Use of E-cigarettes Among Youth in the United States Declines Early in COVID-19 Pandemic

How and why have young e-cigarette users changed their patterns of use since the COVID-19 pandemic began?

More underage and young adult e-cigarette users reported reducing or quitting e-cigarettes since the COVID-19 pandemic began than those who reported increasing their use or switching to other nicotine and cannabis products. Researchers conducted a national cross-sectional anonymous online survey study of 4351 participants in May 2020, including 2167 youth and young adults who use e-cigarettes. The research, published in JAMA Network Open, also explored why these changes occurred.

The researchers surveyed participants aged 13 to 17 years, 18 to 20 years, and 21 to 24 years, with a 50:50 ratio of ever-e-cigarette users to never-e-cigarette users through Qualtrics. They inquired about their use of e-cigarettes, past 30-day use, nicotine dependence (using the Hooked on Nicotine Checklist [HONC]), changes in vaping use since the start of the COVID-19 pandemic in the United States, changes in access and purchasing patterns, and age verification processes.

The researchers conducted logistic regressions to assess differences in study outcomes between underage youth and young adults and to examine factors associated with quitting or reducing e-cigarette use since the pandemic began.

Of the 2125 ever e-cigarette users, 1198 reported they had changed the amount they used since the start of the pandemic, and about 67.7% of those users reported quitting or reducing use.

Of the 776 underage youth who reported changing their consumption, 283 quit e-cigarettes (unadjusted odds ratio [OR], 1.72; 95% CI, 1.32-2.25; P <.05), 239 reduced use (slightly or by half), 129 increased the amount of nicotine in e-cigarettes, 65 increased the amount of cannabis/tetrahydrocannabinol (THC) use in e-cigarettes, 17 switched to other forms of nicotine, and 43 switched from using cannabis/THC in e-cigarettes to other products (18 smoked cannabis and 10 used blunts).

Of the young adults (aged 21 to 24 years), 421 reported changing their e-cigarette use: 105 quit, 183 reduced use (slightly or by half), 82 increased nicotine, 29 increased cannabis/THC, 10 switched to other forms of nicotine, and 12 switched from using cannabis/THC in e-cigarettes to other products (6 smoked cannabis and 3 used edible cannabis).

Purchasing from alternative retail stores and online became more popular. Access changed during the pandemic for 39.8% to 44.5% of e-cigarette users. About 20% of users switched to begin purchasing from alternative retail locations while about 19% of users switched from retail to online stores.

E-cigarette users were 52% less likely to quit or reduce use of e-cigarettes if they had already used them more than 10 times (adjusted odds ratio (aOR), .48; 95% CI, .30-.78; P >.05) or if they were nicotine dependent (aOR, .49; 95% CI, .35-.70; P >.05).

Reasons users stated for reducing their use of e-cigarettes included parents’ knowledge due to stay-at-home ordinances (136 responses), inability to access products (175), and e-cigarettes’ impact on lungs (224), or a combination of the above reasons (213). The vast majority of the 421 users who increased their use attributed their decision to boredom (88), stress (83), the need for a distraction (35), or a combination of those reasons (287).

Limitations of the study include possible recall bias occurring with the self-reported data and not accounting for state- and county-level regulation and enforcement of tobacco policies.

The authors conclude that “[f]urther research is needed to assess the pattern of e-cigarette use and access in subsequent stages of the COVID-19 pandemic.”

Disclosure: One study author declared affiliations with the industry. Please see the original reference for a full list of authors’ disclosures.


Gaiha SM, Lempert LK, Halpern-Felsher B. Underage youth and young adult e-cigarette use and access before and during the coronavirus disease 2019 pandemic. JAMA Netw Open. Published online December 3, 2020. doi:10.1001/jamanetworkopen.2020.27572