Trends in use of electronic nicotine delivery systems by adolescents

doi:10.1016/j.addbeh.2013.09.014

Addictive Behaviors

Volume 39, Issue 1, January 2014, Pages 338-340

https://doi.org/10.1016/j.addbeh.2013.09.014 Get rights and content

Highlights

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We report electronic nicotine delivery system use trends in high school students.
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The prevalence of electronic nicotine delivery system use doubled from 2010–2011.
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Current cigarette smoking is the strongest predictor of use.

Abstract

Electronic nicotine delivery systems (ENDS) have been gaining in popularity. The few prevalence studies in adults have found that most ENDS users are current or former smokers. The objectives of this study were to estimate the prevalence of ENDS usage in adolescents, and examine the correlates of use. Self-administered written surveys assessing tobacco use behaviors were conducted in multiple waves as part of a larger intervention study in two large suburban high schools. The prevalence of past-30 day ENDS use increased from 0.9% in February 2010 to 2.3% in June 2011 (p = 0.009). Current cigarette smokers had increased odds of past-30 day ENDS use in all study waves. When adjusted for school, grade, sex, race and smoking status, students in October 2010 (Adjusted OR 2.12; 95% confidence interval (CI): 1.12–4.02) and June 2011 (Adjusted OR 2.51; 95% CI: 1.17–4.71) had increased odds past-30 day ENDS use compared to February 2010. The prevalence of ENDS use doubled in this sample of high school students, and current cigarette smoking is the strongest predictor of current use. Continued monitoring of ENDS is needed to determine whether it increases the likelihood of cigarette smoking initiation and maintenance in youth.

Introduction

Electronic nicotine delivery systems (ENDS) are marketed as harm reducing alternatives to cigarette smoking and have been gaining in availability and popularity recently (Ayers, Ribisl, & Brownstein, 2011). Proponents of ENDS maintain that they are a safer alternative to smoking, exposing the user to fewer chemicals and that they could aid in cessation or smoking reduction (Cahn & Siegel, 2011). Although ENDS have not been thoroughly evaluated by the Food and Drug Administration, preliminary testing has found low levels of tobacco toxicants, such as tobacco specific nitrosamines (Westenberger, 2009), however early studies have also demonstrated that electronic cigarettes have significantly less cytotoxic effects compared to traditional cigarettes (Romagna et al., 2013). As of this time, the FDA Center for Tobacco Products (CTP) has reported intention to regulate ENDS, although it has not exerted its authority as of yet (US FDA, 2009).

Since the introduction of ENDS to the market in 2007 (Pauly, Li, & Barry, 2007), many concerns have arisen regarding their safety for adolescent populations as a whole. It is unknown if the availability of ENDS serves to alter use of cigarettes among current smokers or leads to increased initiation among non-using youth. Nevertheless, there is concern that ENDS use may undermine social norms about tobacco (Mejia, Ling, & Glantz, 2010), serve as a starter product for cigarettes among youth, or delay smoking cessation among current adolescent smokers.

Given these concerns, it is important to understand the patterns of ENDS use among adolescents. Existing data in adolescents are lacking, although few studies have begun to explore the prevalence and correlates of ENDS use in adults (Pearson et al., 2012, Regan et al., 2013). For example, a 2010 nationally representative online survey of adults (Pearson et al., 2012) found that the prevalence of ever use of ENDS in the adult general public was 3.4%, with an 11.4% usage rate among adult smokers and 2.0% in former smokers. Only one study to our knowledge has assessed trends in ENDS use over time. A consumer-based mail-in survey of over 10,000 US adults found that ever ENDS use increased from 0.6% to 2.7% between 2009 and 2010. Furthermore, this same study showed that awareness of ENDS doubled from 16.4% to 32.2% in the same time period. Given the unanswered questions about the safety of ENDS in youth, and the preliminary trends of usage among adults, it is essential to understand these same trends in youth.

The purpose of this study is to describe the trends of ENDS usage in two high schools in Connecticut and New York over a 16-month period in 2010 and 2011 and examine the correlates of use. The findings from this study will help determine which youth use ENDS, and whether use of ENDS increased over time.

Section snippets

Materials and methods

This is a data analysis of three self-administered written surveys assessing tobacco use behaviors conducted in two suburban high schools in Connecticut and New York between 2010 and 2011. The anonymous surveys were conducted as part of an evaluation of a tobacco use prevention program and also contained questions assessing interest in tobacco cessation services (data not included). The students in grades 9–12 were surveyed in February 2010/Wave 1 (n = 1719; response rate = 76.2%), October

Results

Table 1 demonstrates that the prevalence of past-30 day ENDS use increased from 0.9% in February 2010 to 2.3% in June 2011 (p = 0.009). The prevalence of current (past-30 day) cigarette smoking ranged from 11.6% in February 2010, to 10.8% in October 2010 to 13.6% in June 2011 (p = 0.05). The prevalence of dual cigarette and ENDS use increased from February 2010 (0.8%) to June 2011 (1.9%) (p = 0.03) and the majority of ENDS users also used cigarettes (n = 14/16 (87.5%) in wave 1; n = 24/29 (82.8%) in wave

Discussion

This study provides one of the first reports of the increasing prevalence of ENDS use among adolescents. We found that past-30 day ENDS use had more than doubled over a recent 16-month period. Furthermore, similar to findings in adults, we found that current cigarette use strongly predicts ENDS use in adolescents, and that a majority of ENDS users concurrently use cigarettes. Although the overall prevalence of ENDS use was low (0.9% to 2.3%), the increasing trend of use is concerning given the

Role of funding sources

This work was supported by NIDA grant #R01DA026450. NIDA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Contributors

Authors SKS, AH and KMC designed the study and wrote the protocol. Author DRC and JD conducted literature searches and provided summaries of previous research studies. Authors JD, GK, and DC collected and cleaned the data. Authors DRC and JD are co-first authors, listed alphabetically. JD and DRC conducted the statistical analysis. Author JD and DRC wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.

Conflict of interest

All authors declare that they have no conflicts of interest.

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¹: Deepa R. Camenga and Jennifer Delmerico are co-first authors, listed alphabetically.

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Short CommunicationTrends in use of electronic nicotine delivery systems by adolescents

Highlights

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Role of funding sources

Contributors

Conflict of interest

American Journal of Preventive Medicine

The Journal of Adolescent Health

Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?

Journal of Public Health Policy

Youth Risk Behavior Surveillance — United States, 2011

MMWR. Morbidity and Mortality Weekly Report

Tobacco talk survey — e-Cigarettes a promising opportunity

Monitoring the future national results on drug use: 2012 overview key findings on adolescent drug use

Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA

Tobacco Control

Changes in age trajectories of smoking experimentation during the California Tobacco Control Program

American Journal of Public Health

Short Communication
Trends in use of electronic nicotine delivery systems by adolescents