Changes In E-cigarette Use Research Articles

Depression, anxiety, stress, and current e-cigarette use: Results from the Truth Longitudinal Cohort of youth and young adults (2022−2023)

ObjectiveTo examine associations between depression, anxiety, and stress, as measured by the Depression, Anxiety and Stress Scale (DASS-21) scale, with current e-cigarette use. MethodsData from the Truth Longitudinal Cohort – a nationally representative sample of youth and young adults – was collected between October 2022 to February 2023. The analytic sample was comprised of participants who provided information on e-cigarette use and the DASS-21 scale (N = 4198). Chi-square statistics were used to determine differences by current e-cigarette use across covariates and DASS-21 items. Logistic regression analyses were applied to the cross-sectional data to determine which scales predicted current e-cigarette use, adjusted for the effects of age, gender identity, race and ethnicity, parental educational attainment, perceived financial situation, and current use of alcohol, marijuana, and other tobacco use. ResultsThose who had severe/extremely severe levels of depression, anxiety, and stress had greater odds of current e-cigarette use, relative to those who had normal levels of depression, anxiety, and stress, even after adjusting for covariates. Results also demonstrated associations between age, race/ethnicity, parental education, and current use of alcohol, marijuana, and other tobacco products with current e-cigarette use. LimitationsCross-sectional analyses of self-reported data limit the ability to determine directionality of effects between depression, anxiety, stress, and current e-cigarette use. DiscussionMore severe levels of depression, anxiety, and stress were associated with a greater likelihood of current e-cigarette use. Future research is needed to evaluate changes in e-cigarette use, in response to depression, anxiety, and stress symptomatology.

E-cigarettes use and respiratory symptoms in asthmatic and non-asthmatic adolescents – a systematic review

E-cigarettes were initially developed to aid smoking cessation, evolving from basic cigarette-like devices to more advanced versions. However, despite bans and restrictions, they remain easily accessible to young individuals and contribute to addiction. Studies show that early initiation of vaping in adolescents significantly increases the risk of eventually smoking conventional cigarettes, posing a serious public health problem. This review focused on analysing the harmful effects of electronic cigarettes on the respiratory system in adolescents through original articles and case reports. A total of 24 studies that focused on the effects of e-cigarettes on the respiratory system in adolescents were selected. The studies assessed the occurrence of respiratory system disorders, the impact on asthmatic adolescents, and the relationship between e-cigarette use and the SARS-CoV-2 pandemic. Several studies have demonstrated that adolescents who use e-cigarettes are at an increased risk of experiencing respiratory symptoms. The pandemic has brought about changes in e-cigarette use among teenagers, including reduced use due to health concerns and limited access, as well as increased nicotine levels in response to stress and boredom. It is crucial for healthcare professionals to screen adolescents for e-cigarette use, educate them about the potential harm, and consider e-cigarettes as a possible cause of respiratory symptoms.

Vaping Regulations and Mental Health of Teenagers

While depression and suicide rates have been on the rise in the United States, so has the use of e - cigarettes, commonly known as vaping. E-cigarettes are considered to be safer than traditional cigarettes, yet there is growing evidence that nicotine and other toxins contained in e-cigarettes may have adverse psychological effects on teenagers. For instance, e-cigarette use has been associated with mental health problems in adolescents such as symptoms of depression and suicidal tendencies. This evidence suggests that vaping could contribute to deteriorating mental health of teenagers. In contrast, the antidepressant and mood modulating properties of nicotine could cause teens with underlying conditions to turn to vaping as a way to self-medicate. Existing studies find evidence of a strong negative correlation between vaping and adolescent mental health; none examine if the relationship is causal. This study exploits exogenous changes in state policies restricting youth access to e- cigarettes and a difference-in-differences methodology to identify changes in e-cigarette use and mental health outcomes of teens. Using data from the 2005-2017 national and state Youth Risk Behavior Surveys, results suggest that MLSA laws reduce vaping but worsen the mental well-being of adolescents. For instance, between 2015-2017, MLSA laws are associated with a 3.0 and 1.8 percentage point increase in depression and suicidal attempts, respectively. These are meaningful increases relative to the overall sample averages of 29% and 8.4%, respectively. The findings are primarily consistent with the self-medication hypothesis. Adverse unintended consequences of the MLSA policy on youth mental health call for the need to address diverse concerns when formulating vaping related regulations for minors.

