Several studies have been conducted to examine the prevalence of nicotine-based products, including cigarettes and e-cigarettes (vapes) amongst young adults. These studies examined causes of why young adults engage with these products at such a steep rate.
Most studies focused on the disparity between cigarette and e-cigarette, Electronic Nicotine Delivery Systems (ENDS), as well as the reasoning behind their use. Surveys conducted across the United States suggest that between 40-60% of young adults (18-21) who use e-cigarettes have never smoked cigarettes (Hiler et al., 2020). This is an important statistic because the generation of Americans coming into adulthood have lived through the downfall of the cigarette’s popularity.
The Drug Abuse Resistance Education program (D.A.R.E.) a widely used school-based drug prevention program to assist with elementary education has not successfully positively impacted young adults’ awareness of using cigarettes, e-cigarettes and vaping.
This may contribute to the common attitude amongst young adults that e-cigarettes are more socially acceptable than regular cigarettes, as well as the fact that many U.S. universities are ‘smoke-free’ campuses, and e-cigarettes are marketed as providing a legal way to curb nicotine addiction on campus (Lee et al., 2017). Young adults are also more likely to experiment with e-cigarettes whether or not they have previously smoked cigarettes, in contrast to older adults (Harrell et al., 2019). According to one study, the use of ENDS products quadrupled between 2009-2010, and has continued to rise, with emerging data suggesting that college-aged students between the ages of 18-24 demonstrate the highest use prevalence in comparison to older adults (Napolitano et al., 2018).In a sample survey conducted in 2013-2014, “ENDS use within the previous 30 days was reported in 12.5% of college-aged students compared with 5.8% of adults≥25-years” (Harrell et al., 2019 p. 487). Another factor that may also contribute to the use of e-cigarettes over traditional cigarettes is the perception amongst young adults that ENDS products are less harmful to health, as well as the idea that ENDS products result in less cravings and withdrawal symptoms than traditional cigarettes (Harrell et al., 2019).
Alongside data representative of the prevalence of ENDS use amongst young adults, many studies attempted to isolate the reasons behind the use of nicotine amongst this demographic. Consistently, the use of nicotine products to relieve stress, anxiety, and/or depression amongst young adults ranked high as a reasonfor ENDS use. According to a Truth Initiative survey from August 2021 of 1,000 people aged 15-24, “81% who had used e-cigarettes said they started vaping to decrease stress, anxiety, or depression” (Truth Initiative, 2021).
Many users of both ENDS products and cigarettes (dual users) reported that stress reduction was a reason for use of e-cigarettes, they stated that e-cigarettes provided a good alternative to smoking: “[It] like takes the edge off. In a situation I would smoke a cigarette I would just hit the vape instead. Stressful situations, school which is stress, everything that is stress, I would drive to smoke a cigarette, now I try to lean towards the vape instead.” (Dual user)” (Harrell et al., 2019, p. 6).
According to a Truth Initiative survey, over half of young adults engaged in ENDS product usage with e-cigarettes to cope with stress or anxiety, and over 50% of those who have vaped 20 or more days in the past month stated that use of ENDS products was associated with a reduction of their stress and anxiety (Truth Initiative Survey, 2021). Traditional cigarettes have long been marketed as a “cure” for stress and anxiety, as well as advertised by big tobacco brands as products that can alleviate symptoms of anxiety and depression, which makes it a possibility that young adults suffering from mental health problems use nicotine products in order to ‘self-medicate’ (Bandiera et al., 2017).
While there are many young adults who only engage with ENDS products and not cigarettes for many factors such as the purported health benefits to ENDS products as opposed to traditional tobacco products, there also exists a strong demographic of dual users who engage with ENDS products and traditional cigarettes. This population can provide insight on how ENDS products compare to traditional cigarettes when it comes to alleviating stress: “Among ENDS only users, 40% endorsed the perception that ENDS helped with stress management compared to 56.5% of those who reported both ENDS and cigarette use and 34.4% of neither cigarette nor ENDS users. For those reported ENDS use, 13.3% of ENDS users and 32.4% of dual users reported using ENDS as a stress coping tool” (Napolitano et al., 2018, p. 490).
