In the JournalsPerspective

More than 10 million in US use e-cigarettes

Despite safety concerns of e-cigarettes, they are commonly used in the United States, especially among young adults, according to findings published in Annals of Internal Medicine.

“E-cigarettes were introduced in the United States more than a decade ago, with the general population perceiving these products as a safer substitute for combustible cigarettes,” Mohammadhassan Mirbolouk, MD, from the American Heart Association Tobacco Regulation and Addiction Center, and colleagues wrote. “Subsequently, the prevalence of e-cigarette use has risen, especially among adolescents and younger adults. The medical community, however, remains concerned regarding both the safety of e-cigarettes and their utility as smoking cessation devices.”

Mirbolouk and colleagues analyzed data from the 2016 Behavioral Risk Factor Surveillance System survey to determine the prevalence of current e-cigarette use among adults aged 18 years and older in the United States in 2016. The researchers also assessed use by geographical location, demographic subgroups and cigarette smoking status.

Of the 466,842 patients who were surveyed on e-cigarette use, 15,240 reported current use of e-cigarettes, corresponding to a prevalence rate of 4.5% or 10.8 million current e-cigarette users. Fifteen percent of e-cigarette users never smoked cigarettes.

Individuals aged 18 to 24 years were most likely to use e-cigarettes (9.2%; 95% CI, 8.6-9.8). This corresponded to about 2.8 million e-cigarette users in this age range. Adults younger than 35 years accounted for 51.2% of current e-cigarette users.

There was a high age-standardized prevalence of e-cigarette use among men, LGBT persons, current combustible cigarette smokers, and those with chronic health conditions, according to the researchers. States had varying prevalence rates of e-cigarette use, ranging from 3.1% (95% CI, 2.3-4.1) in South Dakota to 7% (95% CI, 6-8.2) in Oklahoma.

“We believe our study provides the most up-to-date and detailed national and state-level prevalence estimates of e-cigarette use in a nationally representative survey of the United States,” Mirbolouk and colleagues concluded. “These data will help inform health care policymakers about the size and characteristics of the e-cigarette–using population; facilitate monitoring of temporal trends in use patterns; and guide future research efforts, public education campaigns, and tobacco regulatory policy.”

In a related editorial, Nancy A. Rigotti, MD, from Massachusetts General Hospital and Harvard Medical School, wrote that monitoring the use of alternative tobacco products should be a priority for policymakers as they continue to evolve rapidly. Rigotti noted rapidly increasing sales of JUUL, a rechargeable vaping device resembling a flash drive that is marketed via social media, making it more attractive to youth.

“How this will affect the use of new and conventional products by adults and adolescents bears close monitoring,” she added. “Will the appearance of JUUL counter the recent apparent decline in e-cigarette prevalence in the U.S. population? The answers to that and other critical questions are eagerly awaited.” – by Alaina Tedesco

Disclosure: Mirbolouk reports receiving grants from A-TRAC. Please see study for all other authors’ relevant financial disclosures.

 

Despite safety concerns of e-cigarettes, they are commonly used in the United States, especially among young adults, according to findings published in Annals of Internal Medicine.

“E-cigarettes were introduced in the United States more than a decade ago, with the general population perceiving these products as a safer substitute for combustible cigarettes,” Mohammadhassan Mirbolouk, MD, from the American Heart Association Tobacco Regulation and Addiction Center, and colleagues wrote. “Subsequently, the prevalence of e-cigarette use has risen, especially among adolescents and younger adults. The medical community, however, remains concerned regarding both the safety of e-cigarettes and their utility as smoking cessation devices.”

Mirbolouk and colleagues analyzed data from the 2016 Behavioral Risk Factor Surveillance System survey to determine the prevalence of current e-cigarette use among adults aged 18 years and older in the United States in 2016. The researchers also assessed use by geographical location, demographic subgroups and cigarette smoking status.

Of the 466,842 patients who were surveyed on e-cigarette use, 15,240 reported current use of e-cigarettes, corresponding to a prevalence rate of 4.5% or 10.8 million current e-cigarette users. Fifteen percent of e-cigarette users never smoked cigarettes.

Individuals aged 18 to 24 years were most likely to use e-cigarettes (9.2%; 95% CI, 8.6-9.8). This corresponded to about 2.8 million e-cigarette users in this age range. Adults younger than 35 years accounted for 51.2% of current e-cigarette users.

There was a high age-standardized prevalence of e-cigarette use among men, LGBT persons, current combustible cigarette smokers, and those with chronic health conditions, according to the researchers. States had varying prevalence rates of e-cigarette use, ranging from 3.1% (95% CI, 2.3-4.1) in South Dakota to 7% (95% CI, 6-8.2) in Oklahoma.

“We believe our study provides the most up-to-date and detailed national and state-level prevalence estimates of e-cigarette use in a nationally representative survey of the United States,” Mirbolouk and colleagues concluded. “These data will help inform health care policymakers about the size and characteristics of the e-cigarette–using population; facilitate monitoring of temporal trends in use patterns; and guide future research efforts, public education campaigns, and tobacco regulatory policy.”

In a related editorial, Nancy A. Rigotti, MD, from Massachusetts General Hospital and Harvard Medical School, wrote that monitoring the use of alternative tobacco products should be a priority for policymakers as they continue to evolve rapidly. Rigotti noted rapidly increasing sales of JUUL, a rechargeable vaping device resembling a flash drive that is marketed via social media, making it more attractive to youth.

“How this will affect the use of new and conventional products by adults and adolescents bears close monitoring,” she added. “Will the appearance of JUUL counter the recent apparent decline in e-cigarette prevalence in the U.S. population? The answers to that and other critical questions are eagerly awaited.” – by Alaina Tedesco

Disclosure: Mirbolouk reports receiving grants from A-TRAC. Please see study for all other authors’ relevant financial disclosures.

 

    Perspective
    Samir Soneji

    Samir Soneji

    This study reaches several troubling conclusions about electronic cigarette use in the U.S. 

    First, e-cigarette use is more common among LGBTQ adults than straight adults. The tobacco industry has long targeted sexual and gender minorities with focused marketing and advertising campaigns. Higher e-cigarette use may worsen existing disparities in tobacco use among these populations.  

    Second, e-cigarette use is more common younger adults than older adults. A growing body of evidence consistently concludes that e-cigarettes facilitate the transition to traditional cigarette smoking among never-smoking adolescents and young adults. Moreover, this clear harm is not outweighed by any potential benefit of cigarette smoking cessation from e-cigarette use because, as this study finds, e-cigarette use among current cigarette smokers is relatively low.  

    Healthcare providers and the general population, alike, ought to consider the growing scientific literature that identifies numerous domains of harm associated with e-cigarette use, and scrutinize tobacco and e-cigarette industry marketing that promotes e-cigarette use as safe.

    • Samir Soneji, PhD
    • Associate professor
      The Dartmouth Institute

    Disclosures: Soneji reports no relevant financial disclosures.