Cumulative Exposure to E-Cigarette Coupons and Changes in E-Cigarette Use Among U.S. Adults

Coupons are an effective, frequently used tobacco marketing strategy. This study examined prospective associations between cumulative exposure to e-cigarette coupons and changes in e-cigarette use among U.S. adults. Data were from a representative U.S. adult cohort (n=19,824) in the Population Assessment of Tobacco and Health Study (waves [W] 2, 3, 4, and 5), collected from October 2014 to November 2019. Analysis was conducted in 2022. Four logistic regression models examined associations of a number of waves for which participants received e-cigarette coupons during W2-W4 with changes in e-cigarette use: W2 never use to W5 current use (initiation); W2 current nondaily use to W5 daily use (progression); W2 current use to W5 former use (cessation), and W2 former use to W5 current use (return-to-use). Overall, 66.1% of U.S. adults never used e-cigarettes, 10.6% currently used e-cigarettes, and 23.4% formerly used e-cigarettes at W2. The average number of waves for which participants received e-cigarette coupons during W2-W4 was 0.13: 0.10 among W2 individuals who never used e-cigarettes, 0.30 among individuals who currently used e-cigarettes on a nondaily basis, 0.50 among individuals who currently used e-cigarettes, and 0.17 among individuals who formerly used e-cigarettes. Receiving coupons at increased waves was associated with (1) greater odds of initiation (AOR=1.58, 95% CI=1.26-1.97); (2) lower odds of cessation (AOR=0.78, 95% CI=0.67-0.91); and (3) increased odds of return-to-use (AOR=1.39, 95% CI=1.14-1.69). Findings did not differ by W2 cigarette smoking status. E-cigarette coupons may encourage and sustain e-cigarette use. Policies restricting e-cigarette coupons may curb e-cigarette use.

Changes in E-cigarette Use, Cigarette Smoking, and Dual-Use Among the Youth (13-15 Years) in 10 Countries (2013-2019)-Analyses of Global Youth Tobacco Surveys.

The increasing use of e-cigarettes among the youth is a public health problem that needs surveillance. We report changes in e-cigarette use, cigarette smoking, and "dual use" among youth in 10 countries. Global Youth Tobacco Survey (GYTS)s from Georgia, Iraq, Italy, Latvia, Montenegro, Paraguay, Peru, Qatar, Romania, and San Marino were analyzed. Changes in prevalence of "awareness of e-cigarettes," "ever use" (even tried a few puffs) and "current use" (during last 30 days) of e-cigarettes and cigarette smoking, and "dual use" (both e-cigarette and cigarette smoking) between baseline (2013 and 2014) and most recent (2017-2019) surveys were estimated. "Awareness of e-cigarettes" and "ever e-cigarette use" significantly increased (p < .001). "Ever e-cigarette use" was highest in Italy, 93% (95% CI 90.9, 94.4). "Current e-cigarette use" significantly (p < .05) increased by > 50% in most countries. During the most recent surveys, "current e-cigarette" use was > 10% in five countries Italy (18.3%) and Latvia (18.5%) being the highest. Cigarette smoking significantly declined in Italy, Latvia, Peru, and San Marino (p < .05) but remains unchanged in other countries. "Dual use" (both electronic and conventional cigarettes) significantly increased in all countries (p < .001). During the most recent surveys "dual use" was highest in Italy (10%, 95% CI 8.1, 12.2) and Latvia (8.6%, 95% CI 7.2, 10.2). Youth aged 14 and ≥15 years the smokers, were more likely to be e-cigarette users. Awareness and use of e-cigarettes and "dual use" among youth have increased. Closer monitoring of tobacco use among youths and comprehensive tobacco control policies inclusive of e-cigarettes are needed. Secondary data analyses of serial GYTSs in 10 countries showed that both awareness of e-cigarette and e-cigarette use has increased among school-going youth aged 13-15 years. A concurrent increase in "dual use" of e-cigarettes and cigarette smoking during the last 30 days in all 10 countries indicates continued cigarette smoking in the absence of e-cigarettes because of the common risk construct of tobacco product use. Results call for continued surveillance of both e-cigarettes and cigarette smoking among school-going youth. Comprehensive tobacco control measures inclusive of e-cigarettes should be implemented to reduce tobacco use among the youth.

