Over 1 in 10 young adults in the United States regularly use e-cigarettes, according to a new report from the US Centers for Disease Control and Prevention.
The study, conducted by the CDC’s National Center for Health Statistics, provides a snapshot of e-cigarette use in 2021. Based on data from the National Health Interview Survey, the report identified that e-cigarette use generally declined as family income increased. Adults under 44 were more likely to be dual users of both cigarettes and e-cigarettes.
Previous findings from the National Health Interview Survey have shown that cigarette use has fallen to record lows. E-cigarettes, however, have flared in popularity.
From 2020 to 2022, e-cigarette sales jumped in the United States, to 22.7 million products sold each month, according to previous CDC research. More brands – particularly of disposable e-cigarette products – entered the market, while fruit and candy flavors that appeal to younger audiences surged in popularity.
The new data indicates that a little under 1 in 20 adults reported in 2021 that they were current e-cigarette users, with slightly higher rates among men than women. Young adults, between the ages of 18 and 24, used e-cigarettes the most, with 11% indicating that they actively consumed the products.
As people got older, the study found, rates of e-cigarette use dropped – but traditional cigarette use steadily climbed. About 11.4% of survey respondents over 45 said they currently smoked cigarettes.
For Dr. Joanna Cohen, director of the Institute for Global Tobacco Control at Johns Hopkins University, the young demographic of e-cigarette users is worrying. Young people who have never smoked cigarettes – rather than older cigarette users trying to break the habit – make up the bulk of e-cigarette consumers.
“If e-cigarettes were being used as we would hope, the only people who should use them are those who are using them to quit smoking,” said Cohen, who was not involved with the new research. “You would see very different patterns.”
According to the new report, adults with higher family incomes also used e-cigarettes less, with those making over four times the federal poverty level reporting the lowest e-cigarette use rates.
White adults were the most likely to be current e-cigarette users of any racial group, with over double the rates of Black survey respondents.
“Tobacco companies are masters of targeted marketing as well as manipulation,” Cohen said. “They want to make products that are attractive and appealing to a variety of demographics and ages. They also heavily promote their products … to particularly what we might call vulnerable populations.”
The CDC report arrives days after the American Heart Association released a statement warning of the health risks of e-cigarette use.
The statement sounded an alarm about the harmful properties of ingredients used in e-cigarettes, including nicotine – the addictive chemical in the products – and flavoring agents. It notes that those compounds have been shown to carry risks for heart and lung disease in animal studies and that they could pose “dangerous health risks” in humans.
“There is research indicating that nicotine-containing e-cigarettes are associated with acute changes in several hemodynamic measures, including increases in blood pressure and heart rate,” Dr. Jason J. Rose, chair of the American Heart Association’s scientific statement writing committee and an associate professor of medicine at the University of Maryland School of Medicine, said in a news release.
The group also warned that e-cigarette products can contain other substances, including THC, the psychoactive chemical in cannabis, methamphetamine, methadone and vitamins.
According to the statement, comprehensive research on e-cigarettes is limited, but some studies have linked use to the development of respiratory diseases like asthma, emphysema and COPD.
The American Heart Association recommended further research on the long-term consequences of e-cigarettes on the heart, blood vessels and lungs.
“The long-term risks of using e-cigarettes are unknown, but if the risks of chronic use are like combustible cigarettes … we may not observe them for decades,” Rose said. “It is necessary for us to expand this type of research since the adoption of e-cigarettes has grown exponentially.”
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However, research on e-cigarettes can pose challenges. Unlike traditional cigarettes, e-cigarettes have been on the market for only about 15 years, and the types of products consumers prefer change frequently. According to Cohen, a lot of research focuses on e-cigarettes that were popular about five years ago, which are different from those preferred now.
Given the limited body of evidence, the American Heart Association does not recommend e-cigarettes as a tool to quit smoking, it said in the statement. Neither the US Food and Drug Administration nor any international regulatory agency has approved e-cigarettes for smoking cessation.
However, some experts takes a more lenient approach.
E-cigarettes are “not safe,” Cohen warns, but they may be less harmful than combustible cigarettes, she said. If FDA-approved treatments like nicotine replacement therapy and cognitive behavioral therapy don’t benefit smokers trying to quit, e-cigarettes might, she added.
“The only people who should be using e-cigarettes are people who are smoking cigarettes and trying to quit,” Cohen said. “Cigarettes are absolutely not safe: They’re one of the worst things you could do for yourself. Anything in comparison to cigarettes is going to be a bit better than cigarettes. Not safe, but better.”