The Prevalence of E-cigarette Use in a Sample of U.S. Air Force Recruits

Abstract

Introduction: The prevalence of electronic cigarette (e-cigarette) use is increasing markedly in the general population. Yet, remarkably little research exists to examine these ongoing trends in at-risk populations, and nothing is known about the prevalence of e-cigarette use among military personnel. The purpose of the current study is to provide recent (2013-2014) data on the prevalence of regular e-cigarette use in a population of recruits prior to their entry into the U.S. military.

Methods: The study utilized a cross-sectional assessment of e-cigarette and other tobacco and nicotine-containing product (TNCP) use in 2013-2014 among 10,043 U.S. Air Force (USAF) recruits in Technical Training. Chi-square tests, the Cochran-Armitage test for trend, and logistic regression models tested differences and trends across time for e-cigarette use.

Results: The rate of e-cigarette use among recruits was 5.2%, which doubled (3% to 6.5%, p<0.0001) across a 1-year period. E-cigarette use was associated with increased odds of all measured TNCPs, as well as dual and poly use (all p<0.0001).

Conclusions: Rates of e-cigarette use are slightly higher in young USAF recruits than in the general population, and e-cigarette users are likely to be using other TNCPs in tandem. Although additional work is needed to understand the reasons for this concomitant use, this is a necessary first step to understanding e-cigarette use prevalence in military populations. Historic trends suggest that, like general populations, e-cigarette use is on the rise for those entering the USAF and should be monitored to inform future prevention programming.

Figure 1. Prevalence of e-cigarette use among recruits from April 2013 to March 2014 (N=10,043)

Notes: The prevalence of regular e-cigarette use among recruits doubled between April 2013 (Q1) and March 2014 (Q4) (ORa=2.1; 95% CI=1.5-3.1; p<0.0001), indicating significant linear trend (CA χ2=30.4; p<0.0001). Proportions 95% CIs, trends, and odds were calculated using cross tabulations, χ2 test, CA test for trend and logistic regression. Covariates included in the model were gender, age, ethnicity, race, education and marital status.

Figure 2. Tobacco product prevalence by e-cigarette use (N=10,043)

Notes: Regular e-cigarette use is associated with significantly higher odds of regular use of all TNCPs, as well as dual and poly use compared to non e-cigarette users (all p<0.0001). Associations were tested with logistic regression, adjusting for age, gender, race, ethnicity, education and marital status.