Changes in E-Cigarette Use Among U.S. Adults, 2019–2021

E-cigarette use increased between 2014 and 2018 among younger U.S. adults who had never smoked combustible cigarettes, potentially increasing nicotine addiction risk and progression to combustible tobacco products. It is unknown how prevalence changed after the E-cigarette, or vaping, product use-associated lung injury epidemic (late 2019) and COVID-19 pandemic (March 2020) by age group and combustible cigarette smoking status. Data from cross-sectional, nationally representative National Health Interview Surveys in 2019, 2020, and 2021 (analyzed in 2022) were used to estimate current E-cigarette use prevalence, adjusted prevalence difference between survey years, and population counts, by age group (younger, 18-29 years, n=11,700; middle age, 30-44 years, n=21,300, 45-59 years, n=21,308; older, ≥60 years, n=36,224) and cigarette smoking status (current, former, and never). E-cigarette use prevalence increased among younger adults between 2019 and 2021 (8.8%-10.2%, adjusted prevalence difference=1.7% points, 95% CI=0.1, 3.3), primarily owing to an increase among those who never smoked cigarettes (4.9%-6.4%, adjusted prevalence difference=1.7% points, 95% CI=0.3, 3.1). People who never smoked cigarettes constituted 53% (2.68 million) of younger adults who used E-cigarettes in 2021, increasing by 0.71 million from 2019. Conversely, among middle age and older adults, the prevalence was similar in 2019 and 2021 irrespective of cigarette smoking status, and those who formerly smoked cigarettes constituted the largest proportion of people who used E-cigarettes in 2021 (age 30-44 years: 51.8%, 1.8 million; age 45-59 years: 51.6%, 0.85 million; age ≥60 years: 47.5%, 0.45 million). Efforts must address the rise in E-cigarette use among younger adults who never smoked cigarettes. At the same time, assistance is needed to help those who switched to E-cigarettes to stop smoking to transition to non-use of all products.

Investigating the Impact of E-Cigarette Price and Tax on E-Cigarette Use Behavior

Although the relationship between tax and price and youth cigarette use is well established, little is known about these associations and youth e-cigarette use. This research examines U.S. youth sensitivity to changes in e-cigarette prices and tax using standardized measures of e-cigarette taxes and prices. This analysis uses national data on past 30-day use and the number of days using e-cigarettes (i.e., the intensity of use) from the repeat cross-sectional 2015-2019 Youth Risk Behavior Survey, in combination with inflation-adjusted standardized e-cigarette price and tax data to understand whether changes in e-cigarette price and tax were associated with changes in e-cigarette use. Two-part demand regression models controlling for demographics and e-cigarette restriction policies were conducted to calculate price and tax elasticities of demand, in addition to $0.50 and $1.00 price and tax increase simulations. Increased e-cigarette prices and taxes were associated with significant reductions in past 30-day use. Prices were also significantly associated with decreases in the intensity of use. A $0.50 and $1.00 tax increase leads to a 6.3% and 12.2% decrease in past 30-day use and a 4.7% and 9.3% decrease in intensity, respectively. A $0.50 and $1.00 price increase leads to a 4.1% and 8.2% decrease in past 30-day use and a 4.2% and 8.3% decrease in intensity, respectively. Higher prices and taxes reduce youth current e-cigarette use and days using e-cigarettes. Policies increasing e-cigarette prices, such as excise taxes, can reduce youth current e-cigarette use and days using e-cigarettes.

