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Underage Youth and Young Adult e-Cigarette Use and Access Before and During the Coronavirus Disease 2019 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Did underage youth and young adults (13-24 years) self-report changes in use and access to e-cigarettes during the coronavirus disease 2019 pandemic?

Findings  In this national, online, cross-sectional survey study of 2167 youth and young adults using e-cigarettes, 1198 respondents reported changing their amount of e-cigarette use, with 810 reducing or quitting e-cigarette use; e-cigarette access shifted to alternative retail stores and online. Reduced e-cigarette use or quitting was associated with adhering to shelter-in-place guidelines and was less likely if participants had used e-cigarettes more than 10 times or were nicotine dependent.

Meaning  Individuals younger than 21 years reported e-cigarette use and accessed e-cigarettes from online and retail stores during the coronavirus disease 2019 pandemic, suggesting a need to strengthen prevention of e-cigarette sales to such youth, including age verification, and provide cessation resources.

Abstract

Importance  Understanding patterns of e-cigarette use and access during the coronavirus disease 2019 (COVID-19) pandemic is important because e-cigarettes may put users at risk for more severe respiratory effects and other health problems.

Objective  To examine whether underage youth and young adults who ever used e-cigarettes self-reported changes in access and use of e-cigarettes since the COVID-19 pandemic began.

Design, Setting, and Participants  A national, cross-sectional online survey study was conducted from May 6 to May 14, 2020. This sample of 4351 participants aged 13 to 24 years across the US included 2167 e-cigarette ever-users. Quota sampling was used to balance for age, sex, race/ethnicity, and 50% having ever used e-cigarettes.

Main Outcomes and Measures  Change in e-cigarette use (increase, decrease, quit, no change, and switch to another product) and access to e-cigarettes (easier or harder, and change in point-of-purchase) before and after the COVID-19 pandemic began, reasons for change, number of times e-cigarettes were used, nicotine dependence, and sociodemographic data.

Results  This study focused on 2167 e-cigarette ever-users among 4351 participants who completed the survey. Among 2167 e-cigarette users, a total of 1442 were younger than 21 years and 725 were aged 21 years or older; 1397 were female (64.5%) and 438 identified as lesbian, gay, bisexual, transgender, queer (20.2%). The survey completion rate was 40%. Since the COVID-19 pandemic began, 1198 of 2125 e-cigarette users (56.4%) changed their use: 388 individuals (32.4%) quit, 422 individuals (35.3%) reduced the amount of nicotine, 211 individuals (17.6%) increased nicotine use, 94 individuals (7.8%) increased cannabis use, and 82 individuals (6.9%) switched to other products. Participants reported that not being able to go to vape shops and product unavailability were the reasons accessing e-cigarettes was difficult after the pandemic began. Since the COVID-19 pandemic began, individuals reported purchasing from alternative retail stores (disposables, 150 of 632 [23.7%]; pod-based, 144 of 797 [18.1%]; and other e-cigarette, 125 of 560 [22.3%], ie, between 18.1% and 23.7%), purchasing online instead of retail (disposables, 115 of 632 [18.2%]; pod-based, 156 of 797 [19.6%]; and other e-cigarette, 111 of 560 [19.8%], ie, between 18.2% to 19.8%), and shifted to retail instead of online (disposables, 11 of 632 [1.7%]; pod-based, 17 of 797 [2.0%]; and other e-cigarette, 13 of 560 [2.3%], ie, between 1.7%-2.3%). Other individuals reported no change: from retail stores (disposables 262 of 632 [41.5%]; pod-based 344 of 797 [43.2%]; and other e-cigarette, 223 of 560 [39.8%], ie, between 39.8% and 43.2%) and online (disposables 94 of 632 [14.9%]; pod-based 136 of 797 [17.1%]; and other e-cigarette, 88 of 560 [15.8%], ie, between 14.9% and 17.1%). Underage youth reported e-cigarette deliveries from vape shops and/or dealers or friends who received such deliveries, and 63 of 229 (27.5%) self-reported accessing e-cigarettes without age verification. e-Cigarette users were 52% less likely to quit or reduce their use if they previously used e-cigarettes between 11 and 99 times (adjusted odds ratio, 0.48; 95% CI, 0.30-0.78), 68% less likely to quit if they previously used e-cigarettes more than 100 times (adjusted odds ratio, 0.32; 95% CI, 0.20-0.51), and 51% were less likely to quit if they were nicotine dependent (adjusted odds ratio, 0.49; 95% CI, 0.35-0.70).

Conclusions and Relevance  During the COVID-19 pandemic, youth e-cigarette users reported changes in e-cigarette use, point-of-purchase, and ability to purchase e-cigarettes without age verification. The US Food and Drug Administration and local policy makers may find these data useful to inform policies to prevent e-cigarette sales to underage youth.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: October 5, 2020.

Published: December 3, 2020. doi:10.1001/jamanetworkopen.2020.27572

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Gaiha SM et al. JAMA Network Open.

Corresponding Author: Bonnie Halpern-Felsher, PhD, Stanford University, 770 Welch Rd, Ste 100, Palo Alto, CA 94304 (bonnie.halpernfelsher@stanford.edu).

Author Contributions: Drs Gaiha and Halpern-Felsher had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Gaiha, Halpern-Felsher.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Gaiha.

Obtained funding: Halpern-Felsher.

Supervision: Halpern-Felsher.

Conflict of Interest Disclosures: Dr Halpern-Felsher is a paid expert scientist in some e-cigarette litigation and an unpaid scientific advisor and expert witness regarding some tobacco-related policies. Dr Halpern-Felsher reported grants from the National Institutes of Health and other funding from the Taube Family in support of her Taube Endowed Research Faculty Scholar during the conduct of the study. No other disclosures were reported.

Funding/Support: The research reported in this article was supported by the Taube Research Faculty Scholar Endowment (Dr Halpern-Felsher). Additional support was received from grant U54 HL147127 from the National Heart, Lung, and Blood Institute and the Food and Drug Administration Center for Tobacco Products.

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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