E-Cigarette Use Among US Adults in the 2021 Behavioral Risk Factor Surveillance System Survey

Abstract

ImportanceAfter the initial disruption from the COVID-19 pandemic, it is unclear how patterns of e-cigarette use in the US have changed.ObjectiveTo examine recent patterns in current and daily e-cigarette use among US adults in 2021.Design, Setting, and ParticipantsThis cross-sectional study used data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) database. The BRFSS is the largest national telephone-based survey of randomly sampled adults in the US. Adults aged 18 years or older, residing in 49 US states (all except Florida), the District of Columbia, and 3 US territories (Guam, Puerto Rico, and the US Virgin Islands), were included in the data set. Data analysis was performed in January 2023.Main Outcomes and MeasuresThe main outcome was age-adjusted prevalence of current and daily e-cigarette use overall and by participant characteristics, state, and territory. Descriptive statistical analysis was conducted, applying weights to account for population representation.ResultsThis study included 414 755 BRFSS participants with information on e-cigarette use. More than half of participants were women (51.3%). In terms of race and ethnicity, 0.9% of participants were American Indian or Alaska Native, 5.8% were Asian, 11.5% were Black, 17.3% were Hispanic, 0.2% were Native Hawaiian or Other Pacific Islander, 62.2% were White, 1.4% were of multiple races or ethnicities, and 0.6% were of other race or ethnicity. Individuals aged 18 to 24 years comprised 12.4% of the study population. The age-standardized prevalence of current e-cigarette use was 6.9% (95% CI, 6.7%-7.1%), with almost half of participants using e-cigarettes daily (3.2% [95% CI, 3.1%-3.4%]). Among individuals aged 18 to 24 years, there was a consistently higher prevalence of e-cigarette use, with more than 18.6% reporting current use and more than 9.0% reporting daily use. Overall, among individuals reporting current e-cigarette use, 42.2% (95% CI, 40.7%-43.7%) indicated former combustible cigarette use, 37.1% (95% CI, 35.6%-38.6%) indicated current combustible cigarette use, and 20.7% (95% CI, 19.7%-21.8%) indicated never using combustible cigarettes. Although relatively older adults (aged ≥25 years) who reported current e-cigarette use were more likely to report former or current combustible cigarette use, younger adults (aged 18-24 years) were more likely to report never using combustible cigarettes. Notably, the proportion of individuals who reported current e-cigarette use and never using combustible cigarettes was higher in the group aged 18 to 20 years (71.5% [95% CI, 66.8%-75.7%]) compared with those aged 21 to 24 years (53.0% [95% CI, 49.8%-56.1%]).Conclusion and RelevanceThese findings suggest that e-cigarette use remained common during the COVID-19 pandemic, particularly among young adults aged 18 to 24 years (18.3% prevalence). Notably, 71.5% of individuals aged 18 to 20 years who reported current e-cigarette use had never used combustible cigarettes. These results underscore the rationale for the implementation and enforcement of public health policies tailored to young adults.

Reasons for continued usage of ENDS: Differences by device and liquid characteristics among US adults

“…About 6.9% of US adults aged ≥18 years currently use electronic nicotine delivery systems (ENDS), and 3.2% use ENDS daily 1 . ENDS typically include coils powered by batteries, which heat and aerosolize liquids containing nicotine, propylene glycol and/or vegetable glycerin, and various flavors 2 ; and are available with many devices (e.g.…”

E-Cigarette Nicotine Delivery Among Young Adults by Nicotine Form, Concentration, and Flavor

“…E-cigarettes have disproportionately attracted youths and are the most commonly used tobacco product among young people in the US. [1][2][3][4][5][6][7] According to the most recent available data, 18% of young adults in 2021 8 and 10% of middle and high school students in 2023 7 reported current e-cigarette use. Young people are not merely experimenting with e-cigarettes but are increasingly becoming established users, with nearly half (46%) of young adults and a quarter (25%) of adolescents who use e-cigarettes reporting daily use.…”

“…Young people are not merely experimenting with e-cigarettes but are increasingly becoming established users, with nearly half (46%) of young adults and a quarter (25%) of adolescents who use e-cigarettes reporting daily use. 7,8 It has been hypothesized that nicotine dependence in young people has increased because of the market transitioning from harsher freebase nicotine to more palatable nicotine salts. [9][10][11] While e-cigarettes may serve as a safer alternative to regular cigarettes for adults who smoke [12][13][14] and may have reduced smoking among youths, 15 studies on the effect of e-cigarette characteristics, including nicotine form, on abuse liability are urgently needed to address the high rates of e-cigarette use among young people.…”