Research ArticleFrequency of E-Cigarette Use and Cigarette Smoking by American Students in 2014
Introduction
Two national surveys—Monitoring the Future (MTF)1 and the National Youth Tobacco Use Survey (NYTS)2—reported high rates of electronic cigarette (e-cigarette) usage among American students in 2014. Seventeen percent of 12th-graders in the MTF survey said they had used an e-cigarette within the past 30 days. The NYTS reported a tripling of 30-day use from the previous year for middle and high school students, to 13.4%. In both surveys, 30-day e-cigarette usage exceeded 30-day smoking of conventional cigarettes.
Both surveys also found large decreases in high school students’ cigarette smoking. The NYTS reported a 1-year 28% decline in students’ 30-day smoking prevalence, down to 9.2%.2, 3 The MTF data indicated the largest annual percentage decline in smoking in the nearly 40-year history of the survey.4
The NYTS data also indicated a statistically significant increase in hookah use (4.1% to 9.4%) from 2011 to 2014 and statistically significant decreases in use of cigars (11.6% to 8.2%); pipes (4.0% to 1.5%); snus (2.9% to 1.9%); and bidis (2.0% to 0.9%). Including nine products, Arrazola et al.2 concluded that overall tobacco product use had not changed over the 3-year period (24.2% and 24.6%). However, e-cigarettes contain no tobacco, and a large proportion of students use e-cigarettes containing no nicotine (including 55.6% of never-smoking first-time e-cigarette users in one study5). If e-cigarettes are excluded from the “all tobacco products” list, high school students’ use of tobacco products decreased significantly.
The rapid growth in e-cigarette use is concerning because nicotine may pose important risks to the developing adolescent brain6 and many fear that e-cigarette use by non-smoking students will lead many to nicotine addiction and subsequent cigarette smoking.7, 8, 9, 10 Only time will tell whether the latter concern is warranted. Short of a definitive answer, it is useful to learn as much about the relationship between e-cigarette use and smoking as can be ascertained from existing data.
To date, all reports of adolescents’ e-cigarette use have defined use as any use during the past 30 days, which fails to distinguish one- or two-time potentially experimental use from frequent or regular use. It is important, therefore, to determine how often students are using e-cigarettes—not simply whether they are using them—and how that usage relates to students’ cigarette smoking. Toward that end, the present paper examines e-cigarette use in 2014 by high school students, focusing on the frequency of use and comparing it with students’ ever-smoking and current-smoking status.
Section snippets
Study Sample
In 2015, this study used MTF data to analyze the relationship between high school students’ smoking behavior and the frequency of their use of e-cigarettes. A nationally representative survey of drug use among American students, MTF annually surveys nearly 50,000 American students in about 420 public and private secondary schools. MTF has reported data on drug use by Grade 12 students annually since 1975 and eighth- and tenth-graders since 1991. MTF collects data on whether or not students have
Results
Table 1 shows the number of days in the past month that Grade 12 respondents used e-cigarettes, by their ever-smoking status (i.e., those who have never smoked a cigarette, those who smoked once or twice, those who smoked occasionally but never regularly, those who smoked regularly in the past but not at present, and those who smoke regularly now). The relationship between ever-smoking status and use of e-cigarettes was highly significant, with more ever-smoking associated with more-frequent
Discussion
Considering adult use of e-cigarettes, Amato and colleagues12 recently concluded that “Defining…prevalence as any use in the past 30 days may include experimenters unlikely to continue use, and is of questionable utility for population surveillance of public health trends over time.” The novelty of e-cigarettes (and electronic nicotine delivery systems [ENDS] more generally) means that it is impossible to determine, today, how much e-cigarette use by students represents experimentation or a fad
Conclusions
As the public health community further explores these questions, it is critical to keep one’s eyes on the prize: getting rid of tobacco smoking. The 2014 Surgeon General’s report emphasized that combusted tobacco—smoking—is the source of the vast majority of the morbidity and mortality associated with nicotine and tobacco use.19 Recent large decreases in smoking prevalence among both students and adults are very encouraging. Still, the rapid increase in e-cigarette use among youth is
Acknowledgments
I thank Peter Freedman-Doan and Jamie Tam for research assistance.
No financial disclosures were reported by the author of this paper.
References (22)
- et al.
Nicotine and the developing human: a neglected element in the electronic cigarette debate
Am J Prev Med
(2015) - et al.
Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature
J Adolesc Health
(2003) How does electronic cigarette access affect adolescent smoking?
J Health Econ
(2015)- et al.
Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2014
(2015) - et al.
Tobacco use among middle and high school students—United States, 2011–2014
MMWR Morb Mortal Wkly Rep
(2015) - et al.
Tobacco use among middle and high school students—United States, 2013
MMWR Morb Mortal Wkly Rep
(2014) - Monitoring the Future. Table 1. Trends in prevalence of use of cigarettes in Grades 8, 10, and 12....
- et al.
E-cigarette use among high school and middle school adolescents in Connecticut
Nicotine Tob Res
(2014) - et al.
Association of electronic cigarette use with initiation of combustible tobacco smoking in early adolescence
JAMA
(2015) - et al.
Progression to traditional cigarette smoking after electronic cigarette use among U.S. adolescents and young adults
JAMA Pediatr
(2015)
Risk factors for exclusive e-cigarette use and dual e-cigarette use and tobacco use in adolescents
Pediatrics
Cited by (66)
A Close Look at Vaping in Adolescents and Young Adults in the United States
2022, Journal of Allergy and Clinical Immunology: In PracticeConcurrent E-cigarette and marijuana use and health-risk behaviors among U.S. high school students
2021, Preventive MedicineCitation Excerpt :Electronic cigarettes (e-cigarettes) act as a gateway to combustible cigarette smoking initiation among adolescents,(Soneji et al., 2017; Berry et al., 2019; Barrington-Trimis et al., 2016) which increases their probability for the development of nicotine dependence and addiction over time.( Bell and Keane, 2014; Warner, 2016) Despite these concerns, e-cigarettes are the most common tobacco product consumed by youth.( Cullen et al., 2018) Data derived from the U.S. National Youth Tobacco Surveys show that current (past 30-day) use of e-cigarettes among high school students increased significantly from 2017 to 2018,(Cullen et al., 2018) and about 28% of students reported current use in 2019.(
Electronic cigarettes as a harm reduction concept for public health
2021, Toxicological Risk Assessment and Multi-System Health Impacts from ExposureCigarette and electronic vapor product use among high school students in Georgia, 2015–2018
2020, Preventive Medicine Reports