Factors Associated with Changes in E-Cigarette Use and Tobacco Smoking by Adolescents and Young People in Nigeria during the COVID-19 Pandemic

This study aimed to assess the proportion of adolescents and young people (AYP) in Nigeria who changed their frequency of e-cigarette use and tobacco smoking during the COVID-19 pandemic; and factors associated with the increase, decrease or no change in e-cigarette use and tobacco smoking (including night smoking). This study was a cross-sectional study of AYP recruited from all geopolitical zones in the country. Multivariate logistic regression analyses were conducted to determine if respondents’ health HIV and COVID-19 status and anxiety levels were associated with changes in e-cigarette use and tobacco smoking frequency. There were 568 (59.5%) e-cigarette users, of which 188 (33.1%) increased and 70 (12.3%) decreased e-cigarette use and 389 (68.5%) increased night e-cigarette use. There were 787 (82.4%) current tobacco smokers, of which 305 (38.8%) increased and 102 (13.0%) decreased tobacco smoking and 534 (67.9%) increased night tobacco smoking. Having a medical condition was associated with lower odds of increased e-cigarette use (AOR:0.649; p = 0.031). High anxiety (AOR:0.437; p = 0.027) and having a medical condition (AOR:0.554; p = 0.044) were associated with lower odds of decreased e-cigarette use. Having COVID-19 symptoms (AOR:2.108; p &lt; 0.001) and moderate anxiety (AOR:2.138; p = 0.006) were associated with higher odds of increased night e-cigarette use. We found complex relationships between having a medical condition, experiencing anxiety, changes in tobacco smoking and e-cigarette use among AYP in Nigeria during the COVID-19 pandemic that need to be studied further.

Exploring young adults' e-cigarette use behavior during COVID-19.

Changes in daily life related to COVID-19 have impacted e-cigarette use, particularly in young adults. This cross-sectional mixed-methods study explored young adults' perceptions regarding how COVID-19 influenced their e-cigarette use. We analyzed Fall 2020 survey data from 726 past 6-month e-cigarette users (mean age=24.15 years, 51.1% female, 35.5% sexual minority, 4.4% Black, 10.2% Asian, 12.1% Hispanic) and Spring 2021 semi-structured interview data among a subset of 40 participants (mean age=26.30 years, 35.0% female, 45.0% sexual minority, 5.0% Black, 22.5% Asian, 12.5% Hispanic). Participants were drawn from 6 metropolitan statistical areas with varied tobacco and cannabis legislative contexts. Among survey participants, 44.4% also smoked cigarettes, 54.0% other tobacco products, and 60.1% used cannabis. They reported various changes in their daily lives, including changes in the nature and/or status of employment (e.g. 15.3% were laid off, 72.8% experienced household income loss). Regarding changes in e-cigarette use since COVID-19, 22.6% tried to cut down and 16.0% tried to quit. Interview participants commonly indicated that they increased their use due to stress, boredom, changes in accessibility, and/or changes to daily environment that made e-cigarette use more feasible. Results highlight the importance of promoting opportunities for young adults to build relationships to decrease stress, foster a sense of belonging, and increase quality of life (e.g. increasing the accessibility to mental health and social support services, intentionally engaging young adults in pandemic-appropriate community-building and extracurricular activities). This research may help to inform future e-cigarette cessation interventions that consider the unique challenges of societal stressors, such as pandemics.

Changes in e-cigarette use and subsequent cigarette smoking cessation in the USA: evidence from a prospective PATH study, 2013–2018

AimsTo examine the relationship between changes in electronic cigarette (e-cigarette) use and subsequent cigarette smoking cessation.MethodsUsing data from the Population Assessment of Tobacco and Health Study (wave 1–wave 4), we...

