Current E-cigarette Use Research Articles

Abstract A021: Tobacco and e-cigarette use in a sample of young men 18-24 in Mayagüez, Puerto Rico: The Youth Prevention Program

Abstract Background: Smoking is the number one preventable cause of death in the world. In Puerto Rico, 11.3% of the general population reported being current smokers. The majority are men who started smoking at a young age. In addition to cigarette smoking, it is important to monitor the new and potentially dangerous trend of e-cigarette use, which has doubled ever since 2014. This study aimed to determine the prevalence and patterns of current cigarette and lifetime e-cigarette use in a sample of young men 18-24 years old from the Youth Prevention Program (YPREV). Methods: A cross-sectional study among 318 young men was implemented in 2017. Bivariate analysis comparing cigarette and e-cigarette use by selected characteristics were conducted. Results: More than half of the participants reported having smoked cigarettes during the last 30 days. Approximately 39.3% of the participants reported the use of e-cigarette in their lifetime, with 76.9% of the participants indicating trying e-cigarettes for the first time after starting college. When exploring the association between selected characteristics and current cigarette smoking, participants who reported low perceived risk of HIV infection are more likely to smoke cigarettes (p-value >0.01). In relation to e-cigarette, participants who reported being employed were more likely to use e-cigarettes (p-value=0.012). Moreover, participants who belong to the minority serving institution, reported less use of cigarettes and e-cigarettes ever than those part of the community. Conclusions: As YPREV aimed to expand their prevention services to young men in the Western region of Puerto Rico, strategic alliances for the development of multidisciplinary interventions for cigarette and e-cigarette use will be necessary, which will help develop targeted prevention strategies, primarily among freshmen college students in the Western region of Puerto Rico. Citation Format: Nashaly M Saldaña-Santiago, Jorge Rodríguez-Lebrón, Yara Sánchez-Cabrera, Edna Acosta-Pérez, Vivian Colón-López. Tobacco and e-cigarette use in a sample of young men 18-24 in Mayagüez, Puerto Rico: The Youth Prevention Program [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A021.

Electronic Cigarette Use and Associated Risk Factors in U.S.-Dwelling Pacific Islander Young Adults

Background: E-cigarette use is rapidly increasing among US young adults, heightening their risk for vaping-related illnesses. Yet, little is known about e-cigarette use among young adult Native Hawaiians and Pacific Islanders (NHPI): an indigenous-colonized US racial group rarely described in research literature. This exploratory study provides the first known data on e-cigarette use and potential risk factors in NHPI young adults. Method: Self-report data were collected from 143 NHPI young adults (age 18–30 years) living in two large NHPI communities: Samoans in urban Los Angeles County and Marshallese in rural Arkansas. We assessed rates of e-cigarette, cigarette, alcohol, and marijuana use, and positive and negative outcome expectancies from e-cigarettes, that is expected outcomes from e-cigarette use. To identify potential risk factors for NHPI e-cigarette use, regressions explored associations between participants’ current e-cigarette use with current cigarette, alcohol, and marijuana use, and e-cigarette outcome expectancies. Results: Among NHPI young adults, lifetime e-cigarette use rate was 53% and current use rate was 39%. Current rate of dual e-cigarette/cigarette, e-cigarette/alcohol, and e-cigarette/marijuana use was 38%, 35%, and 25%, respectively. In our regression models, current marijuana use and positive e-cigarette outcome expectancies were significantly associated with current e-cigarette use. Conclusions: E-cigarette use is common among NHPI young adults, exceeding rates for other at-risk racial groups. Marijuana use and positive expectations about e-cigarette use may represent potential e-cigarette use risk factors. Collectively, findings underscore the need for additional research to further explore the scope of, and risk and protective factors for, e-cigarette use in this understudied high-risk population.

Electronic Cigarettes and Fecundability: Results From a Prospective Preconception Cohort Study.

