Declines in Electronic Cigarette Use Among US Youth in the Era of COVID-19—A Critical Opportunity to Stop Youth Vaping in Its Tracks

Andrew C. Stokes
2020 JAMA Network Open  
The use of electronic cigarettes (e-cigarettes) has increased at an alarming pace among youth, a striking reversal of decades of public health progress aimed at reducing youth tobacco use in the US. Between 2011 and 2019, the proportion of high school students who were current e-cigarettes users increased from 1.5% to 27.5%. 1 Any use of e-cigarettes by youth is unsafe and includes short-and long-term health effects, such as impacts on the brain, lungs, and heart. 2 The rapid uptake of
more » ... uptake of e-cigarettes in the youth population is likely attributable to a number of factors, including the appeal of flavors, technological refinements in the design of e-cigarette products, and ease of access to vaping products by underage youth despite existing regulatory policies. 3 The coronavirus disease 2019 (COVID-19) pandemic has had far-reaching consequences since emerging in the US in February 2020. This new study by Gaiha and colleagues 4 examines the associations of the COVID-19 pandemic with patterns of youth e-cigarette use, drawing on a national sample of 2167 underage youth and young adults sampled between May 6 and 14, 2020. Among the key findings of the study were that more than half of participants (1198 [56.4%]) reported change in their e-cigarette use since the beginning of the COVID-19 pandemic. Among 1197 participants reporting on the type of change, one-third of youth (388 participants [32.8%]) quit vaping, and another one-third (422 participants [35.3%]) reduced their use of e-cigarettes, with the remaining youth either increasing their use or switching to other nicotine or cannabis products. Second, the point of purchasing e-cigarettes changed markedly before and after the COVID-19 pandemic, with approximately 20% of youth e-cigarette users switching from retail stores to online sources. Third, the study examined factors associated with continuing to vape through the pandemic, finding that higher nicotine dependence, e-cigarette use frequency, poor online age verification, and several other factors were associated with sustained use of e-cigarette products. The findings in the study by Gaiha et al 4 of substantial declines in e-cigarette use associated with COVID-19 is consistent with other emerging evidence. Data from the 2020 National Youth Tobacco Survey (NYTS) 1 indicate that approximately 20% of high school students and 5% of middle school students were current users of e-cigarettes in early 2020, compared with 27.5% of high school students and 10.5% of middle school students in 2019. These data, collected between January 16 and March 16, 2020 suggest that substantial declines in e-cigarette use may have occurred even prior to the period of the study by Gaiha et al 4 and in some cases before stay-at-home orders came into effect. Among 895 participants who decreased or quit use of e-cigarettes, Gaiha et al 4 inquired about the reasons for decreased use. Explanations for decreased use included at home and parents will know (136 participants [15.2%]), cannot get products (175 participants [19.5%]), e-cigarettes may weaken lungs (224 participants [25.0%]), any combination of these factors (287 participants [32.1%]), and other (73 participants [8.2%]). These breakdowns point to the roles of both supplyand demand-side factors in shaping patterns of e-cigarette use during the COVID-19 pandemic. With respect to the supply side, reduced access to products was an important factor, and on the demand side, participants' perceptions regarding health consequences of e-cigarette use appeared to change (eg, that e-cigarettes may weaken lungs). The fact that one-quarter of youth reported concerns regarding health effects of e-cigarette products as a major motivating factor for quitting or reducing e-cigarette use indicates that targeted educational campaigns may be a fruitful strategy for further +
doi:10.1001/jamanetworkopen.2020.28221 pmid:33270120 fatcat:ud5b355eujexxbxf2tpct3zkny