Catania, 2 July 2024 — An important new commentary titled “Measures of Youth E-Cigarette Use: Strengths, Weaknesses, and Recommendations” has been published in the high-impact journal Frontiers in Public Health. The commentary calls for the field of nicotine and tobacco research to refine the definitions of youth e-cigarette use to better align with public and individual health metrics.
As the prevalence of e-cigarette use among youth continues to rise, surpassing traditional cigarette smoking, the need for precise and relevant surveillance has never been more critical. The study addresses the limitations of current definitions, which have often been adapted from adult smoking metrics without considering how these definitions’ relevance might be affected by the unique patterns and lower risk profiles of e-cigarettes.
“As a behavioral scientist, I’ve thought extensively about different ways of measuring how people use e-cigarettes, and how well the different definitions capture actual problematic use, as opposed to experimentation. I’m thrilled that this commentary is published, which I hope can start a dialogue in the field to evaluate and improve the definitions we use, so that we can more effectively track and prevent youth e-cigarette use” explains Dr. Arielle Selya of Pinney Associates and author of the commentary.
The commentary highlights several critical insights:
- Diverse Definitions: Current literature employs a wide range of definitions for youth e-cigarette use, from lifetime use (“even a single puff”) to daily use. While more lenient measures capture a broader range of potentially at-risk youth, much of this use is transient and experimental, posing negligible risks if it does not persist long-term.
- Relevance to Health: Stringent measures, such as daily use, are more relevant to public and individual health. The commentary calls for future research to examine improvements in definitions that include intensity and persistence of use, potentially leveraging technology-assisted data capture.
- Evolving Use Patterns: E-cigarette use among youth peaked in 2019, primarily driven by the popularity of JUUL e-cigarettes, but has since shifted towards disposable products like Puff Bar and Elf Bar. In the US youth e-cigarette use has fallen by over 60% from its 2019 peak. Remarkably, the popularity of e-cigarettes has been paralleled by the near eradication of tobacco smoking among youth.
- Global Trends: Similar trends of increased e-cigarette use and decreased smoking are observed in other countries, including Canada, England, New Zealand, and Germany, underscoring the global relevance of the commentary’s findings.
The authors propose several recommendations for future research and surveillance.
- First of all, future studies should consider definitions that capture the intensity (e.g., number of puffs per day) and persistence or duration of use. These definitions should be validated through self-reports or technology-assisted tools.
- Secondly, it is crucial to define “e-cigarette use” consistently across studies, using measures that have external validity and relevance to health outcomes.
- Thirdly, surveillance should prioritize measures that distinguish transient, experimental use from problematic patterns, characterized by high daily consumption, frequent use, and long duration.
- Finally, digital tracking tools, mobile applications and sensor technology can provide more accurate and objective data on e-cigarette use intensity.
“It’s regrettable that youth e-cigarette metrics borrow from adult smoking evaluations, ignoring product differences and transient use patterns. This leads to inaccurate measures, confusing knowledge about the risks and benefits of e-cigarette use. Accurate metrics should reflect continuous, cumulative, and frequent use, leveraging digital tools for precise data. What we are proposing in this paper will make an impactful difference in the way we address public health challenges” – conclude prof. Riccardo Polosa, founder of CoEHAR.
