Over 1m youth started smoking daily: Study

Nearly 2,300 adolescents and young adults became new tobacco smokers in the US over the period of 2017-2019 with the total number of users under 21 years of age vaping (using e-cigarettes) rising to over 1 million by 2019, accordingly to new published research.

Of these, 56.3 per cent used Juul products in particular, according to research by John Pierce of the University of California San Diego in La Jolla, and colleagues in the May 30, 2022 edition of the online journal Pediatrics.

Researchers reported that 'JUUL Labs' disrupted the e-cigarette market when they introduced the first high nicotine e-cigarette, a sleek product with candy and fruit flavourings.

In 2017, there was a 40 per cent surge in e-cigarette sales in the United States, driven by the products of the 'JUUL Labs'. The US surgeon general labelled it an epidemic of youth vaping. The researchers show this was also accompanied by an increase in new daily tobacco use, with 64.6 per cent of new users occurring among youths aged 14 to 17.

"Our analysis translates to 2,284 new underaged daily tobacco users each day between 2017 and 2019. This rate of youth tobacco initiation has not been seen since the early 1990s, prior to the implementation of tobacco control measures," said co-author John P. Pierce, PhD, Distinguished Professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, and UC San Diego Moores Cancer Center.

"Given the recent evidence of the potential health consequences of vaping flavoured e-cigarettes, this sharp rise among youth requires urgent public health attention and action."

Using data from the nationally representative Population Assessment of Tobacco and Health (PATH) longitudinal study, undertaken by the National Institute on Drug Abuse and the FDA Center for Tobacco Products under contract with Westat, researchers assessed two cohorts of youth and young adults aged 14 to 34 years: one with baseline survey data in 2014 before the surge of JUUL products, and the other in 2017 as the surge in 'JUUL' sales were occurring.

For five age groups, the researchers compared how many participants used tobacco for the first time and how many became daily tobacco users over a two-year period.

Although the comparison of the 2014 cohort to the 2017 group shows a drop in the number of individuals who tried cigarette smoking or who became daily cigarette smokers, overall daily tobacco usage increased led by a rise in daily e-cigarette vaping, particularly among those aged 14 to 17.

Among the 2017 cohort, those aged 14 to 17 had a 3.6-fold higher rate of progression to daily e-cigarettes compared to the 2014 cohort, and two-thirds of all new daily tobacco users were aged 14 to 17 years.

Furthermore, underaged new daily e-cigarette vapers had tobacco dependence scores that were similar to those of new daily cigarette smokers.

E-cigarettes -- battery-operated devices that heat a liquid made of nicotine, flavourings and other chemicals to make an aerosol that users inhale into their lungs -- were first sold in the United States in 2007. An April 2022 study in eLife led by researchers at UC San Diego School of Medicine indicates these non-traditional cigarettes have significant potential for later health consequences.

In 2017, sales in the U.S. skyrocketed. JUUL products led the way with youth-appealing flavours and the introduction of high nicotine concentrations, providing users with similar blood nicotine concentrations to traditional cigarette smokers. The researchers estimate that 600,000 individuals in the U.S. under 21 used 'JUUL' products daily in 2019, a rate 2.5-times higher than those aged 25 to 34. Previous research demonstrated that in 2017, 'JUUL' products were not used by US smokers trying to quit smoking.

"Three major contributors influenced the increase in daily e-cigarette usage: social media campaigns, high nicotine concentrations, and fruit flavours," said senior author Karen Messer, Ph.D., professor of biostatistics at the Herbert Wertheim School of Public Health. "Our prior research indicates that it is very difficult for dependent tobacco users to quit, with many e-cigarette users converting to cigarette smoking. This surge in dependent e-cigarette vaping may be reversing decades of decline in rates of tobacco addiction."

In January 2020, the U.S. Food and Drug Administration announced a ban on most flavourings in cartridge e-cigarettes. However, the policy did not include disposable e-cigarettes, e-liquids, or refillable devices. The FDA is in the public comment stage for a proposed rule prohibiting menthol cigarettes and flavoured cigars.

In 2021, there were an estimated 1.7 million high school-aged vapers with 85 per cent using flavoured products. 'JUUL', which had removed all fruit and candy flavourings at the behest of the FDA in 2019, was no longer the market leader. More than half of high school vapers now used high-nicotine, flavoured, disposable devices, wrote the researchers.

This research was funded, in part, by the National Institutes of Health and the Tobacco-Related Disease Research Program of the University of California, Office of the President.