Although electronic cigarette (e-cigarette) aerosol contains similar toxicants to combustible cigarettes, few studies have examined their influence on fecundability. We assessed the association between e-cigarette use and fecundability, overall and according to combustible cigarette smoking history, in a cohort of 4,586 North American women (aged 21-45 years) enrolled during 2017-2020 in Pregnancy Study Online, a Web-based prospective preconception study. Women reported current and former e-cigarette use on baseline and follow-up questionnaires, and they completed bimonthly follow-up questionnaires until self-reported pregnancy or censoring. Fecundability ratios and 95% confidence intervals were calculated using proportional probabilities models, controlling for potential confounders. Overall, 17% of women had ever used e-cigarettes and 4% were current users. Compared with never use of e-cigarettes, current e-cigarette use was associated with slightly lower fecundability (fecundability ratio = 0.84, 95% confidence interval (CI): 0.67, 1.06). Compared with current nonusers of e-cigarettes and combustible cigarettes, fecundability ratios were 0.83 (95% CI: 0.54, 1.29) for current dual users of e-cigarettes and combustible cigarettes, 0.91 (95% CI: 0.70, 1.18) for current e-cigarette users who were nonsmokers of combustible cigarettes, and 1.01 (95% CI: 0.85, 1.20) for nonusers of e-cigarettes who were current smokers of combustible cigarettes. Current e-cigarette use was associated with slightly reduced fecundability, but estimates of its independent and joint associations with combustible cigarette smoking were inconsistent and imprecise.

E-Cigarette Use Patterns and High-Risk Behaviors in Pregnancy: Behavioral Risk Factor Surveillance System, 2016–2018

The prevalence of e-cigarette use has increased dramatically in the last decade in the U.S. Understanding the prevalence, patterns of use, and risk factor associations of e-cigarette use in pregnant women is particularly important, as this could have potential health implications for the mother and the developing child. Using Behavioral Risk Factor Surveillance System Survey data from 2016 to 2018, adult women of reproductive age (18-49 years) who reported being pregnant (n=7,434) were studied. Self-reported current e-cigarette use was the main exposure. Other measures included combustible cigarette smoking status and high-risk behaviors (including other tobacco, marijuana, or heavy alcohol use; binge drinking; and others). All analyses were done in 2019. Approximately 2.2% of pregnant women reported current e-cigarette use, of whom 0.6% reported daily use. The highest prevalence of e-cigarette use was observed in the youngest age group of pregnant women (3.2%), with 41.7% of all pregnant current e-cigarette users being aged 18-24 years. There was a marked increase in the prevalence of current use of e-cigarettes among pregnant women from 1.9% in 2016 to 3.8% in 2018. Approximately 46% of pregnant current e-cigarette users reported concomitant cigarette smoking. Compared with pregnant never e-cigarette users, pregnant current e-cigarette users had a higher prevalence of other tobacco product use, marijuana use, heavy alcohol intake, binge drinking, and other high-risk behaviors. These findings underscore the need to strengthen prevention and policy efforts, specifically in the vulnerable subgroup of pregnant women.

Temporal Trends in E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016 to 2018

BackgroundIt is important to study the trends of e-cigarette use among various subgroups to understand which populations may be more susceptible to increased use and, therefore, are at risk for potential long-term health effects. MethodsWe used cross-sectional data from the 2016-2017 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 years or older. The 2017 dataset also includes data from participant interviews that had been conducted in the year 2018. Current e-cigarette use was defined as use of e-cigarettes every day or on some days. We analyzed data using survey weights to ensure representativeness of the data to the US population. ResultsThe study population consisted of 936,319 individuals, of whom 28,917 were current e-cigarette users, and corresponded to 10.8 million U.S. adults. Thirty percent were aged between 18 and 34 years. Forty-nine percent were men; 63% were white, 12% black, and 17% Hispanic. The overall prevalence of current e-cigarette use increased from 4.3% in 2016 to 4.8% in 2018. E-cigarette use significantly increased among middle-aged adults (from 3.9% to 5.2%; P = .004), women (from 3.3% to 4.3%; P <.001), and former smokers (from 5.2% to 7.9%; P = .02), but decreased among current smokers (from 14.5% to 13.8%; P = .02). ConclusionsIn a nationally representative sample, we found important trends in e-cigarette use in a relatively short time frame. A significantly increasing prevalence of e-cigarette use was noted among middle-age adults, women, and former smokers. Our study provides important information about e-cigarette trends that can be used by clinicians when counselling patients and by regulatory agencies to develop public policies.

Do state regulations on e-cigarettes have impacts on the e-cigarette prevalence?

