E-cigarette use peaked in 2019, but intensity of use continues to rise

Although the prevalence of e-cigarette use peaked in 2019, the age of initiation of nicotine continues to decrease, and the intensity of use rises annually, researchers reported in JAMA Network Open.

Stanton Glantz, PhD, professor of medicine at the University of California, San Francisco, and colleagues sought to measure the intensity of e-cigarette, cigarette and tobacco product use and their dependence levels among American adolescents.

Glantz and colleagues analyzed the cross-sectional National Youth Tobacco Surveys from 2014 to 2021 to assess first tobacco products used, age at the initiation of use, intensity of use and nicotine addiction. The surveys were administered to American students in grades 6 through 12.

A total of 151,573 respondents were included in the analysis (mean age, 14.57 years; 51.1% male). The proportion of those who smoked an e-cigarette as their first tobacco product increased from 27.2% in 2014 to 78.3% in 2019 and remained at 77% in 2021. By 2017, e-cigarettes were the most common form of first tobacco product used.

The age of first use for e-cigarettes decreased by –0.159 years (95% CI, –0.176 to 0.143) per calendar year. In contrast, the change in age for the first use of cigarettes, cigars and smokeless tobacco was not clinically significant.

Median e-cigarette use increased from 3 to 5 days per month in 2014 to 2018 to 6 to 9 days per month in 2019 to 2020 and 10 to 19 days per month in 2021.

“The changes detected in this survey study may reflect the higher levels of nicotine delivery and addiction liability of modern e-cigarettes that use protonated nicotine to make nicotine easier to inhale,” Glantz and colleagues wrote. “The increasing intensity of use of modern e-cigarettes highlights the clinical need to address youth addiction to these new high-nicotine products over the course of many clinical encounters.”