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

By Melissa Patrick
Kentucky Health News

Nearly 70% of  young people who told researchers they had changed their electronic-cigarette habits had either used e-cigarettes less or had quit altogether since the coronavirus pandemic hit in March, largely because of either stay-at-home orders or because of difficulty accessing the products. 

Tobacco21.org photo

That's the upshot of a national survey of underage youth and young adults who said they had ever used e-cigarettes, taken May 6-14. The online research had 4,351 participants aged 13 to 24, with 2,167 of them -- just short of half the total -- reporting they had ever used e-cigarettes.

The study report says, "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 also 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. 

The study, published in JAMA Network Open, found that 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.  

Of  the 895 e-cigarette users who gave a reason for decreasing their use since the pandemic, one-fourth said it was because e-cigarettes 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.

Top reasons given by those who increased their use were boredom, stress, the need for a distraction or a combination of those reasons.

The survey also asked about the ease or difficulty in obtaining e-cigarette products during the pandemic. It found that the top three reasons cited by 1,939 participants were difficulty getting to the grocery store or gas station (28.7%); shipping times for online orders (21.2%), and inability to get to the shop (19.4%). 

Some said it was easier to buy in the pandemic. Of those 261 participants, about one-third reported that 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 youth) said they had switched to buying online.

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

Nevertheless, the study found that "vape" shops and online retailers are selling e-cig products to underage youth during the pandemic, and 63 of 229 underage youth, or 27.5%, said they had accessed e-cigs without age verification. 

Of the 154 underage youth who reported having to provide age verification, 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.