Social reasons and peer group influence seem to drive use

There has been a substantial increase in the number of teens in the United States and Canada who vape, even as e-cigarette use among adults has decreased over the past two years, researchers found.

And, according to another study, teens are attracted to e-cigarettes (specifically Juul products) primarily because of peer group influences and experimentation, rather than taste, suggesting that policies aimed at restricting the sale of flavored products may be insufficient in curbing the use of these products in this age group.

Both studies were published as research letters in JAMA Pediatrics.

In one study, researchers led by David Hammond, PhD, School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada, wanted to evaluate the changes in prevalence of vaping among teens in the U.S., Canada, and England from 2017 to 2019.

Hammond and colleagues conducted a number of surveys of U.S. (n=12,110), Canadian (12,018), and English (11,362) teens recruited through the Nielsen Consumer Insights Global Panel.

For purposes of the study, self-reported e-cigarette use and cigarette-smoking measures were divided into three categories: use within the past 30 days, use within the past week, and use on at least 20 of the past 30 days.

The authors found that vaping was substantially higher among individuals who reported smoking compared to other respondents in all three countries. However, increases between 2017 and 2019 were seen across all subgroups in the U.S. and Canada, including those who reported never smoking, smoking experimentally, and currently smoking.

They found that the percentage of youths who ever vaped and/or smoked increased by comparable rates between 2017 and 2019 in Canada (from 41.1% to 48.0%) and the U.S. (from 41.2% to 50.4%), but not in England. The percentage of teens who only vaped increased from 9.2% to 16.9% in Canada, and 8.9% to 16.9% in the U.S. There was a slight increase of 7.1% to 9.6% among English teens.

The same patterns were observed for vaping and/or smoking more recently and frequently, with rates of use increasing in the past 30 days (from 16.1% to 21.3% in the U.S., and 15.1% to 21.6% in Canada), the past week (11.7% to 15.3% in the U.S., and 10.5% to 16.2% in Canada), and on 20 or more days in the past month (5.5% to 8.7% in the U.S., and 5.6% to 8.0% in Canada).

And, while the prevalence of vaping was higher among those who reported smoking currently, Hammond and colleagues noted that there are many more individuals who did not smoke in the population, and that teens who do not smoke accounted for a greater number of those who vaped regularly than teens who smoked in 2019.

“The increases in frequent vaping in the U.S. and Canada are consistent with the increase since 2017 in the popularity of nicotine salt products, such as Juul, which have markedly higher nicotine concentrations compared with earlier generations of e-cigarettes,” Hammond and colleagues noted. “In England, e-cigarettes are subject to greater marketing restrictions and a maximum nicotine concentration of 20 mg/mL.”

In a separate study, Georgia G. Wood, University of Michigan, Ann Arbor, and colleagues, used a national sample of teens and young adults (the National MyVoice Cohort) age 14 to 24 years in order to examine the perspective of young people regarding the use of Juul.

In a 4-question survey 1,215 MyVoice participants were asked:

  • “Have you ever heard of Juul?
  • “Why do you think people your age juul?
  • “Do you think juuling is dangerous? Why or why not?
  • “Do you think juuling leads to using alcohol, cigarettes, or other drugs? Why or why not?”

Of the 1,129 who responded, 88% said that they had heard of Juul, while social reasons — such as it’s “trendy and cool” — was the most commonly given explanation (62.2%) for why they used the product. On the other hand, just 5% indicated that flavor drove use of the brand.

Consequently, Wood and colleagues suggested that policies designed to reduce e-cigarette use should focus on social drivers or the fact that youths will experiment with substances that “make them feel cool.”

A high percentage (79%) responded that they believe using Juul is dangerous, while 72% said it can lead to other substance use, such as cigarettes.

Considering that e-cigarette use continues to increase — as pointed out in the study by Hammond and his colleagues — and that most youths in this study believe that Juul use is dangerous suggests “that campaigns and educational programs focused on the dangers of juuling alone may not be effective in reducing this health epidemic,” wrote Wood and colleagues.

“Future campaigns should acknowledge and tackle the social realities of youths today to effectively address the underlying reasons why youths use e-cigarettes despite perceived risks,” they concluded.

  1. Vaping has substantially increased among American and Canadian youths over the last several years.

  2. Those rates continue to rise, despite a perception among youths that vaping is dangerous and can serve as a gateway to the use of other substances such as cigarettes.

Michael Bassett, Contributing Writer, BreakingMED™

Hammond has served as a paid expert witness on behalf of governments and public health authorities in response to legal challenges from tobacco, cannabis, and e-cigarette companies and reported grants from National Institutes of Health and grants from Health Canada during the conduct of the study.

Cat ID: 138

Topic ID: 85,138,730,138,143,192,154,195,925