Adult E-cigarette Users Research Articles

Oral Hygiene Practices of Hungarian Adult E-Cigarette-Only and Dual Users.

This study aimed to explore self-reported oral hygiene practices (OHPs) among Hungarian adult e-cigarette-only (former smokers who switched completely to e-cigarette use or vaping) and dual users (smokers who use e-cigarettes and combustible tobacco cigarettes concomitantly). A cross-sectional, web-based survey of 930 adult Hungarian e-cigarette users was conducted in 2015. Participants reported 10 OHPs, which were included in analyses as separate binary variables and as a composite variable of the 10 OHP items (inadequate/adequate). Chi-square test was used to explore whether separate OHPs differ by vaping status, and to examine the relationship between inadequate OHPs and past combustible or e-cigarette use characteristics. Associations between separate OHPs and vaping status, and between inadequate OHPs and vaping status were tested by multiple logistic regression analyses. More dual users reported toothbrushing twice a day or more than e-cigarette-only users (73.6% vs 65.3%, respectively, p = 0.041) and using sugar-free chewing gum (57.7% vs 45.8%, respectively, p = 0.006) while adequacy of other OHPs did not differ statistically significantly by vaping status. Inadequate OHPs were more typical in the sample (63.7%) than adequate OHPs, however, inadequate OHPs did not differ statistically significantly among dual users and e-cigarette-only users (62.0% vs 64.0%, respectively, OR = 1.20, p = 0.400), controlling for age, gender, education, past combustible and current e-cigarette use characteristics. In this study, both e-cigarette-only and dual users demonstrated similarly high prevalence of inadequate OHPs. Therefore dentists should educate them about effective OHPs and the role of tobacco and e-cigarette use in the development of oral diseases.

Emotion dysregulation, fatigue, and electronic cigarette expectancies

ABSTRACT Emotion dysregulation and the experience of fatigue have both been linked to the maintenance of substance use. However, limited empirical data has evaluated individual differences in these constructs in terms of e-cigarette use expectancies. The present study examined a theoretically relevant model focused on whether the experience of more severe fatigue explains, in part, the relation between individual differences in emotion dysregulation and positive and negative e-cigarette expectancies among 525 adult e-cigarette users (50.9% female, Mage = 35.25 years, SD = 10.10). It was hypothesized that emotion dysregulation, via fatigue severity, would significantly predict greater positive and negative e-cigarette expectancies, which was examined in two separate mediation models. Fatigue severity significantly explained, in part, the relation between emotion dysregulation and positive (b = 0.02, CI [0.01, 0.02]) and negative expectancies of e-cigarette use (b = 0.02, 95% CI [0.02, 0.03]). The current findings suggest that the experience of fatigue helps explain the relation between emotion dysregulation and positive and negative e-cigarette expectancies among adult e-cigarette users. Future work is needed to explicate how reducing fatigue severity in the context of emotion dysregulation may change expectancies about e-cigarette expectancies.

Awareness, trial and use of heated tobacco products among adult cigarette smokers and e-cigarette users: findings from the 2018 ITC Four Country Smoking and Vaping Survey

ObjectiveTo evaluate heated tobacco product (HTP) awareness, trial and current use among adult cigarette smokers and vaping product users in four countries with varying regulations governing HTP sales.DesignData came from...

Perceptions and Experiences of Vaping Among Youth and Young Adult E-Cigarette Users: Considering Age, Gender, and Tobacco Use

PurposeThis study examined differences in the topics of vaping perceptions (positive and negative aspects) and experiences (social media content) among e-cigarette users segmented by age and gender (male and female youth and young adults) and tobacco use (never, former, or current user). MethodE-cigarette users (N = 558, 53.6% male, mean age: 18.6 years [SD = 2.2], mean use: 5.3 days/week [SD = 2.3]) residing in Nova Scotia, Canada, responded to three open-ended topic questions concerning vaping in an online survey. Responses to each topic (e.g., positive aspects) were coded and grouped into categories (e.g., flavors). Chi-square tests were used to examine whether groups differed by topic, and Bonferroni correction tests were used to determine specific group differences in each coded category. ResultsAge and gender groups differed in their positive perceptions of a nicotine rush, tricks, and positive social aspects of vaping and in their negative perceptions of respiratory effects, nicotine effects, product malfunction and cost, and negative social aspects of vaping. Age and gender groups also differed in exposure to tricks and branding on social media. Tobacco use groups differed in their positive perceptions of flavor, nicotine rush, tricks, low cost, enhancement, and smoking cessation and in their negative perceptions of negative social aspects and exposure to tricks on social media. ConclusionsThere are notable similarities and differences among youth and young adult e-cigarette users by age, gender, and tobacco use. Policies and interventions should incorporate these distinctions to effectively address the increasing use of e-cigarettes among young users.

