E-cigarette advocates have often argued that the increase in youth e-cigarette use is not a problem because it represents youth shifting from cigarettes. Earlier work based on analysis of trends and risk profiles in youth participating in the National Youth Tobacco Survey has contradicted this assertion, showing that e-cigarettes were attracting youth at low risk of initiating nicotine use with cigarettes and that the increase in e-cigarette use was larger than the decline in cigarette smoking. Now John Pierce and his colleagues at UCSD have published a much more extensive analysis based on three national surveys conducted between 1992 and 2020 that shows that the decline in late adolescent (age 17-18) and young adult (18-24) cigarette smoking was independent of the increases in youth e-cigarette use.
Their paper, Declines in cigarette smoking among US adolescents and young adults: indications of independence from e-cigarette vaping surge, also suggested that the increase in young adult vaping may have mostly been a cohort effect of youth who were addicted to e-cigarettes as teens aging into young adulthood.
They also specifically examined earlier claims that increased youth vaping represented substitution for cigarettes and that higher e-cigarette taxes were pushing youth to smoking:
Previously, Meza et al41 hypothesised that the rise in e-cigarette vaping in adolescents increased the rate of decline in adolescent cigarette smoking, using as a metric the annual per cent change in prevalence. When we analysed change in prevalence directly for US population aged 17–18 years, rather than as an annual per cent change, we were unable to replicate their result. We went a step further and added cigarette vaping prevalence to the model of cigarette smoking prevalence and found no association between trends in vaping prevalence and smoking prevalence. Using the variance in changes in prevalence across states among those aged 18–24 years, there was a low correlation (r=0.11) between the decline in cigarette smoking prevalence and the increase in exclusive vaping. Abouk et al43 studied 14 jurisdictions with at least some tax on e-cigarettes, but only two of these were large states with taxes large enough to possibly influence behaviour.44 They concluded that taxing e-cigarettes would push young people to cigarettes; however, in the two states with sizeable e-cigarette taxes, we did not find this to be the case. There was no evidence suggesting the increase in adolescent e-cigarette vaping was associated with a postponed increase or decrease in young adult cigarette smoking. Taken together, these data suggest that the factors leading to an increase in nicotine vaping are largely independent of those associated with the long-term consistent decline observed in cigarette smoking. [emphasis added]
Here is the abstract:
Objective To compare trends in cigarette smoking and nicotine vaping among US population aged 17–18 years and 18–24 years.
Methods Regression analyses identified trends in ever and current use of cigarettes and e-cigarettes, using three US representative surveys from 1992 to 2022.
Results From 1997 to 2020, cigarette smoking prevalence among those aged 18–24 years decreased from 29.1% (95% CI 27.4% to 30.7%) to 5.4% (95% CI 3.9% to 6.9%). The decline was highly correlated with a decline in past 30-day smoking among those aged 17–18 years (1997: 36.8% (95% CI 35.6% to 37.9%; 2022: 3.0% (95% CI 1.8% to 4.1%). From 2017 to 2019, both ever-vaping and past 30-day nicotine vaping (11.0% to 25.5%) surged among those 17–18 years, however there was no increase among those aged 18–24 years. Regression models demonstrated that the surge in vaping was independent of the decline in cigarette smoking. In the 24 most populous US states, exclusive vaping did increase among those aged 18–24 years, from 1.7% to 4.0% to equivalent to 40% of the decline in cigarette smoking between 2014–15 and 2018–19. Across these US states, the correlation between the changes in vaping and smoking prevalence was low (r=0.11). In the two US states with >US$1/fluid mL tax on e-cigarettes in 2017, cigarette smoking declined faster than the US average.
Conclusions Since 1997, a large decline in cigarette smoking occurred in the US population under age 24 years, that was independent of the 2017–19 adolescent surge in past 30-day e-cigarette vaping. Further research is needed to assess whether the 2014–15 to 2018–19 increase in exclusive vaping in those aged 18–24 years is a cohort effect from earlier dependence on e-cigarette vaping as adolescents.
The full citation is: Pierce JP, Luo M, McMenamin SB, Stone MD, Leas EC, Strong D, Shi Y, Kealey S, Benmarhnia T, Messer K. Declines in cigarette smoking among US adolescents and young adults: indications of independence from e-cigarette vaping surge. Tob Control. 2023 Nov 8:tc-2022-057907. doi: 10.1136/tc-2022-057907. Epub ahead of print. PMID: 37940404. It is available here.
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