BackgroundWe examine the association among five types of state regulations on electronic cigarettes (defining e-cigarettes, special tax, packaging, youth access and licensure) and initiation and current usage of e-cigarettes in...

E-Cigarette Use and Regular Cigarette Smoking Among Youth: Population Assessment of Tobacco and Health Study (2013–2016)

This study examines the association between current e-cigarette use at baseline and regular cigarette smoking at follow-up among U.S. youth. A longitudinal analysis of youth (aged 12-17 years) data from Waves 1-3 of the Population Assessment of Tobacco and Health Study (2013-2016) was conducted between January 2019 and December 2019. Youth who reported past-30-day current e-cigarette use at baseline were identified and followed for regular cigarette smoking (≥20 days) at follow-up. Compared with noncurrent e-cigarette users at baseline, current e-cigarette users (cigarette nonsmokers) had 5.0 (95% CI=1.9, 12.8) times higher odds of becoming regular cigarette smokers 1 year later. Additionally, there was a direct linear relationship between the number of days of e-cigarette use at baseline and the number of days of cigarette smoking 1 year later. Current e-cigarette use among U.S. youth is associated with higher odds of transitioning to regular cigarette smoking, likely reflecting robust transitions rather than experimentation. These results suggest that promoting e-cigarettes as the current practice for tobacco harm reduction will likely have the unintended consequence of initiating youth cigarette smokers.

Is dual use of nicotine products and cigarettes associated with smoking reduction and cessation behaviours? A prospective study in England

ObjectivesTo investigate associations of dual use of e-cigarettes and cigarettes with subsequent quitting activity (smoking reduction, quit attempts and use of evidence-based cessation aids). To overcome potential confounding by factors...

Use of Electronic Cigarettes in European Populations: A Narrative Review.

The increasing popularity of electronic cigarettes in past decades has aroused public health concern. This study aims to review the literature on the prevalence of e-cigarette use among the general adult and young populations in Europe. We searched Medline and Google Scholar from September 2019, and included “prevalence of e-cigarettes”, “electronic cigarettes” or “e-cigarettes”, and “electronic nicotine delivery system” or “vaping”. The prevalence of current e-cigarette use ranged from 0.2% to 27%, ever-use ranged from 5.5% to 56.6% and daily use ranged from 1% to 2.9%. Current smokers of conventional cigarettes showed the highest prevalence for the use of e-cigarettes, ranging from 20.4% to 83.1%, followed by ex-smokers, with ranges from 7% to 15%. The following socio-demographic factors were associated with a higher chance of using e-cigarettes: male sex and younger age groups; results for economic status were inconclusive. In European countries, there is a higher prevalence of e-cigarette use among males, adolescents and young adults, smokers of conventional cigarettes, and former smokers.

The Association of Electronic Cigarette Use and the Subjective Domains of Physical and Mental Health: The Behavioral Risk Factor Surveillance System Survey.

IntroductionIndividuals who use electronic cigarettes (e-cigarettes) may have a poor perception of physical and mental health. We, therefore, studied the association of e-cigarettes with subjectively reported health domains.MethodsWe utilized cross-sectional data from the 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative U.S. telephone-based survey. All variables were self-reported. E-cigarette use was characterized as never, former, or current. Health domains included overall health, physical health, and mental health, which was assessed as the frequency of emotional support, life satisfaction, and feeling stressed. Weighted multivariable-adjusted logistic regression models were used to examine the association between e-cigarette use and these health domains.ResultsOur study population consisted of 755,355 (79%) never e-cigarette users, 111,940 (16%) former users, and 28,917 (5%) current users. There was a significant association between e-cigarette use and the less favorable perceived state of overall health, physical health, or mental health. For example, the OR (95% CI) for the association of current e-cigarette use with health domains was as follows: good perception of overall health: 0.78 (0.74,0.83), physical health: 0.69 (0.66,0.73), adequate emotional support: 0.89 (0.79,0.99), feeling satisfied: 0.83 (0.71,0.96), or being free of stress: 0.64 (0.53,0.76). Similar results were obtained in younger individuals (aged 18-34 years).ConclusionsE-cigarette use is associated with a less favorable perception of physical and mental health as compared to never use, particularly among younger adults. These results have important implications for clinicians for patient counseling and regulatory agencies to regulate e-cigarette sales.