Differences in motives by personality risk profiles: Examining regular youth and young adult e-cigarette users

IntroductionResearch concerning e-cigarette use has revealed links between personality traits and motives for use. However, no studies have examined how these traits holistically relate to motives. MethodsE-cigarette users (N = 468) residing in Nova Scotia, Canada (aged 16–24) completed an online survey containing a demographic and vaping questionnaire, the Substance Use Risk Profile Scale, and a modified Drinking Motives Questionnaire. A k-means cluster analysis and one-way MANOVA were used to segment users and measure differences in motives for use by cluster membership. Crosstabulation analyses were conducted to measure demographic differences. ResultsA four-cluster solution generated groups that differed based on SURPS: Anxiety sensitivity laden risk, global high-risk, global low-risk, and sensation seeking laden risk vape users. The global low-risk group had the lowest levels of coping, conformity, and social motives, while the global high-risk group had the highest levels of these motives except coping. Females were overrepresented in the anxiety sensitivity laden risk group and underrepresented in the sensation seeking laden risk group. Employed individuals were overrepresented in the global low-risk group. ConclusionSegmenting e-cigarette users based on SURPS can identify groups with stronger vaping motives to better prevent initiation and continued use.

Exploring positive expectancies and quit status among adult electronic cigarette users

ABSTRACT Initial research on electronic cigarette (e-cigarette) use suggests differences exist in levels of use, beliefs, and cessation difficulties among users. However, little research has explored how these factors interact to confer worse e-cigarette outcomes. The current study examined the association between positive expectancies of e-cigarette use and e-cigarette processes among 544 (51.1% female; Mage = 35.4 years, SD = 10.12) adult e-cigarette users who had and had not attempted to quit e-cigarettes, a defining characteristic believed to distinguish those with and without greater e-cigarette quit difficulty. Results indicated that greater positive outcome expectancies of e-cigarette use were significantly related to increased perceived risks, benefits, and barriers to quitting. The strength of the associations was stronger for those who reported past quit attempts compared to those who never attempted quitting. Overall, the current study highlights the potentially important role that positive expectancies for e-cigarette use and quit attempt status play in e-cigarette processes. Findings suggest a possible need to contextualize positive expectancies for e-cigarette use within future e-cigarette cessation tactics and tailoring treatments based on quit attempt status.

An investigation of racial and ethnic differences in e-cigarette beliefs and use characteristics

In this study we provide information on e-cigarette use characteristics in relation to racial and ethnic characteristics in a sample of 535 adult e-cigarette users. We also evaluated how anxiety sensitivity (AS; fear of anxiety) interacted with race/ethnicity to predict vaping outcomes. We found an association between greater AS and higher e-cigarette dependence for White, but not Black, participants. A similar trend was observed for level of risk perception. Also, Hispanic status was associated with higher perception of e-cigarette benefits. Overall, the present study contributes to the understanding of factors linked to e-cigarette use.

Type of e-liquid vaped, poly-nicotine use and nicotine dependence symptoms in young adult e-cigarette users: a descriptive study

BackgroundData are lacking on type of e-liquid vaped among e-cigarette users. Further, few studies assess all sources of nicotine used by e-cigarette users to assess whether poly-nicotine use relates to nicotine dependence (ND). The objectives were to describe young adult e-cigarette users by: (i) type of e-liquid vaped; (ii) poly-nicotine use; (iii) ND symptoms; and (iv) attempts to quit conventional cigarettes.MethodsData were available in cycle 23 of a longitudinal investigation on the natural course of cigarette smoking and ND. A total of 775 young adults (44% male; mean (SD) age 30.5(1.0)) completed mailed self-report questionnaires in 2017–20.ResultsOf 775 participants, 149 (19.2%) reported past-year e-cigarette use. Overall, 55.0% of e-cigarette users had used cannabis-containing e-liquid (31.5% vaped cannabis e-liquid exclusively); 50.4% used nicotine-containing e-liquid (23.5% vaped nicotine e-liquid exclusively); and 39.9% used e-liquid without nicotine (8.7% vaped e-liquid without nicotine exclusively). Most e-cigarette users (82.6%) used other nicotine-containing products including conventional cigarettes (72.5%); 60.8% reported ND symptoms, rising to 79.4% among those who vaped nicotine-containing e-liquid. Finally, 29.0% tried to quit conventional cigarettes using e-cigarettes in the past-year, but only 16.7% found them helpful.ConclusionsE-cigarettes now appear to appeal to a broader market than smokers who want to quit. More than half of young adult e-cigarette users vaped cannabis-containing e-liquid in the past year while only one-quarter had used e-cigarettes to assist with cessation. Most e-cigarette users used multiple nicotine-containing substances (including combustible cigarettes) which were associated with reports of ND symptoms.

