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BRFSS OVERVIEW |
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Though COVID-19 remains a focal point of concern as the official public health emergency (PHE) is extended, public health researchers and workers have slowly begun to resume attentions to other ongoing and emergent public health crises such as the long-running opioid epidemic, increases in alcohol-related behaviors such as binge drinking and heavy drinking, and e-cigarette use and smoking rates, especially among young adults.
The recent ban and removal of all JUUL e-cigarette products by the U.S. Food and Drug Administration (FDA) is one of the biggest moves to address this issue at the federal level. Additionally, as of June 2022, all 50 states, the District of Columbia, and nearly all U.S. territories have enacted legislation banning sales of e-cigarettes to underage individuals (under age 21). These actions at the federal and state level are aimed at curbing an alarming and persistent rise in e-cigarette usage, especially flavored e-cigarettes, among high-school and middle-school-aged children, as shown in a recent study conducted by the FDA and the Centers for Disease Control and Prevention (CDC). However, the issue of rising e-cigarette use is not limited to only teens and young adults.
Significant Increases Across the States
Nationally, the rate of adult e-cigarette use in 2021 was 6.6 percent. Across the states, e-cigarette use among adults in 2021 ranged from a high of 9.4 percent in Oklahoma to a low of 4.5 percent in Maryland.
Rates of E-Cigarette Use Among Adults, Top Five and Bottom Five States, 2021
While these rates may initially seem low, a comparison to a previous SHADAC analysis on e-cigarette use shows that in just five years the overall rate of adults reporting using e-cigarettes has increased significantly by over two percentage points (PP) from 4.4 percent in 2017.
The range of e-cigarette usage reported by adults across the states has experienced similar trends. From 2017 to 2021*, Oklahoma remained the state with the highest rate of adult e-cigarette use, rising significantly to 9.4 percent in 2021 from 7.1 percent in 2017. The state with the lowest rate of adult e-cigarette use shifted from the District of Columbia (D.C.) in 2017, with a rate of just 2.5 percent, to Maryland in 2021, with a rate of 4.5 percent. Again, the difference between the two lowest rates was statistically significant, indicating an overall increase in e-cigarette use by adults during this time period.
Overall, the states ranking in the top and bottom five for e-cigarette use among adults remained largely unchanged from 2017 to 2021. Kentucky, Oklahoma, and Tennessee remained among the states with the highest rates of reported adult e-cigarette use, with Alabama and Louisiana in 2021 replacing Indiana and Wyoming. Connecticut, Maryland, Vermont, and D.C. remained among the states with the lowest rates of reported e-cigarette use from 2017 to 2021, with New Hampshire in 2021 replacing California.
E-Cigarette Use by Age Group
Most efforts toward curbing rising e-cigarette use have been aimed at teen and young adult age groups, and as the figure below shows, it is easy to see why.
While rates of e-cigarette usage rose across all age groups over the past five years, the highest increases were seen among younger adults age 18-24 and 25-34.
Adult E-Cigarette Use by Age Group from 2017 to 2021
The rate of e-cigarette use among adults age 18-24 nearly doubled, rising by over 8 percentage points from 10.1 percent in 2017 to 18.5 percent in 2021, a statistically significant difference. Similarly, the rates for adults age 25-34 increased significantly from 6.6 percent in 2017 to 11.1 percent in 2021. In fact, all age groups except adults age 45-64 saw significant increases in the rate of e-cigarette use from 2017 to 2021.
Conclusion
In 2019, the CDC began tracking the number of lung injuries and related deaths associated with vaping and e-cigarette use. By early 2020, they revealed that all 50 states, D.C., and several territories were submitting pertinent data to CDC and that the number of lung injuries across the nation had been recorded at 2,807 with deaths recorded at 68. According to recent research from Johns Hopkins University, many of these deaths have not come from regulated market products, but from black market modifications to devices or to vaping liquids—mirroring concerns about current trends in the opioid crisis, which has shifted from prescription (i.e., regulated market) opioid painkillers to unregulated fentanyl that traffickers mix into drugs, leaving consumers unaware of the exact makeup or potency of the product they are purchasing.
While the true effectiveness of state legislations and the FDA ban on e-cigarette products will be revealed with time, they are solid steps towards curbing rising rates of e-cigarette use across a number of age groups in the U.S.
Source: SHADAC Analysis of 2017-2021 Behavioral Risk Factor Surveillance System (BRFSS) public use files.
Notes: * 2019 data is not available. Statistically significant changes at the 95% confidence level unless otherwise noted.