Prevalence of Electronic Cigarette Use Among Adolescents in New Jersey and Association With Social Factors

Use of electronic cigarettes (e-cigarettes) is high among adolescents, but the extent to which the JUUL e-cigarette brand accounts for the high prevalence has not been explored using population-based surveys. To examine e-cigarette and JUUL use among adolescents in New Jersey. Survey study using data from the 2018 New Jersey Youth Tobacco Survey, a cross-sectional statewide representative survey of tobacco use. The survey was school based and sampled New Jersey students in grades 9 to 12. Use of tobacco products; JUUL as first tobacco product tried; exposure to JUUL at school; number of friends perceived as JUUL users; liking or following a tobacco brand on social media; and buying or receiving tobacco-branded merchandise. Prevalence ratio (PR) for current and frequent e-cigarette use, inclusive of JUUL. In this sample of 4183 adolescents, respondents were 49.6% female and 49.6% non-Hispanic white. Students were evenly distributed across grades 9 through 12. Overall, the estimate for current use of e-cigarettes inclusive of JUUL was higher (24.2%; 95% CI, 22.5%-25.9%) compared with current use assessed by use of e-cigarettes only (17.8%; 95% CI, 16.4%-19.4%) or JUUL use only (21.3%; 95% CI, 19.7%-23.0%). Divergence in e-cigarette use estimates was higher for certain subgroups, including female respondents and non-Hispanic black respondents. Also, 88.8% (95% CI, 86.6%-91.1%) of current e-cigarette users reported JUUL as a brand they used. Hispanic students (PR, 0.78; 95% CI, 0.69-0.89) and non-Hispanic students of other races (PR, 0.64; 95% CI, 0.51-0.81) were significantly less likely than non-Hispanic white students to be current e-cigarette users, and students in 12th grade were more likely than those in 9th grade to be current users (PR, 1.29; 95% CI, 1.11-1.48). Current e-cigarette use was positively associated with current use of other tobacco products (PR, 2.57; 95% CI, 2.24-2.95), endorsing a tobacco brand on social media (PR, 1.43; 95% CI, 1.19-1.72), having tobacco-branded merchandise (PR, 1.70; 95% CI, 1.46-1.97), having close friends who used JUUL (PR, 3.81; 95% CI, 3.17-4.58), and seeing JUUL used on school grounds (PR, 1.43; 95% CI, 1.24-1.65). Estimates of prevalence were greater when modeling frequent use. This study found that prevalence of current and frequent e-cigarette use among adolescents was higher when inclusive of JUUL use, and JUUL was by far the most common e-cigarette brand used, providing support for inclusion of brand-specific questions when assessing e-cigarette use. The results also identify characteristics of adolescents who may be more likely to use e-cigarettes.

Transitions across tobacco use profiles among adolescents: results from the Population Assessment of Tobacco and Health (PATH) study waves 1 and 2.

To estimate progression to polytobacco use (PTU) over 1year among a sample of US youth. Prospective survey with two waves 1year apart: wave 1 (2013-14) and wave 2 (2014-15). We conducted latent transition analysis (LTA) to identify latent class transitions and examine socio-demographic predictors of transition types. United States. A total of 11, 996 people who were aged 12-17 years at wave 1. Publicly available data were used from the Population Assessment of Tobacco and Health (PATH) study, a nationally representative sample of US civilian, non-institutionalized population aged 12 years and older. Tobacco use status was assessed and classified in terms of: never use, non-current (not in the past 30 days) and current (past 30-day) use of cigarettes, cigars, e-cigarettes, hookah and smokeless tobacco. Other nicotine products were excluded because rates of use were either too low to model (e.g. pipe) or the product was not assessed in the PATH youth sample (e.g. nicotine replacement products). We identified three distinct patterns: class 1, non-use (wave 1 prevalence=86%; wave 2 prevalence=78%); class 2, ever use of cigarettes and e-cigarettes (wave 1 prevalence=11%; wave 2 prevalence =14%); and class 3, current PTU (wave 1 prevalence=4%; wave 2 prevalence=7%). Probability of progression from non-use to ever use of cigarettes and e-cigarettes was 0.06 and ever use of cigarettes and e-cigarettes to current PTU was 0.32. Non-users were more likely to transition to ever use of cigarettes and e-cigarettes if they were older (versus younger), white (versus non-white) or if their parental education level was high school or less (versus more than high school); and ever users of cigarettes and e-cigarettes to current PTU if they were older, male or white. US youth who had previously tried e-cigarettes and cigarettes at wave 1 (2013-14) had a 32% chance of transitioning to current use of two or more tobacco products within 1year.

