Rapid Increase in Underage E-Cigarette Use in the US

A study published in the Journal of Adolescent Health reveals that the number of daily e-cigarette users aged 21 and under increased to over one million in 2019. Of those users, 56.3% reported using Juul e-cigarettes. The study was conducted by Dr. John Pierce, a cancer prevention researcher at the University of California, San Diego and his colleagues in pediatrics.

Research suggests that the significant increase in daily usage among American teenagers could be a warning of future health problems and requires urgent action by the FDA. The data reflects a possibility that the new generation of smokers no longer relies on combustible tobacco and it is hoped that they never switch to traditional cigarettes to avoid health problems - although electronic cigarettes themselves are not harmless.

Juul Labs is a trendy e-cigarette device company with flavors that appeal to children, which has resulted in over 2,300 lawsuits due to being too attractive to teenagers. Although Juul argues that its products are designed for adult smokers, studies have shown that the usage of e-cigarettes among adults is declining.

The percentage of daily Juul users among the adult population is relatively low, with 42.9% of users being between the ages of 21 and 24 and only 22.6% being above the age of 25.

In this study, participants aged 12-34 were divided into two groups. These data were tracked for two years, from 2014 to 2016 and from 2017 to 2019. The first group consisted of 24,409 people who participated before the increase in Juul sales in 2014, while the second group consisted of 20,161 individuals who participated during the period of Juul's rapid growth in 2017.

Compared to 2014, there has been a 12.3 percentage point increase in the number of people using e-cigarettes for the first time in 2017, reaching 24.7%. Over this period, the rate of e-cigarette experimentation among 18-21 year olds in the United States has decreased by 3.6 percentage points to 12.2%. Researchers suggest this may be due to concerns over e-cigarette or e-cigarette-related lung injuries, known as EVALI, which have been linked to products containing vitamin E acetate and tetrahydrocannabinol (THC), which can mimic symptoms of COVID-19 and even lead to death.

The author suggests that the increasing use of electronic cigarettes may be attributed to innovative social media marketing strategies, technologies that make higher concentrations of nicotine aerosols "less repulsive," and appealing child-friendly flavors.

The author points out that the FDA has responded to the popularity of electronic cigarettes by reducing the use of flavoring additives, but has not limited the amount of nicotine allowed in electronic cigarettes like other countries have done.

As Juul products have expanded in the marketplace, the overall tobacco use rate has increased from 44.5% to 50.2%. During the two-year follow-up period, there was a greater proportion of non-daily smokers who transitioned to daily use in 2017 compared to 2014 (5.3% versus 4.9% in the cohort). Additionally, more than 64% of the increase in tobacco use was driven by children aged 14-17, with nearly half being e-cigarette users.

In 2017, the rate of dependence on electronic cigarettes was 17.4% for the youngest age group, a figure similar to that of adults under 35 years old.

Meanwhile, by 2017, there was a significant decrease in the number of smokers across all age groups. Smoking rates decreased by 33% for the youngest age group and by 49% for the 18-21 age group compared to 2014.

One limitation of this study is that participants were from different time periods, making it difficult to apply the findings to time-based variables.

来源：MEDPAGETODAY Translation: Source: MedPage Today