E-cigarette use during pregnancy and its association with adverse birth outcomes in the US

The popularity of e-cigarette use among young adults is a growing concern. However, little is known about factors associated with e-cigarette use in pregnant women and birth outcomes. In this retrospective cohort study, we evaluated the influence of several factors on behavioral changes in e-cigarette use before and during pregnancy, and assessed the association between e-cigarette use and subsequent birth outcomes among pregnant women. The Population Assessment of Tobacco and Health (PATH) study, a government-sponsored national longitudinal study based in the US, Waves 1 through 4 (2013–2018) were used. Multivariate logistic regressions were conducted to estimate behavioral changes in e-cigarette use during pregnancy and subsequent influence on high-risk birth (e.g., preterm birth, low birth weight, birth defects, etc.) and fetal death. Although pregnant women who quit vaping before pregnancy (OR = 1.14, 95% CI 0.54–2.40) or had any use during pregnancy (OR = 1.19, 95% CI 0.38–3.73) showed non-differential risk of having a high-risk birth in comparison to women who did not initiate vaping, we observed that the usage of mint/menthol flavor was correlated with higher risk of fetus death (OR = 3.27, 95% CI 1.17–9.19). Healthcare providers should encourage e-cigarette users to quit prior to and during early pregnancy.

Associations between living in localities with e-cigarette sales restrictions and e-cigarette use change among young adults in Los Angeles County

IntroductionLocal e-cigarette sales restrictions (ESRs) may impact e-cigarette use. This study examined the associations between living in localities with various ESR policies and changes in e-cigarette use among young adults...

Identifying changes in e-cigarette use among a longitudinal sample of Canadian youth e-cigarette users in the COMPASS cohort study, 2017/18–2018/19

ObjectivesThere are few studies describing longitudinal changes in vaping patterns among current youth e-cigarette users. The objective of this study was to identify-one-year changes in e-cigarette use patterns among a longitudinal sample of Canadian youth e-cigarette users between 2017/18 and 2018/19. MethodsThe longitudinal sample included n = 4,071 current (past 30-day) e-cigarette users in grades 9–11 attending schools in four Canadian provinces. Students reported the number of days they used e-cigarettes in the past 30 days in 2017/18 and 2018/19. Based on responses, students could have escalated, reduced, stopped, or maintained their level of vaping. The prevalence of each e-cigarette use pattern was identified across demographic characteristics and regression models identified significant predictors of each use pattern. ResultsOver one year, 49.2% of current youth e-cigarette users escalated, 12.8% reduced, 20.2% stopped, and 17.8% maintained their frequency of e-cigarette use. Baseline e-cigarette use frequencies varied according to use pattern. Current youth e-cigarette users with higher baseline vaping frequencies had lower odds of escalating and stopping e-cigarette use and higher odds of reducing e-cigarette use relative to maintaining the same frequency of use. ConclusionsWhile about half of current youth e-cigarette users increased their frequency of e-cigarette use over a 1-year period, a significant number also decreased or stopped vaping at a time when the prevalence of youth e-cigarette use increased rapidly in Canada. There is a need for longitudinal data to monitor and evaluate changes to e-cigarette use patterns that may be in response to changing public health policies.

Changes in E-cigarette Use Among Youth and Young Adults During the COVID-19 Pandemic: Insights Into Risk Perceptions and Reasons for Changing Use Behavior.

IntroductionThis study assessed changes in e-cigarette use since the COVID-19 pandemic began and reasons for these changes among US youth and young adults.Aims and MethodsWe combined data from two cross-sectional samples of youth and young adult (15–24 years) participants of a monthly surveillance study (data collected in April and June 2021). Analyses were restricted to past-year e-cigarette users who reported using e-cigarettes before the pandemic (n = 1762). Participants reported changes in e-cigarette use since the pandemic began, reasons for changing their behavior, and their perceptions around COVID-19 risk related to e-cigarette use. Multinomial logistic regression models assessed associations between demographics and COVID vaping risk perceptions and changes in e-cigarette use.ResultsOver a third of the sample (37.9%) reported increasing e-cigarette use, while 28.9% reported decreasing use, and 33.1% reported no change. Analyses revealed associations between change in e-cigarette use and age, race and ethnicity, e-cigarette use status, and COVID vaping risk perceptions. The most common reason for increasing use was managing stress (36%); the most common reasons for decreasing use included fewer social interactions (22%) and concerns over general health (18%). Results also indicated differences in reasons for decreasing use by race and ethnicity, and differences in reasons for both increasing and decreasing use by age.ConclusionsThis study provides recent data on how the ongoing and evolving COVID-19 pandemic has impacted youth and young adults’ e-cigarette use. Findings identify subpopulations that may benefit from e-cigarette prevention interventions, as well as insights that may inform the content and delivery of such interventions.ImplicationsThis study provides recent insights into if and why the ongoing COVID-19 pandemic has impacted e-cigarette use behavior among youth and young adults. Findings contribute to the understanding of the role e-cigarettes play in young people’s lives—insights that can inform youth and young adult prevention efforts.