ENDS use among college students: Salivary biomarkers and persistent cough

Though e-cigarette aerosol has been associated with altered lung cell function, few studies have examined the effects of use on immune response and respiratory symptoms. The purpose of this study was to examine if recent persistent cough or cytokine levels are related to Electronic Nicotine Delivery Systems (ENDS) use in college students. In April 2019, 61 undergraduate students at the University of Kentucky completed surveys and provided a salivary sample to evaluate cytokine levels (Interleukin (IL-) 2, 4, 6, 8, 10, 12, 13 and TNFα, INFγ), using quota sampling to obtain comparable numbers of ENDS users and non-ENDS users. Data analysis included chi-square tests and multivariable logistic and linear regression. All ENDS users reported JUUL as their primary product. ENDS users were more likely to be younger, use cigarettes and marijuana, and report a persistent cough. Controlling for cigarette and marijuana use, there was a trend toward greater likelihood of persistent cough among ENDS users. Compared with nonusers, salivary IL-2 and INFγ were elevated and IL-4 was decreased, controlling for cigarette and marijuana use. There was a trend toward lower IL-12p70 values among ENDS users with these covariates. Findings reveal dysregulation of salivary immune profiles toward a TH1 phenotype in emerging adult ENDS users and short-term immune function may be dysregulated in young adult e-cigarette users.

Effectiveness of a Quit Vaping Text Message Program in Promoting Abstinence Among Young Adult E-Cigarette Users: Protocol for a Randomized Controlled Trial.

BackgroundMillions of young adults currently vape electronic cigarettes (e-cigarettes), yet little research on vaping cessation interventions exists. Text messaging is a promising, scalable intervention strategy for delivering vaping cessation treatment.ObjectiveThis study evaluates the effectiveness of a text message quit vaping program (This is Quitting) in promoting abstinence from e-cigarettes among young adults; examines changes in self-efficacy, perceived social norms, and social support for quitting as hypothesized mediators of effectiveness; and examines if treatment effectiveness is moderated by gender, race, ethnicity, or sexual minority status.MethodsOverall, 2600 young adult (aged 18-24 years) e-cigarette users in the United States will be recruited via web advertisements to participate in the study. Participants will be randomized to This is Quitting or an assessment-only control condition. The primary outcome measure is 30-day vaping abstinence at 7 months post enrollment.ResultsStudy recruitment began on December 18, 2019, and is projected to be completed by spring 2020. The final 7-month follow-up is anticipated to be completed by fall/winter 2020. Because this is the first-ever evaluation of a quit vaping program, we were unable to draw on existing literature to determine the appropriate sample size. Therefore, we examined abstinence rates among an initial pilot sample of 269 participants (This is Quitting: n=148 and control: n=121) who completed the 1-month follow-up to determine the final sample size. The 1-month response rate was 79.2% (213/269), with no difference between arms. Using intention-to-treat analyses that counted nonresponders as still vaping, 30-day abstinence rates were 16.2% (24/148) among those randomized to This is Quitting and 8.3% (10/121) among those randomized to control. A treatment difference of 16% vs 8% is detectable with 80% power at 2-sided alpha=.05 with 260/group (520 total). To detect treatment differences of this magnitude in a 20% subsample (eg, Hispanic or sexual minority young adult e-cigarette users), we will enroll 1300/group (2600 total).ConclusionsThe scientific, clinical, and public health communities are desperate for cessation resources to address vaping among young people. This study is the first-ever comparative effectiveness trial of an intervention to help young people quit vaping. It focuses on evaluating the effectiveness of a theory-grounded, empirically informed text message intervention among young adults. The study is fully powered to examine potentially important subgroup differences among young people who are more vulnerable to e-cigarette use. Although potentially more challenging from a research ethics and pragmatic standpoint, evaluating quit vaping intervention approaches in teens is an important area for future research. Data from this trial will establish a benchmark of effectiveness for other vaping cessation programs and begin to create a body of evidence focused on how best to help young people break free from e-cigarettes.Trial RegistrationClinicalTrials.gov NCT04251273; https://clinicaltrials.gov/ct2/show/NCT04251273International Registered Report Identifier (IRRID)DERR1-10.2196/18327

