Disposable E-Cigarette Use Prevalence, Correlates, and Associations With Previous Tobacco Product Use in Young Adults

Abstract

Introduction Novel, inexpensive disposable e-cigarettes widely sold in attractive flavors might be exempt from U.S. federal regulations. To inform regulatory and public health priorities, this study examined young adult disposable e-cigarette use uptake among existing tobacco users vs. non-users and possible use correlates that could be potential regulatory targets. Methods Prospective cohort data were analyzed in 2021. Among baseline (2018-2019) never disposable e-cigarette users (n=1903; Mean[SD]:19.3[0.8] years-old), we tested prospective associations of baseline tobacco product use with follow-up (2020) disposable e-cigarette use initiation, followed by stratified analyses distinguishing baseline exclusive and dual e-cigarette/combustible tobacco use. Exploratory cross-sectional associations of tobacco-related correlates with vaping frequency among current disposable users (n=266) were tested. Results Follow-up ever disposable e-cigarette use initiation was higher among baseline former (22.1%) and current (50.2%) vs. never (6.3%) rechargeable (non-disposable) e-cigarette users. In stratified analyses, follow-up disposable e-cigarette use initiation was 0% in baseline never-vaping exclusive current smokers, higher in baseline never-vaping former smokers vs. never users of any tobacco product (18.2% vs. 5.7%; adjusted odds ratio[AOR][95%CI]=3.9[2.1-7.5]), and higher among baseline current dual users vs. never-smoking exclusive current vapers (61.3% vs. 42.2%; AOR[95%CI]=3.0[1.5-6.0]). Among follow-up current disposable e-cigarette users (overall prevalence=10.9%), using ice-flavored (vs. fruit/sweet-flavored) e-cigarettes (adjusted rate ratio[95%CI]=1.5[1.0-2.1]) and vaping dependence symptoms (adjusted rate ratio[95%CI]=2.2[1.5-3.2]) were cross-sectionally associated with more past-month disposable e-cigarette use days. Conclusions Young adult disposable e-cigarette use was of appreciable prevalence, including among tobacco product never users and former smokers. Regulation of disposable e-cigarettes, including ice-flavored products, might benefit young adult health. Implications Sales of disposable e-cigarette products increased significantly in the United States from 2019 to 2020. These products contain high nicotine concentrations and various flavors that may appeal to young people. This study provides the first evidence that disposable e-cigarette use may be common among young adults, including among tobacco product never users and former smokers. Frequency of disposable e-cigarette use was positively associated with using ice-flavored e-cigarettes and vaping dependence. Regulatory policies and enforcement strategies addressing disposable e-cigarettes merit consideration in young adult health policy and prevention priorities.

Trends in unit sales of cooling flavoured e-cigarettes, USA, 2017–2021

“…The same study also found that ice flavour users had increased odds of concurrent combustible tobacco product use, increased frequency and intensity of e-cigarette use, use of disposable e-cigarettes and greater dependence symptoms when compared with users of other flavours 5. These findings align with a study that found young adults who use disposable e-cigarettes with ice flavours reported using the products on more days per month than their peers who use fruit or sweet-flavoured products 11…”

“…5 These findings align with a study that found young adults who use disposable e-cigarettes with ice flavours reported using the products on more days per month than their peers who use fruit or sweet-flavoured products. 11 To date, no published research has assessed the market share or sales trends of cooling flavoured e-cigarettes in the USA; such data could help document the extent of these products in the marketplace, and help inform public health policy and practice. To address this gap, this study assessed cooling flavoured e-cigarette sales in the USA, by major characterising flavour category and product type.…”

Ice flavours and non-menthol synthetic cooling agents in e-cigarette products: a review

“…In some comparisons to non-hybrid fruit/sweet or menthol/mint flavour e-cigarette use, use of ice-hybrid flavours was associated with higher number of past-30-day vaping days, more vaping episodes per vaping day, using disposable non-cartridge pod-style e-cigarettes, past-30-day combustible tobacco use and vaping dependence symptoms 13. In a separate analysis of a subsection of this young adult sample who used disposable e-cigarettes, the association between use of ice-flavoured (vs fruit/sweet-flavoured) e-cigarettes and more past-30-day vaping days was replicated 86…”

Use Patterns, Flavors, Brands, and Ingredients of Nonnicotine e-Cigarettes Among Adolescents, Young Adults, and Adults in the United States

“…Research has focused on prevalence, 1 , 7 , 24 device types, 1 , 25 , 26 patterns of use, 7 , 24 , 27 , 28 and health effects of using e-cigarettes with nicotine 29 , 30 , 31 , 32 , 33 , 34 and cannabis. 8 , 22 However, few studies address nonnicotine e-cigarettes, including usage patterns; preferred brands, flavors, and other ingredients; and co-use with nicotine e-cigarettes.…”