Smoking and E-Cigarette Use Among U.S. Adults During the COVID-19 Pandemic

IntroductionWith concerns about tobacco use being a risk factor for severe disease from COVID-19, understanding nicotine- and tobacco-use patterns is important for preventive efforts. This study aims to understand changes in combustible cigarette and E-cigarette use among U.S. adults.MethodsIn August 2020, a cross-sectional survey of a nationally representative sample of adults aged ≥18 years in the National Opinion Research Center's AmeriSpeak Panel who reported past 6–month use of combustible cigarettes or E-cigarettes was conducted. Multivariable logistic regression assessed the factors associated with increased product use and quit attempts since hearing about COVID-19.ResultsA total of 1,024 past 6–month cigarette smokers/E-cigarette users were surveyed. Among cigarette smokers, 45% reported no change in cigarette smoking, and 33% reported increased cigarette smoking since hearing about COVID-19. Higher stress was associated with increased cigarette smoking. Among E-cigarette users, 41% reported no change in E-cigarette use, and 23% reported increasing E-cigarette use. A total of 26% of cigarette smokers and 41% of E-cigarette users tried to quit because of COVID-19. Higher perceived risk of COVID-19 was associated with attempts to quit combustible cigarettes (AOR=2.37, 95% CI=1.59, 3.55) and E-cigarettes (AOR=3.14, 95% CI=1.73, 5.70).ConclusionsCigarette and E-cigarette use patterns varied in response to the COVID-19 pandemic. Most cigarette smokers and E-cigarette users perceived product use as increasing COVID-19‒related health risks, and this was associated with attempts to quit. Some cigarette smokers, especially those reporting higher stress, increased product use. Proactive provision of cessation support to smokers and E-cigarette users may help mitigate the stress-related increases in product use during the COVID-19 pandemic.

A Comparative Analysis of E-cigarette Users and State-Specific Prevalence Change in the United States Between 2017 and 2018.

IntroductionDespite states’ regulatory efforts, e-cigarettes are gaining popularity, which poses a public health concern. The study objective is to compare demographic and state prevalence changes in e-cigarette use from 2017 to 2018.MethodsA retrospective analysis was conducted using publicly available data from the Behavioral Risk Factor Surveillance System survey (2017-2018). The prevalence of current e-cigarette use was analyzed with direct age-adjustment based on the 2010 United States Census population.ResultsThe overall use of e-cigarettes increased from 4.3% in 2017 to 5.4% in 2018. Although most demographics reported increased prevalence from 2017 to 2018, the most significant change was observed in younger adults (18-24), males, Hispanics, college graduates, non-smokers, marijuana non-users, and heavy alcoholics. Oklahoma (9.8%), Hawaii (7.8%), Arkansas (7.7%), and Colorado (7.3%) greater prevalence in 2018. Significant inclining prevalence was observed in Alaska, Connecticut, and Massachusetts, while Illinois reported a sharp decline. California, the District of Columbia, and Puerto Rico consistently reported the lowest prevalence. Idaho, Maine, Michigan, North Dakota, and Oregon are transitioning to a higher prevalence of e-cigarette use from 2017 to 2018.ConclusionThe rising prevalence of e-cigarettes across demographics warrants a holistic approach to behavioural change interventions, health awareness and education, and regulatory efforts.