Age-varying associations between e-cigarette use and peer use, household use, and exposure to e-cigarette commercials among alternative high school students in Southern California.

INTRODUCTIONElectronic cigarettes (e-cigarettes) have rapidly become the most commonly used tobacco product among youth in the United States. Exposure to advertising, peer use, and household use, increases the risk of current e-cigarette use; however, the influence of these factors may be dynamic across adolescence. The aim of this study is to examine the age-varying associations between e-cigarette use and peer use, household use, and exposure to e-cigarette commercials among alternative high school students in Southern California.METHODSUsing data previously collected for a tobacco marketing study, we examine the age-varying associations of current e-cigarette use and three risk factors (peer use, exposure to commercials, and household use) across ages 15 to 20 years using time-varying effect modeling (TVEM). Analyses include three waves of data from alternative high school students (N=1060 students; 2036 observations).RESULTSThe probability of e-cigarette use gradually increased over the age of 15 years and then decreased by the age of 17 years for females and after the age of 18 years for males. Significant gender differences were observed between the ages of 17 and 19.5 years. Peer e-cigarette use was associated with higher odds of current e-cigarette use across all ages for females and after the age of 16 years for males. Exposure to e-cigarette commercials increased current use significantly for males between the ages of 16 and 18 years. Household use increased the odds of current use of e-cigarettes between the ages of 17 and 19 years for males and under 16.5 and over 18 years for females.CONCLUSIONSThe findings highlight the utility of TVEM in understanding the risk factors of e-cigarette use and suggest that these factors are dynamic across adolescence.

Association between electronic cigarette use and smoking cessation in the European Union in 2017: analysis of a representative sample of 13 057 Europeans from 28 countries

ObjectivesTo examine the association between electronic cigarette (e-cigarette) use and smoking cessation in the European Union (EU) in 2017 according to e-cigarette use frequency and smoking cessation duration.DesignCross-sectional survey of...

Association of Electronic Cigarette Regulations With Electronic Cigarette Use Among Adults in the United States

Millions of Americans use electronic cigarettes (e-cigarettes). A growing number of state and local governments have started to draft and implement laws regarding the sale, marketing, and use of e-cigarettes. The association of US state regulations regarding e-cigarettes with e-cigarette use remains unknown. To examine the association of US state regulations regarding e-cigarettes with current e-cigarette use among adults in the United States. This cross-sectional study included adults aged 18 years or older from the 2016 and 2017 Behavioral Risk Factor Surveillance System, which is a nationwide, telephone-administered survey that collects state-representative data on health-related risk behaviors, chronic health conditions, and use of preventive services. Data analysis was performed from February 1, 2019, to April 31, 2019. United States state laws regulating e-cigarette use, including prohibiting e-cigarette use in indoor areas of private workplaces, restaurants, and bars; requiring retailers to purchase a license to sell e-cigarettes; prohibiting self-service displays of e-cigarettes; prohibiting sales of tobacco products, including e-cigarettes, to persons younger than 21 years; and e-cigarette taxes. Current use of e-cigarettes. Among 894 997 participants aged 18 years or older (503 688 women [51.3%], 679 443 non-Hispanic white [62.6%], 71 730 non-Hispanic black [16.3%], 69 823 Hispanic [11.4%], and 74 001 non-Hispanic other races [9.8%]), 28 907 (weighted prevalence, 4.4%) were currently using e-cigarettes. The age-standardized weighted prevalence of current e-cigarette use varied across US states and territories, from 1.0% in Puerto Rico to 6.2% in Guam. After adjustment for demographic, socioeconomic, and lifestyle factors, including conventional cigarette use, the odds ratios of current e-cigarette use were 0.90 (95% CI, 0.83-0.98) for state laws prohibiting e-cigarette use in indoor areas of private workplaces, restaurants, and bars; 0.90 (95% CI, 0.85-0.95) for state laws requiring retailers to purchase a license to sell e-cigarettes; 1.04 (95% CI, 0.99-1.09) for state laws prohibiting self-service displays of e-cigarettes; 0.86 (95% CI, 0.74-0.99) for state laws prohibiting sales of tobacco products, including e-cigarettes, to persons younger than 21 years; and 0.89 (95% CI, 0.83-0.96) for state laws applying taxes to e-cigarettes. These findings suggest that several state regulations regarding e-cigarettes may be associated with reduced e-cigarette use among US adults.

