Review
E-cigarette prevalence and correlates of use among adolescents versus adults: A review and comparison

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Abstract

Perceived safer than tobacco cigarettes, prevalence of electronic cigarette (e-cigarette) use is increasing. Analyses of cartridges suggest that e-cigarettes may pose health risks. In light of increased use and the potential for consequences, we searched Google Scholar and Pubmed in July of 2013 using keywords, such as e-cigarette and vaping, to compare differences and similarities in prevalence and correlates of e-cigarette use among adolescents (grades 6–12) versus adults (aged ≥18 years). Twenty-one studies focused on e-cigarette use. Ever-use increased among various age groups. In 2011, ever-use was highest among young adults (college students and those aged 20–28; 4.9%–7.0%), followed by adults (aged ≥18; 0.6%–6.2%), and adolescents (grades 6–12 and aged 11–19; <1%–3.3%). However, in 2012 adolescent ever-use increased to 6.8% and, among high school students, went as high as 10.0%. While the identified common correlate of e-cigarette use was a history of cigarette smoking, a notable proportion of adolescents and young adults who never smoked cigarettes had ever-used e-cigarettes. E-cigarette use was not consistently associated with attempting to quit tobacco among young adults. Adults most often reported e-cigarettes as a substitute for tobacco, although not always to quit. Reviewed studies showed a somewhat different pattern of e-cigarette use among young people (new e-cigarette users who had never used tobacco) versus adults (former or current tobacco users). Research is needed to better characterize prevalences, use correlates, and motives of use in different population groups, including how adolescent and young adult experimentation with e-cigarettes relates to other types of substance use behaviors.

Introduction

Electronic cigarettes (e-cigarettes) are battery operated nicotine delivery devices released in 2004 to provide a way to more safely mimic the experience of tobacco cigarettes (Cobb et al., 2010). Most e-cigarettes share a similar design, a plastic tube holding a battery, airflow sensor, vaporizer, and nicotine/flavor cartridge with a chemical component, such as propylene glycol, that turns liquid to vapor (Cobb et al., 2010). Multiple companies produce e-cigarettes (e.g. V2 Cigs, Bedford Slims), making them widely available (Yamin et al., 2010), and Bonnie Herzog of Wells Fargo estimates that in 2013 U.S. e-cigarette sales will reach $1.7 billion (Mangan, 2013). E-cigarettes are perceived of as safer than tobacco and as tobacco cessation devices. They have been found as effective, though not more, than nicotine patches for short-term cigarette cessation (Dockrell et al., 2013, Etter and Bullen, 2011, Bullen et al., 2013), and cartridge analyses find fewer toxins than are found in traditional cigarettes (Goniewicz et al., 2013a). However, in a randomized trial 29% of e-cigarette users continued e-cigarettes at 6-months compared to only 8% of patch users (Bullen et al., 2013), suggesting e-cigarette use might persist after other quit methods. In addition, cartridges have been found to contain hazards, such as cytotoxic heavy metal and silicate particles (Williams and Talbot, 2011). It is unclear how appealing e-cigarettes are to young people, and there is concern they may cause nicotine addiction or act as a gateway to tobacco use (Riker et al., 2012). We conducted a literature review to explore differences and similarities in prevalence and correlates of e-cigarette use among adolescents aged 13–18 years (grades 6–12) and adults aged ≥18 years. A previous review by Pepper and Brewer (2013) examined studies of e-cigarette beliefs and use. We add to it by comparing findings among different age groups and including additional studies on adolescents. We report findings with identified gaps in research and suggestions for future studies. Table 1, Table 2, Table 3

Section snippets

Materials and methods

We searched Google Scholar and PubMed in July of 2013 using the keywords e-cigarette, electronic cigarette, vaping, vaper, and vapor. There were 2796 hits (Fig. 1). After removing patents and case law, we reviewed hits from 2004 to 2013. A total of 266 articles were reviewed and articles excluded (197) if they were not journal articles, not peer-reviewed, not published in English, and not focused on e-cigarettes. The 69 remaining articles were sorted into categories. This review focused on

Results

Twenty-one studies were identified. Six focused on adolescents (Camenga et al., 2014, Corey et al., 2013, Pepper et al., 2013a, Pepper et al., 2013b, Goniewicz and Zielinska-Danch, 2012, Cho et al., 2011), three on young adults (aged 18–28 or college age) (Choi and Forester, 2013, Sutfin et al., 2013, Goniewicz and Zielinska-Danch, 2012), and seven on adults aged ≥18 (Dockrell et al., 2013, King et al., 2013, Regan et al., 2013, Vickerman et al., 2013, Adkison et al., 2013, Li et al., 2013,

Discussion

It appears that e-cigarette use prevalences are increasing among various age groups. Based on the most recent comparable U.S. data (2011), lifetime use was higher among young adults (aged 20–28 years and college students, range: 4.9%–7.0%), followed by adults (aged ≥18, range: 0.6%–6.2%) and then adolescents (grades 6–12, range: <1%–3.3%). However, lifetime use prevalence among adolescents increased to 6.8% in 2012, comparable to the prevalence in the 2011 young adult and adult data, and in

Contributors

Author Chapman conducted the literature search. Authors Chapman and Wu wrote the manuscript.

Role of funding source

This work is made possible by research support from the U.S. National Institutes of Health (R01MD007658, R33DA027503, R01DA019623, and R01DA019901; PI: Li-Tzy Wu) and Department of Psychiatry and Behavioral Sciences (Psychiatry Basic Science Research 4416016), Duke University School of Medicine. The sponsoring agency had no further role in the writing of this paper or the decision to submit the paper for publication. The opinions expressed in this paper are solely those of the authors.

Conflict of interest

Authors declare they have no conflicts of interest.

Acknowledgments

This work is made possible by research support from the U.S. National Institutes of Health.

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