Underage Youth and Young Adult e-Cigarette Use and Access Before and During the Coronavirus Disease 2019 Pandemic

Understanding patterns of e-cigarette use and access during the coronavirus disease 2019 (COVID-19) pandemic is important because e-cigarettes may put users at risk for more severe respiratory effects and other health problems. To examine whether underage youth and young adults who ever used e-cigarettes self-reported changes in access and use of e-cigarettes since the COVID-19 pandemic began. A national, cross-sectional online survey study was conducted from May 6 to May 14, 2020. This sample of 4351 participants aged 13 to 24 years across the US included 2167 e-cigarette ever-users. Quota sampling was used to balance for age, sex, race/ethnicity, and 50% having ever used e-cigarettes. Change in e-cigarette use (increase, decrease, quit, no change, and switch to another product) and access to e-cigarettes (easier or harder, and change in point-of-purchase) before and after the COVID-19 pandemic began, reasons for change, number of times e-cigarettes were used, nicotine dependence, and sociodemographic data. This study focused on 2167 e-cigarette ever-users among 4351 participants who completed the survey. Among 2167 e-cigarette users, a total of 1442 were younger than 21 years and 725 were aged 21 years or older; 1397 were female (64.5%) and 438 identified as lesbian, gay, bisexual, transgender, queer (20.2%). The survey completion rate was 40%. Since the COVID-19 pandemic began, 1198 of 2125 e-cigarette users (56.4%) changed their use: 388 individuals (32.4%) quit, 422 individuals (35.3%) reduced the amount of nicotine, 211 individuals (17.6%) increased nicotine use, 94 individuals (7.8%) increased cannabis use, and 82 individuals (6.9%) switched to other products. Participants reported that not being able to go to vape shops and product unavailability were the reasons accessing e-cigarettes was difficult after the pandemic began. Since the COVID-19 pandemic began, individuals reported purchasing from alternative retail stores (disposables, 150 of 632 [23.7%]; pod-based, 144 of 797 [18.1%]; and other e-cigarette, 125 of 560 [22.3%], ie, between 18.1% and 23.7%), purchasing online instead of retail (disposables, 115 of 632 [18.2%]; pod-based, 156 of 797 [19.6%]; and other e-cigarette, 111 of 560 [19.8%], ie, between 18.2% to 19.8%), and shifted to retail instead of online (disposables, 11 of 632 [1.7%]; pod-based, 17 of 797 [2.0%]; and other e-cigarette, 13 of 560 [2.3%], ie, between 1.7%-2.3%). Other individuals reported no change: from retail stores (disposables 262 of 632 [41.5%]; pod-based 344 of 797 [43.2%]; and other e-cigarette, 223 of 560 [39.8%], ie, between 39.8% and 43.2%) and online (disposables 94 of 632 [14.9%]; pod-based 136 of 797 [17.1%]; and other e-cigarette, 88 of 560 [15.8%], ie, between 14.9% and 17.1%). Underage youth reported e-cigarette deliveries from vape shops and/or dealers or friends who received such deliveries, and 63 of 229 (27.5%) self-reported accessing e-cigarettes without age verification. e-Cigarette users were 52% less likely to quit or reduce their use if they previously used e-cigarettes between 11 and 99 times (adjusted odds ratio, 0.48; 95% CI, 0.30-0.78), 68% less likely to quit if they previously used e-cigarettes more than 100 times (adjusted odds ratio, 0.32; 95% CI, 0.20-0.51), and 51% were less likely to quit if they were nicotine dependent (adjusted odds ratio, 0.49; 95% CI, 0.35-0.70). During the COVID-19 pandemic, youth e-cigarette users reported changes in e-cigarette use, point-of-purchase, and ability to purchase e-cigarettes without age verification. The US Food and Drug Administration and local policy makers may find these data useful to inform policies to prevent e-cigarette sales to underage youth.

Changes in electronic cigarette use and label awareness among smokers before and after the European Tobacco Products Directive implementation in six European countries: findings from the EUREST-PLUS ITC Europe Surveys.

