The popularity of e-cigarettes remained disturbingly high during the COVID pandemic, particularly among young adults who had never used traditional cigarettes, according to findings published Friday in the JAMA Network Open Journal of the American Medical Association. The study, "E-Cigarette Use Among US Adults in the 2021 Behavioral Risk Factor Surveillance System Survey," was supported by the American Heart Association's Tobacco Center of Regulatory Science (TCORS), which is jointly funded by the Food and Drug Administration (FDA) and the National Institutes of Health (NIH).
The study authors analyzed data from the 2021 nationally representative Behavioral Risk Factor Surveillance System (BRFSS) survey to study e-cigarette use among roughly 415,000 U.S. adults. They found a high prevalence of U.S. adults using e-cigarettes during the pandemic, with nearly 20% of 18- to 24-year-olds using the products. The survey also revealed that nearly 75% of 18- to 20-year-olds who reported current use of e-cigarettes said they had never used combustible cigarettes.
"The findings show that the tobacco industry continues to foster addiction in younger generations by developing and marketing new tobacco products that get young adults hooked," said Rose Marie Robertson, M.D., FAHA, deputy chief science and medical officer of the American Heart Association, a global force for healthier lives for all. Robertson is co-director of the Association's TCORS and a co-author of the study. "We're seeing troubling evidence that e-cigarettes and other emerging tobacco products continue to lure young people into nicotine addiction."
The study was published one day after the Centers for Disease Control and Prevention (CDC) and FDA released the 2023 National Youth Tobacco Survey which found that e-cigarettes continue to hold the top spot as the most widely used tobacco product among both middle and high school students for the tenth consecutive year.
The National Youth Tobacco Survey data emphasize the persistent public health concern of youth e-cigarette use, as half of the students in grades 6 through 12 who have tried e-cigarettes continue to currently use them. Notably, around a quarter of students reporting current e-cigarette use admitted to using them daily, with the overwhelming majority – a whopping 90% - opting for flavored e-cigarettes.
Other key findings from the BRFSS study include:
- Young U.S. adults were using e-cigarettes more than ever before during the pandemic. The study shows that 72% of those aged 18 to 20 who reported e-cigarette use had no prior history of combustible cigarette use, and that a high proportion of young adults who use e-cigarettes reported daily use. Additionally, 18% of those aged 18 to 24 continued to use e-cigarettes during the pandemic.
- The pandemic may have accelerated the popularity of e-cigarette use. The study finds that the higher prevalence of e-cigarette use observed in 2021 may have been due to changes that occurred during the pandemic, such as increased online sales, which made them more accessible and easier to stockpile. Moreover, other studies suggest that the heightened stress experienced during the pandemic may have resulted in more individuals turning to e-cigarettes thinking they might be a coping mechanism, despite the lack of evidence for this.
- E-cigarette dependency continues to impact people of certain demographics more than others. The study finds that e-cigarette use during the pandemic was more prevalent among men; people who identify as lesbian, gay, bisexual or transgender; individuals who live in rural areas and those with chronic health conditions.
"These findings lend increasing importance to the critical need for public policies that protect youth, young adults and others from being targeted by the tobacco industry," Robertson said. "The popularity of e-cigarettes among young adults who have never used traditional cigarettes is cause for deep concern for the health of our communities."
Tobacco use is a leading cause of preventable disease and death and a major risk factor in the development of heart disease and stroke. Of the approximately 480,000 people in the U.S. who die from smoking each year, 35% of those deaths are from cardiovascular disease.
There are misconceptions about the safety of e-cigarettes, which are often touted as a safer alternative and potential tobacco cessation tool. However, increasing evidence suggests that e-cigarettes can cause significant adverse effects in the neurologic, cardiovascular and respiratory systems. Studies have shown that e-cigarettes and their constituents can injure the airway epithelium (the cells that line our airways) and can increase pulmonary inflammation and suppress respiratory immune function.
Additionally, nicotine can cause an increase in blood pressure and heart rate and can affect the ability of blood vessels to increase blood flow. Importantly, it is highly addictive, with most addicted individuals beginning their exposure as youth or young adults.
E-cigarettes have been designed to be especially enticing and addictive because, unlike combustible cigarettes, they come in thousands of combinations, including highly appealing mint, menthol, fruit and dessert flavors. A number of these flavors also make these products easier to use because they mask the harshness of tobacco, provide a cooling effect and suppress coughing. They are also harder to quit because the desirable flavors entice individuals to take more frequent and larger hits, delivering more nicotine and leading to a stronger nicotine addiction.
The American Heart Association is committed to ending tobacco and nicotine addiction in the U.S. and advocating for the elimination of all characterizing flavors other than tobacco from all tobacco products. The removal of all flavorings from tobacco products is necessary to reduce appeal to youth and adults and to achieve the tobacco endgame and its benefit for longer, healthier lives.
