Full length articlePrevalence, correlates, comorbidity and treatment of electronic nicotine delivery system use in the United States
Introduction
E-cigarettes or electronic nicotine delivery systems (ENDS) were first patented in China in 2003 and introduced to the U.S. market in 2007 (Hon, 2003). Sales were valued at $20 million in 2009, over $2 billion in 2014, with sales projected to reach $17 billion in 2017 in the U.S. alone (Rom et al., 2014). Awareness of ENDS also rose during this time, from 40.9% in 2010–79.7% in 2013, with current and ever use increasing from 1.3% to 1.9% and from 3.3% to 8.1%, respectively (King et al., 2013; Regan et al., 2015). Despite increases in sales, awareness and use of ENDS, very little is known about their relationships to addiction liability, comorbidity with psychiatric disorders, treatment or quality of life.
Recently, several U.S. epidemiologic surveys have reported the prevalence of ENDS use. The 2014 National Health Interview Survey (NHIS), the only face-to-face U.S. survey to date, reported current and ever ENDS use rates as 3.7% and 12.6% (Delnevo et al., 2015). Five consumer-based web, mail, and random digit dialing surveys conducted in the U.S. also reported rates of ENDS use: the 2012–2013 National Adult Tobacco Survey (current use, 4.2%) (Agaku et al., 2014); the 2012–2013 Health Styles Survey (current use, 1.9%; lifetime use, 8.1%) (King et al., 2013); the 2012 Knowledge Networks Knowledge Panel Survey (current use, 1.4%; lifetime use, 8.2%); the 2010 Consumer Styles Survey (current use, 3.6%; lifetime use 6.5%) (Giovenco et al., 2014); and the 2010 Knowledge Networks Knowledge Panel Survey (current use, 3.4%) (Zhu et al., 2013).
These surveys all contributed valuable information, but leave important questions unanswered about the current epidemiology of ENDS use in the U.S. For example, due to their mode of administration and response rates, little is known about the sociodemographic correlates of ENDS use at the national level. Furthermore, to date, no nationally representative sample has addressed the associations between ENDS use and nicotine use disorder and other psychiatric disorders, an important area of inquiry given strong relationships observed between tobacco use, nicotine use disorder and other psychopathology (Breslau, 1995, Grant et al., 2004). To address this gap in our knowledge, we present nationally representative data on the prevalence of ENDS use and its associations with Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) (American Psychiatric Association, 2013) tobacco use disorder, other substance use disorders and major mood, anxiety, trauma-related and personality disorders in addition to examining treatment among ENDS users. The data were derived from the National Institute on Alcohol Abuse and Alcoholism’s 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) (Grant et al., 2014).
Section snippets
Sample
The target population of the 2012–2013 NESARC-III comprised the noninstitutionalized U.S. population, 18 years and older, residing in households and selected group quarters (Grant et al., 2014). Respondents were selected through multistage probability sampling. Primary sampling units were counties/groups of contiguous counties, secondary sampling units (SSUs) comprised groups of Census-defined blocks, and tertiary sampling units were households within sampled SSUs, within which eligible adult
Prevalence and sociodemographic correlates
Prevalences of 12-month and lifetime ENDS use were 3.8% and 5.4%. Interestingly, the majority of ENDS users also concurrently used traditional cigarettes (89.2% for 12-month, 95.4% for lifetime). Rates of 12-month and lifetime ENDS use were greater among men than women (Table 1). Regardless of time frame, the odds of ENDS use were greater among Whites compared with Blacks, Hispanics and Asians/Pacific Islanders. Odds were also greater among younger adults (<64 years) than older adults (≥65
Discussion
In 2012–2013, prevalences of 12-month and lifetime ENDS use were 3.8% and 5.4%, representing about 8.9 and 12.6 million American adults. The 12-month prevalence of ENDS use falls towards the top of the range (1.4%–4.2%) while the lifetime prevalence lies around the bottom of the range (6.5%–12.6%) of prevalences reported in other U.S. surveys (Agaku et al., 2014, Delnevo et al., 2015, Giovenco et al., 2014, Zhu et al., 2013). The overwhelming majority of 12-month and lifetime ENDS users also
Conclusions
In summary, the present study showed that ENDS use is strongly related to DSM-5 NUD and a variety of DSM-5 substance use, and personality disorders and selected mood and anxiety disorders and largely goes untreated in the U.S. At a time when associations between ENDS use and quit intentions, attempts and cessation of conventional smoking are inconclusive (Bullen, 2014) and evidence suggesting health harms of ENDS use is just beginning to be understood (Breland et al., 2016, Callahan-Lyon, 2014,
Conflict of interest
Compton reports ownership of stock in General Electric Co., 3M Co., and Pfizer Inc., unrelated to the submitted work. No conflicts of interest declared by any other author.
Role of funding source
The NESARC-III was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), with supplemental support from the National Institute on Drug Abuse. Support is also acknowledged from the intramural program, NIAAA, NIH. Sponsors and funders of the NESARC-III had no role in the design and conducted of the study; collection, management analysis, and interrelation of data; and preparation, review and approval of the manuscript.
Contributors
Literature review: Chou, Saha, Zhang, Ruan, Blanco, Compton
Writing first draft: Chou, Grant Critical review of second/subsequent drafts: Blanco, Compton, Zhang, Chou, Huang, Ruan, Saha
Supervision: Compton, Blanco, Grant
Statistical analysis: Saha, Grant, Ruan, Chou, Blanco, Compton, Zhang
Collected data: Chou, Saha, Zhang, Grant, Ruan
All authors approved of the final manuscript before submission.
Disclaimer
The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations or agencies or the US government.
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