E-cigarette use rose amid outbreak of vaping-associated lung injury

Key takeaways:

• E-cigarette use increased among younger adults from 8.8% in 2019 to 10.2% in 2021.
• The increase was primarily driven by a rise in e-cigarette use among those who had never smoked cigarettes.

E-cigarette use significantly increased among younger adults from 2019 to 2021, a time that spanned an outbreak of e-cigarette- or vaping-associated lung injury, known as EVALI, according to researchers at the American Cancer Society.

“Unfortunately, these numbers show we’re moving in the wrong direction concerning e-cigarette use in this vulnerable population,” Priti Bandi, PhD, a senior principal scientist of cancer risk factors and screening surveillance research at the American Cancer Society, said in a press release.

Bandi and colleagues wrote in the American Journal of Preventive Medicine that e-cigarette use as a smoking cessation aid increased before the EVALI epidemic and COVID-19 pandemic, but the prevalence by age groups and smoking status since then have been unknown.

The researchers pooled data from the National Health Interview Survey in 2019, 2020 and 2021 to investigate e-cigarette use trends in those subgroups, along with prevalence differences between survey years.

Of the 90,532 respondents, 20.6% were aged 18 to 29 years, 25.2% were aged 30 to 44 years, 24.1% were aged 45 to 59 years and 30% were aged 60 years and older.

Bandi and colleagues found that e-cigarette use among those aged 18 to 29 years increased from 8.8% in 2019 to 10.2% in 2021, for an adjusted prevalence difference of 1.7% (95% CI, 0.1-3.3).

The rise was significantly influenced by young adults who had never smoked cigarettes, for whom e-cigarette use rose from 4.9% in 2019 to 6.4% in 2021 (95% CI, 0.3-3.1). That group made up 53% of all young adults who used an e-cigarette in 2021, according to the researchers.

“Our research finding is concerning as it may point to an increase in nicotine addiction risk for young adults, potentially contributing to progression to combustible tobacco products, and may also increase exposure to unknown toxicants, carcinogens, and the risk of respiratory diseases,” Bandi said.

The prevalence of e-cigarette use in 2019 and 2021 was similar for every other adult age group “because declines between 2019 and 2020 offset increases between 2020 and 2021,” the researchers wrote.

Those who formerly smoked made up the largest proportion of adults who used e-cigarettes in 2021 among those:

• aged 30 to 44 years (51.8%);
• aged 45 to 59 years (51.6%); and
• aged 60 years and older (47.5%).

Additionally, among former and current smokers, e-cigarette prevalence remained similar in 2019 and 2021, which “possibly reflects rising perceptions that e-cigarettes are relatively more harmful than cigarettes after EVALI epidemic and COVID-19 pandemic, which may contribute to low acceptability and use of e-cigarettes as smoking-cessation aids,” the researchers wrote.

Ultimately, “e-cigarette use is not harmless at any age,” Bandi noted.

“It may have serious health risks, including negative short-term effects on airways and blood vessels, and we do not know the long-term effects of their use,” she said. “We must address the rise in e-cigarette use among younger adults who never smoked cigarettes and, at the same time, help those who may have switched from cigarettes to e-cigarettes to stop using these devices completely.”

References:

• Bandi P, et al. Am J Prev Med. 2023;doi:10.1016/j.amepre.2023.02.026.
• New research shows e-cigarette use up sharply among younger adults in U.S. during EVALI outbreak and COVID-19 pandemic. https://www.eurekalert.org/news-releases/986343. Published April 18, 2023. Accessed April 18, 2023.