Cannabis Use among Dual Electronic and Combustible Cigarette Smokers: Relations with Pain and Hazardous Drinking

Background: E-cigarette use is on the rise and many adult e-cigarette users also smoke combustible cigarettes. Past work suggests that dual use (i.e. use of both electronic and combustible cigarettes) is associated with greater rates of cannabis use, yet little is known about the nature of cannabis use among dual users. Objectives: The current study examined 414 adult dual users (48.3% female, Mage = 35.1 years), half of whom endorsed current (past month) cannabis use. Results: Results indicated that cannabis users reported more severe pain, greater pain interference, and more hazardous drinking. In addition, cannabis use was robustly related to hazardous drinking after statistically controlling for demographic and pain-related variables. Cannabis use was also associated with hazardous drinking indirectly via pain interference at greater levels of pain severity. Conclusions/Importance: These results highlight several clinical correlates of cannabis use among adult dual users, and also suggest that pain may play an important role in hazardous drinking among these individuals.

Perceived addiction to vaping among youth and young adult regular vapers

BackgroundThe prevalence of e-cigarette use among youth and young adults has increased markedly in recent years; however, little is known about young people’s perceptions of e-cigarette addiction. This study examines...

E-cigarette device power moderates the effects of non-tobacco flavors and nicotine on product appeal in young adults

BackgroundIdentifying e-cigarette product characteristics that moderate the effects of non-tobacco flavors and nicotine on user appeal can inform regulations issued in tandem with e-cigarette nicotine and flavor policies aimed to protect young adult health. An e-cigarette device’s electrical power affects the amount of solution aerosolized per puff, leading to more concentrated or diluted aerosol, which may alter product appeal. This laboratory experiment tested whether e-cigarette device power moderated the independent and interactive effects of non-tobacco flavors and nicotine on appeal in young adults. MethodIn a within-subject design single-visit protocol, young adult e-cigarette users (N = 100) administered standardized doses of e-cigarette solutions varying in flavor (fruit, menthol, tobacco) and nicotine (nicotine-containing [6 mg/mL], nicotine-free). Solutions were administered via a variable-voltage tank-style device at low (7.3 W[3.3 V@1.5 Ω resistance]) and high (12.3 W[4.3 V@1.5 Ω resistance]) power settings. Participants rated each dose’s appeal (0–100 scale). ResultsThe high (vs. low) power setting attenuated the appeal-enhancing effects of menthol (vs. tobacco) flavors (Menthol × Power, estimate = −5.44, P = .03). Power did not moderate the appeal-enhancing effects of fruit flavors. High (vs. low) power amplified the appeal-reducing effects of nicotine-containing (vs. nicotine-free) solutions (Nicotine × Power, estimate = 6.69, P < .001) and augmented the extent to which fruit and menthol flavors suppressed nicotine’s appeal-reducing effects (Flavor × Nicotine × Power, estimates = 9.40–14.85, Ps≤0.03). ConclusionE-cigarette device power appears to moderate flavor- and nicotine-induced changes in product appeal in nuanced ways, including by augmenting the ability of non-tobacco flavors to mask nicotine’s appeal-reducing effects. Regulatory restrictions on high-powered e-cigarette devices warrant consideration in efforts to protect young adult health.

Sex differences in the appeal of flavored e-cigarettes among young adult e-cigarette users.

Experimental evidence suggests that females (vs. males) may be more sensitive to and derive greater reinforcement from the sensory aspects of combustible cigarette smoking (e.g., flavor, taste). However, it is unknown if there are similar sex differences in the appeal of flavored e-cigarettes. Young adult male (N = 65) and female (N = 35) e-cigarette users (mean age = 25.4; 53% current smokers) attended 1 laboratory session in which they self-administered standardized e-cigarette doses according to a Flavor (fruit vs. tobacco vs. menthol) × Nicotine (6 mg/mL vs. 0 mg/mL) × Voltage (3.3 V vs. 4.3 V) within-participant fully crossed factorial design. Following each trial, participants completed ratings of appeal (mean of liking, disliking [reverse scored], and willingness-to-use-again ratings). Sex was tested as a between-subjects moderator of the effects of flavor on appeal. There was a significant interaction between sex and flavor for e-cigarette appeal (p < .001). In males, fruit-flavored e-cigarettes generated greater appeal than menthol and tobacco (ps < .001). In females, both fruit- and menthol-flavored e-cigarettes generated greater appeal than tobacco (ps < .001), but there was no significant difference between fruit- and menthol-flavored e-cigarettes (p = .40). The findings of this study suggest that males prefer fruit-flavored e-cigarettes, and females prefer both menthol- and fruit-flavored e-cigarettes. The impact of regulatory policies targeting e-cigarette flavors in the population may vary by sex. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Compliance in Controlled E-cigarette Studies.

