-cigarettes, this study did not establish whether or not issues like laws truly had an effect.
According to Blaha, variations in state-level laws and regulations may also be reflected in variations in e-cigarette use.
According to him, “For instance, the considerable declines in e-cigarette use in Massachusetts and New York correlated with the reported declines in e-cigarette sales in these states following their state-wide prohibitions on flavored e-cigarette sales.”
According to Boakye, the increase in daily e-cigarette usage is cause for concern because it may signal a shift from infrequent or experimental use to greater nicotine dependence, addiction, and health risks. Furthermore, although current e-cigarette use among young individuals between the ages of 18 and 20 has decreased, a sizable portion, 15.6%, still report using these gadgets.
Therefore, Tobacco-21 regulations need to be enforced more strictly, and policies discouraging the social sharing of e-cigarettes are needed. Additionally, steps that deter young adults from using e-cigarettes are required.
Additionally, there is a need for ongoing monitoring of e-cigarette use patterns, especially daily use, as this constitutes a troubling new pattern of use with a higher risk of nicotine addiction and eventual initiation of combustible cigarettes, “added Blaha.
To help guide regulations intended to discourage these transitions, more research is required to evaluate the characteristics that predict the shift from occasional to frequent or daily e-cigarette usage.
The authors go on to say that medical practitioners should feel at ease addressing e-cigarette use with patients in order to educate them about the risks, screen for e-cigarette and other tobacco product use, and encourage efforts to quit.
Because not all states supplied data on e-cigarette usage in 2018 and 2020, estimates for those years may not be nationally representative, which is a limitation of this study.