Similarly, when it comes to perceptions of stress relief, over 50% of dual users and 40% of ENDS-only users were more likely to believe that ENDS product use contributed to stress relief, in comparison to 17% of cigarette-only users (Napolitano et al., 2018). Many young people have misinterpreted tobacco products as providing stress relief, with Truth Initiative surveys showing “a large majority of young people who have used e-cigarettes started vaping to decrease feelings of stress, anxiety, or depression, and many continue vaping to cope with these feelings” (Truth Initiative Survey, 2021). Misconceptions about nicotine’s efficacy as a stress, anxiety, and depression reliever could potentially originate in the cycle of nicotine withdrawal, which causes irritability, anxiety and depression. Withdrawal symptoms are alleviated temporarily by renewed use of nicotine products, creating a false sense of relief. (Truth Initiative, 2021).
Prior to the COVID-19 pandemic, the mental health crisis amongst American young adults had already skyrocketed. Over 70% of young people specified that anxiety and depression were a major problem amongst their peers. With this mental health crisis, the sale of e-cigarettes amongst this demographic has increased, with highly-addictive nicotine acting as a sort of temporary and fast-acting numbing agent to symptoms of mental illness.
The number of college students that engage with ENDS products as well as traditional cigarettes in order to alleviate stress has also risen exponentially, and many institutions are attempting to transition to smoke-free campuses in an effort to curb these numbers. However, these efforts have an unintended effect of encouraging the rise in ENDS product usage, by making “regulatory decisions aimed at limiting cigarette appeal, reinforcing effects, and accessibility” in the effort to reduce traditional cigarette usage on campus (Hiler et al., 2020).
Overwhelmingly, nicotine product use amongst young adults in America has been on a dramatic rise with the introduction of more socially-acceptable ENDS products to the market. Misconceptions surrounding the efficacy of nicotine and tobacco in curing or alleviating symptoms of mental illness, stress, and anxiety via false advertising and pop culture have contributed drastically to the popularity of vaping and smoking on college campuses and in American high schools.
References
Bandiera, F. C., Loukas, A., Li, X., Wilkinson, A. V., & Perry, C. L. (2017). Depressive symptoms predict current e-cigarette use among college students in Texas. Nicotine & Tobacco Research, 19(9), 1102–1106. https://doi.org/10.1093/ntr/ntx014
Colliding crises: Youth Mental Health and nicotine use. Truth Initiative. (2021, September). Retrieved December 29, 2022, from https://truthinitiative.org/research-resources/emerging-tobacco-products/colliding-crises-youth-mental-health-and-nicotine-use
Harrell, P. T., Brandon, T. H., England, K. J., Barnett, T. E., Brockenberry, L. O., Simmons, V. N., & Quinn, G. P. (2019). Vaping expectancies: A qualitative study among young adult nonusers, smokers, vapers, and dual users. Substance Abuse: Research and Treatment, 13, 117822181986621. https://doi.org/10.1177/1178221819866210
Hiler, M., Spindle, T. R., Dick, D., Eissenberg, T., Breland, A., & Soule, E. (2020). Reasons for transition from electronic cigarette use to cigarette smoking among young adult college students. Journal of Adolescent Health, 66(1), 56–63. https://doi.org/10.1016/j.jadohealth.2019.09.003
Lee, H.-Y., Lin, H.-C., Seo, D.-C., & Lohrmann, D. K. (2017). Determinants associated with e-cigarette adoption and use intention among college students. Addictive Behaviors, 65, 102–110. https://doi.org/10.1016/j.addbeh.2016.10.023
Napolitano, M. A., Lynch, S. B., & Stanton, C. A. (2018). Young adult e-cigarette users: Perceptions of stress, body image, and weight control. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 25(2), 487–495. https://doi.org/10.1007/s40519-018-0627-6