Article 20 of the European Tobacco Product Directive (TPD), which went into effect in May 2016, regulates electronic cigarettes (e-cigarettes) in the European Union (EU). The aim of this study was to evaluate changes in e-cigarette use, design attributes of the products used and awareness of e-cigarette labelling and packaging among smokers from six EU Member States (MS) before and after TPD implementation. Data come from Wave 1 (2016, pre-TPD) and Wave 2 (2018, post-TPD) of the ITC Six European Country Survey among a sample of smokers and recent quitters who use e-cigarettes from six EU MS. Weighted logistic generalized estimating equations regression models were estimated to test the change in binary outcomes between Waves 1 and 2 using SAS-callable SUDAAN. In 2018, current daily/weekly e-cigarette use among adult smokers was just over 2%, but this varied from the highest in Greece (4%) to lowest in Poland (1.2%). From Waves 1 to 2, there was a significant increase in respondents reporting noticing and reading health and product safety information on leaflets inside e-cigarette packaging (8.39-11.62%, P < 0.001). There were no significant changes between waves of respondents reporting noticing or reading warning labels on e-cigarette packages/vials. e-cigarette use among smokers in these six EU countries is low. Although reported noticing and reading leaflets included in the packaging of e-cigarettes increased significantly from before to after the TPD, there was no significant change in reported noticing and reading of warning labels. Findings indicate the importance of continued monitoring of TPD provisions around e-cigarettes.

Vaping in adolescents: epidemiology and respiratory harm.

This review highlights epidemiologic changes in e-cigarette use in adolescents, discusses recent advances in aerosolized nicotine delivery, and provides and updated profile of research related to the lung-specific harm of e-cigarettes. In the past decade, nicotine-containing e-cigarettes have emerged as the most popular tobacco and nicotine delivery modality among adolescents in the United States. The surge in popularity of these devices has coincided with an outbreak of vaping-related lung injury, bringing e-cigarette use to national attention, and creating a great deal of confusion regarding their potential for respiratory harm. Newer pod-based devices and formulations of e-liquids have resulted in products appeal to youth and deliver nicotine with increasing efficiency. E-liquid aerosols are associated with direct harm to respiratory epithelium and have been shown to alter pulmonary function, inflammation, mucociliary clearance, and lung histology. Although the long-term harms of regular e-cigarette use are unknown, numerous studies including early longitudinal data suggest e-cigarette use is associated with incidence of respiratory disease, independent of concurrent traditional cigarette use. Improved understanding and recognition of harm will contribute to the basis of further studies examining the role of e-cigarettes on chronic respiratory disease and will inform future prevention education.

Association between changes in harm perceptions and e-cigarette use among current tobacco smokers in England: a time series analysis

BackgroundThere is a decreasing trend in the proportion of individuals who perceive e-cigarettes to be less harmful than conventional cigarettes across the UK, Europe and the US. It is important to assess whether this may influence the use of e-cigarettes. We aimed to estimate, using a time series approach, whether changes in harm perceptions among current tobacco smokers have been associated with changes in the prevalence of e-cigarette use in England, with and without stratification by age, sex and social grade.MethodsRespondents were from the Smoking Toolkit Study, which involves monthly cross-sectional household surveys of individuals aged 16+ years in England. Data were aggregated monthly on ~ 300 current tobacco smokers between 2014 and 2019. The outcome variable was the prevalence of e-cigarette use. The explanatory variable was the proportion of smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes. Covariates were cigarette (vs. non-cigarette combustible) current smoking prevalence, past-year quit attempt prevalence and national smoking mass media expenditure. Unadjusted and adjusted autoregressive integrated moving average with exogeneous variables (ARIMAX) models were fitted.ResultsFor every 1% decrease in the mean prevalence of current tobacco smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes, the mean prevalence of e-cigarette use decreased by 0.48% (βadj = 0.48, 95% CI = 0.25–0.71, p < .001). Marginal age and sex differences were observed, whereby significant associations were observed in older (but not in young) adults and in men (but not in women). No differences by social grade were detected.ConclusionsBetween 2014 and 2019 in England, at the population level, monthly changes in the prevalence of accurate harm perceptions among current tobacco smokers were strongly associated with changes in e-cigarette use.