E-cigarette studies have found that the use of a variety of flavors and customizable devices results in greater use frequency and user satisfaction. However, standardized research e-cigarettes are being developed as closed systems with limited flavor options, potentially limiting user satisfaction. In this study, we explore protocol compliance in an e-cigarette study using a standardized, assigned device with puff time and duration tracking (controlled e-cigarette) and potential limitations that controlled devices and e-liquids can introduce. In a crossover study, 49 young adult e-cigarette users were recruited using convenience sampling and assigned a controlled e-cigarette device and flavored or unflavored e-liquids on standardized protocols. E-cigarette use frequency (number of puffs per day, collected from the device) and serum cotinine levels were obtained at each of three study visits over 3 weeks. The correlation of cotinine and e-cigarette use over the preceding week was calculated at each study visit. Correlation of nicotine intake, as measured by serum cotinine, and puff time, as measured by puffs count and duration from the e-cigarette device, as an indicator of study protocol compliance, substantially declined after the first week of the study and were no longer correlated in the remaining study weeks (R2 = 0.53 and p ≤ .01 in week 1, R2 < 0.5 and p > .05 for remaining weeks). There is an emerging need for controlled e-cigarette exposures studies, but low compliance in the use of assigned devices and e-liquids may be a limitation that needs to be mitigated in future studies. This study is the first to analyze compliance with instructions to use a standardized e-cigarette device with puff time and duration tracking (controlled e-cigarette) across all subjects and an assigned e-liquid flavor over a 3-week period. We find that protocol compliance, as measured by correlations between e-cigarette use measures and cotinine levels, was only achieved in the first week of the study and declined thereafter. These findings indicate that the assignment of a study device and instruction to only use the study device with assigned e-liquid flavor may not be sufficient to ensure participant compliance with the study protocol. We suggest that additional measures, including behavioral and biological markers, are needed to ensure sole use of the study e-cigarette and e-liquid and to be able to interpret results from controlled e-cigarette studies.

Predicting electronic cigarette dependence and perceived barriers for electronic cigarette cessation: examining the roles of fatigue severity and emotion dysregulation

ABSTRACT Objectives: Emotion dysregulation is an important individual difference variable for substance use. Limited empirical data has evaluated the influence of emotion dysregulation on e-cigarette use and outcomes related to use. Similarly, the role of fatigue has received little attention in this regard despite emerging links with e-cigarette use. Methods: Therefore, the present study examined a theoretically informed model focused on whether the experience of more severe fatigue explains, in part, the relation between emotion dysregulation and e-cigarette dependence and perceived barriers to e-cigarette cessation among 525 adult e-cigarette users (50.9% female, Mage = 35.25 years, SD = 10.10). Results: Results suggest that fatigue severity significantly explains part of the relation between emotion dysregulation and dependence (b = 0.04, 95% CI [0.02, 0.06]) as well as perceived barriers for e-cigarette cessation (b = 0.21, 95%CI [0.14, 0.29]). In addition, reverse models were tested that suggest emotion dysregulation may also explain, in part, the relation between fatigue severity and dependence (95% CI [0.07, 0.34]) as well as perceived barriers for e-cigarette cessation (95% CI [0.96, 1.92]). Conclusions: The current study provides initial empirical support for the role of fatigue severity in the relation between emotion dysregulation and e-cigarette use processes, but also highlights the potential for bi-directional effects.

Expectancies and reasons for use of e-cigarettes among young adults: A longitudinal analysis.

