Ruoyan Sun, Ph.D., suggests new framework in tracking tobacco and nicotine use in adolescents in the United States
(Photography: Steve Wood)Cigarette smoking has decreased steadily among adolescents in the United States over the past two decades. However, the use of e-cigarettes has drastically increased since 2014 and is the most commonly used nicotine or tobacco product among middle and high school students, according to the Centers for Disease Control and Prevention.
Researchers at the University of Alabama at Birmingham analyzed cross-sectional data from the CDC’s National Youth Tobacco Survey data from 1999-2020 to examine whether the decrease in smoking correlated to an overall decrease in adolescent nicotine and tobacco use. Their findings indicate that the CDC’s any tobacco product use measurement, a binary measurement which asks if someone has used any tobacco product in the past 30 days, does not accurately depict nicotine and tobacco usage or associated risks in adolescents during the e-cigarette era, especially in the context of different mixes of products over time.
“The majority of cigarette brands contain similar ingredients, concentration and chemicals,” said Ruoyan Sun, Ph.D., assistant professor in the UAB School of Public Health’s Department of Health Care Organization and Policy and a study researcher. “Conversely, there are a wide variety of e-cigarette products with different chemical levels and makeups. To track nicotine and tobacco use patterns and their associated risks more accurately, surveys need to account for the frequency of product use and product-specific risks.”
The Birmingham Health District established in 2019 prohibits smoking on public property, including the UAB campus. Read more about the Health District here.
Nicotine, the principal chemical responsible for addiction among smokers, is present in most e-cigarettes. While some studies suggest e-cigarettes have fewer health risks than cigarettes, there are concerns that the popularity of vaping could increase the likelihood of adolescents’ turning to traditional cigarettes. There are also no definitive assessments of health and development risks in adolescents who vape.
Sun and her team used the NYTS data to develop a new metric to quantify nicotine and tobacco product use, called nicotine product days. The measurement tracks the frequency of nicotine product use within a 30-day period. When using a non-risk-adjusted NPD measurement, they found a decrease in nicotine and tobacco use from 1999-2013 followed by a sharp increase attributed solely to vaping among adolescents.
Accounting for the frequency of nicotine product use is the first of two adjustments needed in better evaluating tobacco and nicotine use, according to Sun. The second is to include product-related risks into the metric. Risk-adjusted NPDs allow researchers to contemplate health implications of different types and mixtures of e-cigarette products, as well as other tobacco products such as cigars and hookah. Sun also acknowledges that, with a low assessment of the long-term risks of vaping compared with those of smoking, risk-adjusted NPDs might show an overall continued decline of health risks associated with tobacco and nicotine use in adolescents from 2014-2020.
Read Ruoyan Sun, Ph.D.’s commentary on the study here.
“Accounting for differential risks of nicotine and tobacco products can provide a clearer overall picture of the adolescents’ risks,” Sun said. “Updating survey and measurement guidelines to better assess product details and consumption patterns is the first step in helping public health experts understand the risks associated with changing patterns of youth tobacco and nicotine utilization.”
Read more about the Trends in Nicotine Product Use Among U.S. Adolescents, 1999-2020 here.