Cigarette smoking declines among young adults, but e-cigarette use increases to new high
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Key takeaways:
- Everyday e-cigarette use rose from 1.2% in 2013-2014 to 8.3% in 2021 among young adults.
- Researchers said treatments are lacking for established vaping.
Cigarette smoking has decreased among young adults in the United States, but nearly 15% reported regularly using e-cigarettes in 2021, a level higher than previously reported, according to study findings published in JAMA Internal Medicine.
“These findings have important implications for the future of tobacco prevention and treatment efforts,” Benjamin A. Toll, PhD, professor in the department of psychiatry at Yale School of Medicine, told Healio. “What stands out in particular is the dramatic inflection between 2019 and 2021, where combustible tobacco use drops by approximately a third.”
Prior research has shown that e-cigarette use, or vaping, among young adults correlated with an increase in vaping-associated lung injuries. Despite this, screening for e-cigarette use remains lower than screening for other substances in primary care.
Toll and colleagues measured e-cigarette use and cigarette smoking among adults aged 18 to 24 years using Population Assessment of Tobacco and Health (PATH) study data from six survey waves spanning 2013 to 2021.
The researchers found that from the first wave (2013-2014) to the sixth wave (2021):
- the prevalence of those who ever used cigarettes decreased from 53.2% to 35.2%;
- the prevalence of those who ever used e-cigarettes increased from 32% to 52.7%;
- the prevalence of those who were currently established smokers decreased from 19.6% to 6.1%;
- the prevalence of those who were currently established vapers increased from 3.8% to 14.5%;
- the prevalence of those who were currently established vapers but never currently established smokers increased from 1.1% to 8.1%; and
- everyday e-cigarette use increased from 1.2% to 8.3%.
Notably, the prevalence of current established vaping in the sixth wave was higher than previously reported by the CDC (11%), according to the researchers. That increase coincides “with the introduction of salt-based devices in 2015 to 2018,” they wrote.
The data, they added, suggest that e-cigarettes could become the dominant tobacco product in the U.S.
Toll highlighted the importance of screening for e-cigarette use in primary care.
“We published data earlier this year showing that in primary care e-cigarette use screening is conducted at a significantly lower rate than combustible tobacco, alcohol or illicit substance use,” he said. “Health systems should undertake efforts to improve screening rates in primary care.
“Physicians should speak to the increased risk of nicotine addiction that e-cigarettes represent,” Toll said. “Most e-cigarette users report a desire to quit and the concentrated delivery of nicotine in modern e-cigarettes products can make that incredibly difficult. We don't know yet what the long-term health consequences are, but we are very uncomfortable that there are so many flavored and disposable e-cigarettes that are clearly marketed to young people.”
References:
- National survey indicates more young adults begin tobacco use with vaping, not cigarettes. https://www.eurekalert.org/news-releases/1007641. Published Nov. 13, 2023. Accessed Nov. 13, 2023.
- Sanford BT, et al. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2023.5239.
Perspective
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This survey suggests that though cigarette smoking has decreased over the past 10 years in young adults, it has been associated with a rise in e-cigarette use. The study also reports that previous never-smokers have taken up e-cigarettes, which is a disturbing trend. The relative risk of cigarette smoke compared to e-cigarettes is unknown, though there seems to be a thought in some circles that e-cigarettes are safer than tobacco cigarettes. We do know that no smoking of any kind is better for your lungs and overall health compared to either tobacco or e-cigarettes.
Just as in all preventive health recommendations, physicians have to play a central role in educating our patients about the risks of e-cigarettes, and most physicians are doing so already. It is our practice to inquire about both tobacco and e-cigarettes at each visit when we see our patients. If they are doing either, we will discuss the potential harm to their lungs and other parts of the body, as well cessation strategies.
Northwestern University Feinberg School of Medicine
Member, Primary Care Peer Perspective Board
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