E-cigarette use has reached record highs in the US, with more than 17 million adults and 2 million children addicted to the devices.
A new national survey published today shows that nearly one percent of adults over the age of 18 used e-cigarettes on some days or every day in 2021 – almost a fifth more than in 2018.
Southern states such as Oklahoma, Kentucky, Alabama and Tennessee, where traditional cigarette use is also the highest, topped the list of states with the highest rates of vaping.
Meanwhile, the District of Columbia, Maryland, Massachusetts and New Hampshire had the smallest number of e-cigarette users.
The study comes a day after a report from the Centers for Disease Control and Prevention (CDC) found that 2.1 million middle and high school students are vapers.
E-cigarette use among children fell year on year, but the report suggested that half of students who try them become addicted.
Southern states such as Oklahoma, Kentucky, Alabama and Tennessee, where traditional cigarette use is also the highest, topped the list of states with the highest rates of vaping. Meanwhile, the District of Columbia, Maryland, Massachusetts and New Hampshire had the smallest number of e-cigarette users
Researchers suggested vaping has increased in 2021 due to greater availability during the Covid-19 pandemic
For the new study on adults, researchers from eight states evaluated e-cigarette use among more than 400,000 adults in all 50 states and several U.S. territories.
They found that 6.9 percent of participants over the age of 18 used e-cigarettes on some days, which amounts to about 17 million. Three percent, almost eight million, used them every day.
The researchers said the increase could be due to the stress of the Covid-19 pandemic and easier access now that vapes can be found in virtually every supermarket in America.
While e-cigarettes are generally thought to be safer than regular cigarettes, mounting evidence shows that vaping is still extremely harmful.
Earlier this year, the American Heart Association (AHA) warned that the cocktail of nicotine, thickeners, solvents and flavorings in vape devices pose greater risks to heart health than smoking cigarettes.
For the study, the team conducted a telephone survey of 414,755 adults over the age of 18 in all 50 states, the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands.
The majority of participants – 62 percent – were white and about 51 percent were female.
Participants were asked one question about e-cigarettes: “Do you now use e-cigarettes or other electronic vapor products every day, some days, or not at all?”
Those who said they vape every day or a few days were considered e-cigarette users, while those who answered “every day” were classified as using e-cigarettes daily.
They also asked whether the participants had used combustible cigarettes, which are traditional cigarettes or rolled tobacco. Participants were asked, “Have you smoked at least one hundred cigarettes in your entire life?” and ‘Do you now smoke every day, some days, or not at all?’
Daily e-cigarette use was highest among non-Hispanic white, lesbian or gay, bisexual and transgender people.
About 11.7 percent of participants reported smoking exclusively combustible cigarettes
Those who previously smoked combustible cigarettes were also more likely to vape daily than those who had not.
This is an increase compared to previous years, the researchers said. They pointed to data from 2016 through 2018, which ranged between 4.6 percent and 5.4 percent.
“The higher prevalence of e-cigarette use in 2021 may be due to changes that occurred during the pandemic, such as increased online sales, which allowed for easy accessibility and associated supplies,” the researchers wrote.
‘Additionally, the increased psychosocial stress experienced during the pandemic may have led more people to turn to e-cigarettes as a coping mechanism.’
The team also looked at 2019 state-by-state data from the Center for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System study.
Oklahoma topped the list for both current and daily e-cigarette users, at 9.4 and 4.6 percent, respectively. Kentucky came in second for current users at 9.3 percent, followed closely by Alabama and Tennessee, which each had 9.1 percent.
In terms of daily vapers, Tennessee had 4.6 percent, and Alabama and Kentucky each had 4.4 percent.
Maryland was the state with the lowest number of current and daily e-cigarette users, at 4.5 and 1.8 percent, respectively. It was closely followed by Massachusetts, New Hampshire and South Dakota.
The researchers said variation across states could be due to state-specific factors such as “the timing and response to the COVID-19 pandemic, socioeconomic conditions, stringency of tobacco regulatory policies, and the extent to which excise taxes on e-cigarette devices are being imposed in these jurisdictions enforced.”
There were several study limitations. The researchers wrote that relying on self-reported data increases the likelihood of misclassification and participants have recall biases.
They also said that while the Covid pandemic affected the results, the exact link is unclear.
About 6.9 percent of American adults – 17 million – reported using e-cigarettes some or every day, and 3.2 percent used them every day. And of those who vape, 46.6 said they did so daily
Long-term exposure to diacetyl and acetylpropionyl, two flavoring chemicals, has been linked to shortness of breath, chronic cough, asthma and congested airways.
Experts have also warned against second-hand vaping.
Scientists from universities in Virginia and North Carolina reported that when e-cigarette users puffed in their cars for less than 10 minutes, the air around them became loaded with potentially toxic particles known specifically as PM2.5 (which indicates a diameter of 2.5 micrometers or smaller).
PM2.5 can be generated from natural and man-made sources, such as the combustion of fossil fuels. When inhaled, the substance enters the lungs and irritates the entire respiratory system, possibly causing or aggravating asthma, bronchitis and severe wheezing.
The matter is so small that it can enter the bloodstream, leading to system-wide inflammation that increases risk to cardiovascular health.
Vapes without nicotine can also lead to “e-cigarette, or vaping, product use associated with lung injury,” or EVALI.
The exact cause of the injury is still not fully understood, but researchers have since focused on the compound vitamin E acetate, which is often used as a thickener in illegal cannabis vape devices.
There is no test to determine if someone has EVALI, so the diagnosis is based on symptoms, including shortness of breath, fever, chills, cough, vomiting, diarrhea, headache, dizziness, fast heart rate and chest pain, according to the American Pulmonary Association (ALA).
EVALI has caused a number of distressing health problems. A 34-year-old Ohio woman who consumed about eight cartridges of vape liquid every week, the equivalent of 50 cigarettes a day, found herself on life support within 24 hours of going to the emergency room for breathing problems.
In another terrifying case, a 20-year-old woman from Britain named Abby Flynn developed a rare lung condition called ‘popcorn lung’ that doctors warned could leave her dependent on an oxygen machine before the age of 30.
Federal data shows that about 14 percent — more than 2.5 million — of U.S. youth in sixth through 12th grades vape, while another study reported one in 20 American adults vape. That compares to only one in ten tobacco smokers.
The new study was published Friday in the journal JAMA Network.