February 3, 2020

Stanton A. Glantz, PhD

Not only are more kids starting nicotine with e-cigs, but they are starting younger

Rebecca Evans-Polce and colleagues just published “Trends in E-Cigarette, Cigarette, Cigar, and Smokeless Tobacco Use Among US Adolescent Cohorts, 2014-2018” in American Journal of Public Health.  They used data from the National Youth Tobacco Survey from 2014-2018, the years in which e-cigarette use really took off, to assess the age at which kids started using e-cigarettes, cigarettes, smokeless tobacco, and cigars.  They found that the age of initiation for cigarettes, smokeless, and cigars did not change over these 5 years, but that the age initiation for e-cigarettes dropped. 

In 2014, 8.8% of lifetime e-cigarette users had started by age 14; in 2018 this fraction had increased to 28.6%.

This result adds to the overwhelming case that e-cigarette use is an epidemic with kids and highlights the need to continue to press for bans on the sale of all flavored tobacco products, including e-cigarettes, and also stopping the sale of all e-cigarettes that have not been approved as “appropriate for the protection of public health” by the FDA.

This is also more evidence that the FDA’s “enforcement policy” that exempts popular new disposable and refillable e-cigarettes is likely to fail to have much impact on youth use.  It needs to be comprehensive.

Here is the abstract:

Objectives. To examine changes in age of initiation of e-cigarette, cigarette, cigar, and smokeless tobacco use among adolescents in the United States.Methods. We used data from 5 cohorts of the National Youth Tobacco Survey (2014-2018; n = 26 662).Results. In 2014, 8.8% of lifetime e-cigarette users initiated use at 14 years or younger, as compared with 28.6% of lifetime e-cigarette users in 2018. There was no such change in initiation ages for cigarettes, cigars, and smokeless tobacco among lifetime users of each of these products.Conclusions. US adolescents are initiating e-cigarette use at younger ages in recent years. This is concerning given the association of e-cigarette use with subsequent cigarette use. Continued surveillance of these trends and additional prospective research are needed. Tobacco prevention programs, policies, and regulations that make it more difficult for youths to obtain e-cigarettes are warranted.

The full citation is Rebecca Evans-Polce, Phil Veliz, Carol J. Boyd, Vita V. McCabe, and Sean Esteban McCabe. Trends in E-Cigarette, Cigarette, Cigar, and Smokeless Tobacco Use Among US Adolescent Cohorts, 2014–2018. American Journal of Public Health 2020;110: 163-165, https://doi.org/10.2105/AJPH.2019.305421 .  It is available here.

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