Daily e-cigarette use among teens ‘seemed to accelerate’ after 2017

Daily e-cigarette use among teens “seemed to accelerate” after 2017, according to a new study in JAMA Network Open.

Last year, more than 2.5 million students reported currently using tobacco, with symptoms such as wheezing and shortness of breath also being reported in youth users.

Co-author Jonathan P. Winickoff, MD, MPH, a professor of pediatrics at Harvard Medical School and at MassGeneral Hospital for Children, told Healio that the inspiration for the study came from seeing large numbers of patients in his practice being “extremely addicted” to e-cigarettes.

“I had been concerned that people were underestimating the continued effect of e-cigarettes on youth,” Winickoff said. “I noticed that for a lot of my patients, they would be using e-cigarettes throughout the day. For example, [e-cigarettes weren’t just in use] when they were outside of the home; these children were actually sneaking them in their own bedroom. And if they woke up during the night, they would use [a product] to just be able to get back to sleep because they were uncomfortable due to nicotine withdrawal.”

Winickoff saw the trend “just continuing and worsening” in his patients but believed that little was being done or studied regarding e-cigarettes.

“I felt like the spotlight had shifted away from [this issue], so I wanted to see what the data showed in terms of addiction for kids,” Winickoff said.

In their review, Winickoff and his colleagues examined data from the National Youth Tobacco Survey, which asked 151,573 middle and high school students across the country from the years 2014 to 2021 about their habits with tobacco and e-cigarettes, including vaping products.

“We looked at the number of days per month that students said they used their e-cigarettes, and we also looked at the rates of cigarette, cigar and smokeless tobacco use per number of days per month,” Winickoff said.

Among the surveyed adolescents who reported current use of a tobacco product, the percentage who reported using an e-cigarette as their first tobacco product increased from 27.2% in 2014 to 78.3% in 2019. Intensity of e-cigarette use also shifted from 9 or fewer days a month to 10 or more days a month.

“What we found was that middle and high school students were, over time, using their products on more days per month,” Winickoff said. “This trend really seemed to accelerate after 2017. Once the protonated form of nicotine e-cigarettes came on the market, it seemed like there was a dramatic shift to higher levels of adolescent addiction, and those levels were over 10-fold what they had been prior to these newer forms of e-cigarettes.”

The findings are especially urgent, Winickoff said, with California set to vote on Proposition 31. The proposition is a referendum regarding a 2020 law that prohibited the retail sale of certain flavored tobacco products, and it could mean a full-on ban in the largest state on the West Coast if citizens vote “no” on the measure.

“This is a huge opportunity to ban menthol-flavored tobacco products and other flavored e-cigarettes in the entire state of California,” Winickoff said.

Early intervention is crucial, Winickoff added, to head off further tobacco habits later in life.

“If they don't intervene with that child, they may go on to use tobacco products for the rest of their life,” Winickoff said. “Switch over to combustible cigarettes, they may use other forms of combustible tobacco, and they may not be able to quit. I have to treat every child, even just an occasional user, as a clinically urgent situation.”

References:

Glantz S, et al. JAMA Netw Open. 2022;doi: 10.1001/jamanetworkopen.2022.40671.

The Office of the California Legislature’s Nonpartisan Fiscal and Policy Advisor. Referendum on 2020 law that would prohibit the retail sale of certain flavored tobacco products. https://lao.ca.gov/BallotAnalysis/Proposition?number=31&year=2022. Accessed Nov. 7, 2022.