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. 2023 Nov 1;6(11):e2340859.
doi: 10.1001/jamanetworkopen.2023.40859.

E-Cigarette Use Among US Adults in the 2021 Behavioral Risk Factor Surveillance System Survey

John Erhabor  1   2 , Ellen Boakye  1   2 , Olufunmilayo Obisesan  3 , Albert D Osei  3 , Erfan Tasdighi  1 , Hassan Mirbolouk  4 , Andrew P DeFilippis  2   5 , Andrew C Stokes  2   6 , Glenn A Hirsch  2   7 , Emelia J Benjamin  2   8   9 , Carlos J Rodriguez  2   10 , Omar El Shahawy  2   11 , Rose Marie Robertson  2   5 , Aruni Bhatnagar  2   12 , Michael J Blaha  1   2
Affiliations

E-Cigarette Use Among US Adults in the 2021 Behavioral Risk Factor Surveillance System Survey

John Erhabor et al. JAMA Netw Open. .

Abstract

Importance: After the initial disruption from the COVID-19 pandemic, it is unclear how patterns of e-cigarette use in the US have changed.

Objective: To examine recent patterns in current and daily e-cigarette use among US adults in 2021.

Design, setting, and participants: This cross-sectional study used data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) database. The BRFSS is the largest national telephone-based survey of randomly sampled adults in the US. Adults aged 18 years or older, residing in 49 US states (all except Florida), the District of Columbia, and 3 US territories (Guam, Puerto Rico, and the US Virgin Islands), were included in the data set. Data analysis was performed in January 2023.

Main outcomes and measures: The main outcome was age-adjusted prevalence of current and daily e-cigarette use overall and by participant characteristics, state, and territory. Descriptive statistical analysis was conducted, applying weights to account for population representation.

Results: This study included 414 755 BRFSS participants with information on e-cigarette use. More than half of participants were women (51.3%). In terms of race and ethnicity, 0.9% of participants were American Indian or Alaska Native, 5.8% were Asian, 11.5% were Black, 17.3% were Hispanic, 0.2% were Native Hawaiian or Other Pacific Islander, 62.2% were White, 1.4% were of multiple races or ethnicities, and 0.6% were of other race or ethnicity. Individuals aged 18 to 24 years comprised 12.4% of the study population. The age-standardized prevalence of current e-cigarette use was 6.9% (95% CI, 6.7%-7.1%), with almost half of participants using e-cigarettes daily (3.2% [95% CI, 3.1%-3.4%]). Among individuals aged 18 to 24 years, there was a consistently higher prevalence of e-cigarette use, with more than 18.6% reporting current use and more than 9.0% reporting daily use. Overall, among individuals reporting current e-cigarette use, 42.2% (95% CI, 40.7%-43.7%) indicated former combustible cigarette use, 37.1% (95% CI, 35.6%-38.6%) indicated current combustible cigarette use, and 20.7% (95% CI, 19.7%-21.8%) indicated never using combustible cigarettes. Although relatively older adults (aged ≥25 years) who reported current e-cigarette use were more likely to report former or current combustible cigarette use, younger adults (aged 18-24 years) were more likely to report never using combustible cigarettes. Notably, the proportion of individuals who reported current e-cigarette use and never using combustible cigarettes was higher in the group aged 18 to 20 years (71.5% [95% CI, 66.8%-75.7%]) compared with those aged 21 to 24 years (53.0% [95% CI, 49.8%-56.1%]).

Conclusion and relevance: These findings suggest that e-cigarette use remained common during the COVID-19 pandemic, particularly among young adults aged 18 to 24 years (18.3% prevalence). Notably, 71.5% of individuals aged 18 to 20 years who reported current e-cigarette use had never used combustible cigarettes. These results underscore the rationale for the implementation and enforcement of public health policies tailored to young adults.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr DeFilippis reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Stokes reported receiving grants from Johnson & Johnson and Swiss Re outside the submitted work. Dr Rodriguez reported receiving grants from Amgen outside the submitted work. Dr Robertson reported receiving grants from the NIH and US Food and Drug Administration (FDA) during the conduct of the study. Dr Blaha reported receiving grants from the FDA, NIH, American Heart Association, Novo Nordisk, Bayer, and Amgen as well as personal fees from Vectura, Boehringer Ingelheim, Merck, Novartis, and Agepha outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Weighted Prevalence of E-Cigarette Use Among US Adults, 2021 Behavioral Risk Factor Surveillance System
Error bars indicate 95% CIs.
See this image and copyright information in PMC

References

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