P032 E-CIGARETTE AND CIGARETTE USE AMONG U.S. ADULT IBD PATIENTS: POPULATION-LEVEL SURVEY

Abstract Background Cigarette smoking can negatively affect treatment response in inflammatory bowel disease (IBD) patients, especially among those with Crohn’s disease (CD). E-cigarette has been considered a safer alternative to delivering nicotine for IBD patients who smoke. However, given the recent large number of reported e-cigarette-related lung injury cases, CDC released an interim guidance update on those lung injuries. They also coined a term EVALI (e-cigarette, or vaping, product use associated lung injury) emphasizing the possible harms in e-cigarette smoking. To the best our knowledge, we currently do not know the recent smoking habits in American IBD patients, especially when it reveals that e-cigarette use might cause serious lung injuries. Methods We used National Health Interview Survey (NHIS) for 2015–2016, which is a nationally representative survey for noninstitutionalized adults in the US. Weighted counts and percentages were estimated using survey design for the population-level results. We identified those who reportedly were told by a doctor or healthcare professional that they have IBD. We first estimated the prevalence of current e-cigarette or cigarette use among IBD patients. We then estimated the frequency of use (every day or some days) among the current users. We also categorized IBD patients into 4 groups by smoking type: those using e-cigarette only, cigarette only, using both, and neither. To see the characteristics of e-cigarette users, we stratified e-cigarette users by current/former/never cigarette use status. Results We identified 951 participants (population estimate: 3.1 million) with IBD. Among those people, 5.0% (95% CI: 3.1–6.9) was current e-cigarette users while 17.9% (95% CI: 14.8–21.0) was current cigarette smokers. Prevalence of every-day use and some-day use of e-cigarette was similar (2.4% vs 2.6%), while there was much higher prevalence of every-day use than some-day use in cigarette (15.3% vs 2.6%). Those who were using both e-cigarette and cigarette was 3.2% (Table). Majority of e-cigarette users were also currently using cigarette (63.6%, 95% CI: 48.9–78.3), while 32.7% (95% CI: 18.4–47.0) of them were former cigarette smokers. Only 3.7% (0.0–8.9) of them never used cigarettes. Conclusion While numerous studies show e-cigarette use is generally increasing rapidly in the US, we found that 5% of IBD patients are currently using e-cigarette. Almost two-thirds of them were also currently smoking cigarette and one-third of them were former smokers. It is possible that most of the e-cigarette users are still in the process of transitioning from cigarette smoking and thus using both types. We lack information on effects of using e-cigarette or both e-cigarette and cigarette in IBD treatment outcomes, as well as how e-cigarette use will complicate other health risks in IBD patients (e.g. lung injuries). We need further research on these effects to properly guide IBD patients who are in need of smoking cessation.

Body esteem, weight-control outcome expectancies, and e-cigarette use among young adults.

Evidence is still scarce regarding the use of e-cigarettes by young people for weight-control reasons. This study aimed to test a model in which the prospective association between negative body esteem and e-cigarette use is mediated by weight-control outcome expectancies for e-cigarette use. The model was tested across genders. Data were collected at three time points, 6 months apart, from 2327 young adults (mean age = 21.2; SD = 2.2; 54% women). Self-reported data were collected on demographics, body mass index, body esteem, weight-control outcome expectancies for e-cigarette use, and current e-cigarette use and cigarette smoking. Among women, we found a significant indirect effect of lower body esteem on higher likelihood of current e-cigarette use 1 year later, mediated by higher weight-control outcome expectancies at 6-month follow-up, adjusting for demographics, body mass index, and baseline e-cigarette use and cigarette smoking. Among men, body esteem was not found to have significant effect on either weight-control expectancies or e-cigarette use. Based on the current findings, young adult women who have higher negative body esteem are at increased risk for using e-cigarettes for weight-control motives. The current findings are some of the first to show prospective associations among weight-control motives and e-cigarette use among young adults. These findings suggest that a group of vulnerable young women may be using e-cigarettes to lose or control weight. More research is needed to understand their choice of flavors, nicotine concentration, and device type. In addition, research is needed to understand whether e-cigarettes are being marketed, directly or indirectly, as being useful for weight loss or control. There may be a need for health promotion strategies that provide healthier alternatives to young women struggling with low body esteem who use e-cigarettes for weight loss or control.

