Study of young people's e-cigarette use early in pandemic shows many had quit or cut back, but some under 21 were still buying

Tobacco21.org photo

By Melissa Patrick
Kentucky Health News

A study of young electronic-cigarette users in May found that most had cut back their use of the products since the pandemic began, but some had increased their use -- and some under the new legal age of 21 were still able to buy them.

A national survey taken May 6-14 found that most users aged 13-24 had changed their e-cigarette habits since the pandemic began about two months earlier. Nearly 70% of that group had used them less or quit altogether, largely due to stay-at-home orders or difficulty obtaining the products. 

The study report, published in JAMA Network Open, said 56.4% of e-cigarette users reported changing their habits since the pandemic began, with 388 (32.4%) quitting, and 422 (35.3%) reducing their consumption of nicotine.

On the other hand, it found that 211 (17.6%) increased their nicotine consumption, 94 (7.8%) increasing their use of cannabis, and 82 (6.9%) switched to other products.  

The report says understanding patterns of e-cigarette use is important during the pandemic because e-cigs may put users at risk for more severe respiratory effects, as well as other health problems. 

"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," the report says.

Of the 895 e-cigarette users who gave a reason for using them less in the pandemic, one-fourth said it was because they may weaken their lungs. Nearly 20% said it was because they could not get the products; 15% said they were at home, so their parents would know; and about one-third said it was a combination of two or more of those reasons. The rest provided other reasons.

Those who said they increased their use attributed that to boredom, stress, the need for a distraction, or a combination of those reasons.

Sales to youth: The survey also asked about ease or difficulty in obtaining e-cigarette products in the pandemic. The top three difficulties were problems getting to the retail outlet (28.7%); shipping times for online orders (21.2%), and inability to get to a "vape" shop (19.4%).

Some, 261 out of 1,939 (13.4%), said it was easier to buy in the pandemic. About a third of that group said their retail source was delivering it to them directly; about one in five said the retailer was delivering it to a friend; and nearly 20% (including 21 underage) said they switched to buying online.

The study found a shift to online buying, especially among young adults. 

It found that 63 of 229 underage youth in the survey, or 27.5%, said they had accessed e-cigs without age verification. Of the 154 underage who said they had to verify legal age, 73% said they had to physically show their ID; 7% gave an e-mail login, 18% uploaded ID information; and 2% said "other." 

The researchers called on the U.S. Food and Drug Administration to "use its authority to prevent online sales of e-cigarettes to underage youth and to 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." 

The report says, "Underage youth who turn to online purchases of e-cigarettes during the pandemic in lieu of their previous sources may continue to use these easy-access means, making online prohibitions or age verification even more essential." 

It also calls for state and local governments to require effective age verifications for online sales and to take away licenses and/or issue penalties on companies that continue to sell to those who are underage. 

The researchers also stress the need for improved access to cessation programs, noting that many of the youth and young adults who reported no reduction in  their e-cigarette use during the pandemic had increased use of the products prior to the pandemic and increased nicotine dependence. 

The researchers also point out that the least-cited reason for decreased e-cigarette use after the pandemic was that "parents will know," which suggest that the easily hidden products allow underage youth to continue to hide and use the products at home, even with family members nearby.