A combination of stay-at-home orders and vape and smoke shop closures contributed to why many young adults and people under 21 years old quit or reduced vaping.
A national study looking at the e-cigarette habits among young adults and underage youth during the coronavirus disease 2019 (COVID-19) pandemic has found that 67.7% of e-cigarette users who changed their vaping habits during the pandemic had reduced their use or quit entirely.
“Understanding such patterns and shifts may inform the development of timely and age-appropriate public health messaging and provide insights on policy levers for long-term prevention of underage access to and use of e-cigarettes,” wrote the investigators.
Vaping among young people has been a growing concern in the United States, with 27.5% of high school students and 10.5% of middle school students reporting use of e-cigarettes in the last month in 2019. In 2018, 7.6% of people aged 18 to 24 reported past-month e-cigarette use. Vaping is known to weaken the respiratory and immune systems and research has shown that tobacco and substance users are more at risk for severe respiratory effects from COVID-19.
The population-based study published in JAMA Network Open surveyed 2167 e-cigarette users, 1442 of which were underaged and 725 young adults who were aged 21 years or older. The survey was conducted from May 6, 2020, to May 14, 2020. The mean age of underage users and young adults was 17.21 ± 2.7 years and 22.44 ± 2.9 years, respectively. Of the 2167 users, 64.5% (1397) of the participants were female, 33.4% (723) were male, and 20.2% (438) identified as part of the LGBTQ+ community.
In addition, 14.7% (319) of participants were Black but non-Hispanic, 6.7% (146) were Asian/Pacific Islander, 19.2% (416) were Hispanic but not Black, 50.9% (1102) were White and non-Hispanic, and 8.5% (184) had another ethnicity or were multiracial.
Out of the 2125 users who reported on their use changes, 56.4% (1198) reported having a change in how much they were vaping since the start of the COVID-19 pandemic, with 36.5% of underage youth and 24.9% of young adults reporting they quit and 30.8% of underage youth and 24.9% of young adults reporting a reduction.
Study results showed that accessing e-cigarettes was made more difficult because of the inability to go to gas stations (28.7%), vape shops (19.4%), and longer shipping times (21.2%) as a result of stay-at-home orders and store closures.
Investigators found that the most commonly reported reasons for individuals reducing or quitting were a fear of weakened lungs as a result of e-cigarettes (25%), parents find out about vaping habits (15.2%), and the inability to access e-cigarettes (19.5%).
Results showed that individuals who were adhering to stay-at-home orders were 1.5 times more likely to reduce or quite vaping. Users were 31% less likely to quit if they experienced longer shipping times and 51% less likely to quit if they were dependent on nicotine. Investigators said that they are unsure whether quit attempts will be sustained after the pandemic is over.
Use of e-cigarettes increased for 16.6% of underage youth and 19.5% of young adults and use of cannabis/tetrahydrocannabinol in e-cigarettes increased for 8.4% of underage youth and 6.9% for young adults. Investigators said that the most reported reasons for an increase in use were that individuals were bored, stressed, and needed a distraction.
Some users (261) found it easier to access e-cigarettes, citing the ability for some vape shops and dealers to deliver (54.8%) and the availability of online purchasing (19.5%). Overall, many participants (39.8% to 44.5%) reported having to shift their point-of-purchase, whether it be from one retailer to another or from a retailer to online, since the pandemic began.
Study findings also suggested that vape shops and online platforms are selling to underage youth during the pandemic, with 27.5% of underage youth self-reporting that there was no age-verification when purchasing. Of the underage youth who reported having to provide age verification, 72.7% had to do so physically, 7.1% gave an email login, 18.2% uploaded ID information online, and 1.9% said other.
In response to this, investigators called for the FDA to use their authorities to prevent online sales of e-cigarettes to underage youth and deny marketing authorization to e-cigarette companies whose premarket tobacco product applications can’t prove that they can stop underage youth from buying their products.
They also suggested that state and local governments should require effective age verification for online sales and take away licenses and/or develop penalties for companies that continue to sell to people who are underage.
"Despite the fact that underage youth likely experienced greater restrictions on their movement and use of e-cigarettes in their home, we observed no significant difference in their quitting behavior compared with young adults," they concluded.
Gaiha SM, Lempert LK, Halpern-Felsher B. Underage youth and young adult e-cigarette use and access before and during the coronavirus disease 2019 pandemic. JAMA Network Open. December 3 2020;3(12):e2027572. doi:10.1001/jamanetworkopen.2020.27572