63. Who’s Vaping? Understanding the Psychographics of Adolescent E-Cigarette Users in an Era of Growing Use

Teen e-cigarette use in the U.S. increased significantly from 2017 to 2018, reversing a trend of declining overall tobacco use. For high school students, current e-cigarette use increased from 11.7% in 2017 to 20.8% in 2018, a staggering 78% increase. Given the effects of nicotine addiction on youth, and the potential association between e-cigarette use and cigarette smoking initiation among youth, it is important to understand which adolescents are at higher risk for e-cigarette use. We sought to investigate the psychographics of adolescent e-cigarette users - their social orientation and their personal values - to identify which teens are at greatest risk, which can serve to inform the development of future interventions.

Does e-cigarette experimentation increase the transition to daily smoking among young ever-smokers in France?

IntroductionAccording to multiple studies, e-cigarette use among adolescents is associated with subsequent smoking initiation. However, little is known about its effect on the transition from smoking initiation to daily smoking. MethodsUsing retrospective data from a French national representative survey collected in 2017 (n = 39,115), we analyzed the role of ever using e-cigarettes on daily cigarette smoking status at 17 among ever smokers (n = 21,401). Risk-ratios (RR) were computed through modified Poisson regressions with an inverse probability of treatment weighting (IPTW) approach. ResultsAmong French adolescents aged 17, 16.8 % declared current e-cigarette use (1.9 % reported daily use) and 34.1 % cigarette smoking (25.1 % reported daily smoking). Among ever-smokers, adolescents who declared having ever used e-cigarettes were less likely than those who did not to transition to daily smoking at 17: RR = 0.62 95 %CI [0.60 – 0.64]. We found similar results for those who experimented with e-cigarettes before initiating smoking, RR = 0.76 95 %CI [0.66 – 0.89]. ConclusionsOur results found no evidence of an increased risk of transitioning to daily smoking at 17 among ever-smokers who also experimented with e-cigarettes. Further studies should investigate the longer-term role of vaping on future smoking habits with the use of causal inference methods.

Risk of Stroke With E-Cigarette and Combustible Cigarette Use in Young Adults

Rising trends in stroke incidence and hospitalizations because of combustible cigarette smoking have been noted among younger adults. However, the association between e-cigarette use and stroke in this population remains largely unknown. This study examines the association between e-cigarette use with or without a history of previous or concurrent combustible cigarette use and stroke among young adults. Pooled data (2016-2017) were analyzed from the Behavior Risk Factor Surveillance System, a nationally representative, cross-sectional telephone survey, in 2019. The sample size was 161,529 participants aged 18-44 years. The association between e-cigarette use and stroke was examined using logistic regression adjusting for patient demographics, relevant comorbidities without or with history, and concurrent use of combustible cigarette use. Current dual use of e-cigarettes and combustible cigarettes was associated with 2.91 times higher odds of stroke versus nonsmokers (AOR=2.91, 95% CI=1.62, 5.25) and 1.83 times higher odds versus current sole combustible cigarette users (AOR=1.83, 95% CI=1.06, 3.17). Compared with nonsmokers, current sole e-cigarette users did not show significantly different odds of stroke (AOR=0.69, 95% CI=0.34, 1.42). However, odds of stroke were lower for sole e-cigarette users versus current sole combustible cigarette users (AOR=0.43, 95% CI=0.20, 0.93). Sole e-cigarette use is not associated with greater odds of stroke in young adults. However, if young adults have former or current combustible cigarette use, odds of stroke are significantly increased even compared with current sole combustible cigarette use. Switching from combustible cigarettes to e-cigarettes does not confer stroke benefits.