Use of electronic cigarettes, or e-cigarettes, has increased exponentially in recent years. Mechanisms that might underlie this increase include expectancies and reasons for e-cigarette use. This study was designed to identify and evaluate changes in expectancies and reasons for e-cigarette use among young adults over time and to determine whether such changes were associated with changes in e-cigarette use. Data for these analyses were collected from a sample of 137 young adult e-cigarette users who completed electronic surveys 5 times over a 12-month period. Results yielded five e-cigarette use expectancy and reason factors: Affect-Related Reasons, Social Reasons, Positive Social Expectancies, Positive Internal Expectancies, and Negative Expectancies. Linear mixed models showed that Negative Expectancies significantly increased over time (p = .004), whereas Affect-Related Reasons significantly decreased over time (p = .001). Additional linear mixed models indicated that, whereas both frequency and quantity of e-cigarette use decreased over time, changes in Positive Internal Expectancies were positively associated with changes in frequency of e-cigarette use (p = .032) and changes in Positive Social Expectancies were positively associated with changes in both frequency (p = .007) and quantity (p = .026) of e-cigarette use. These findings suggest that young adults' expectancies and reasons for using e-cigarettes fluctuate over time, and changes in expectancies seem to be longitudinally associated with changes in e-cigarette use. Positive expectancies for e-cigarette use represent targets for clinical, prevention, and intervention efforts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Subjective sleep quality and electronic cigarette dependence, perceived risks of use, and perceptions about quitting electronic cigarettes

IntroductionAlthough subjective sleep quality has been associated with combustible cigarette use, little is known about its role in electronic cigarette (e-cigarette) use or beliefs about use. To address this gap, the current study examined subjective sleep quality among adult e-cigarette users in relation to e-cigarette dependence, perceived risks of e-cigarette use, and perceived barriers for quitting e-cigarettes. MethodsA cross-section design was employed. Participants included 304 e-cigarette users (53.6% female, Mage = 36.7 years,SD = 10.3, 75% were combustible cigarette users) using a Qualtrics platform. ResultsResults indicated that poorer subjective sleep quality was significantly related to greater e-cigarette dependence and perceived barriers for quitting e-cigarettes (ΔR2 = 0.06, p < .001 for each model) but was not significantly associated with perceived risks of e-cigarette use. ConclusionsThis work provides novel evidence for the potential role of subjective sleep quality in e-cigarette dependence and beliefs about quitting. To the extent sleep quality is related to e-cigarette addiction and cognition, it represents an important construct to assess and target for change in efforts to facilitate change in e-cigarette dependence and perceived barriers for quitting. ImplicationsThis study is among the first data to link subjective sleep quality to e-cigarette dependence and beliefs about risk of use and perceptions about barriers for quitting among adults. Similar to results found for combustible cigarettes, these findings suggest that subjective sleep quality may be important to consider in efforts to facilitate change in e-cigarette dependence and perceived barriers for quitting.

Changing patterns in E-cigarette use among Minnesota adults between 2014 and 2018.

Minnesota has observed declining combustible tobacco use and a large increase in e-cigarette use among youth and young adults. Less is known about adult e-cigarette users' frequency of use, smoking status, use of flavors, and demographic differences. The Minnesota Adult Tobacco Survey (MATS) is a cross-sectional, random digit-dial telephone survey representative of Minnesotans aged 18 and over. MATS measured e-cigarette use in 2014 (N = 9304) and 2018 (N = 6065). In 2018, 6.0% of adult Minnesotans used an e-cigarette in the past 30 days; this was unchanged from 2014 (5.9%). While past 30-day e-cigarette use declined for current smokers (2014: 27.3%; 2018: 16.1% p < 0.001), it increased for never smokers (2014: 1.2%; 2018: 4.4% p < 0.001) and 18-24-year-olds (2014: 12.8%; 2018: 21.9% p = 0.001). Daily e-cigarette use increased from 2014 to 2018 for current smokers (p = 0.001), 25-44-year-olds (p < 0.001), females (p = 0.001), and those with a high-school education (p = 0.006). Among e-cigarette users in 2018, use of flavored e-cigarettes was associated with smoking status (p = 0.041), age (p < 0.001), and using e-cigarettes to quit smoking (p = 0.011). E-cigarettes appeal primarily to younger adults. Of concern are increases in never smokers initiating e-cigarette use, increasing their exposure to nicotine, addiction, and the risk of future combustible tobacco use. Simultaneously, fewer smokers are using e-cigarettes but those who do are using them more frequently. Use of flavored e-cigarettes was common and correlated with interest in quitting combustible cigarettes. These findings can inform recent calls for additional tobacco control policy and programs aimed at reducing e-cigarette use.

E-cigarette users commonly stealth vape in places where e-cigarette use is prohibited

Introduction‘Stealth vaping’ is the practice of vaping discreetly in places where electronic cigarette (e-cigarette) use is prohibited. While anecdotal evidence suggests that stealth vaping is common, there have been no...