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. 2023 Aug 21;35:102376. doi: 10.1016/j.pmedr.2023.102376

E-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander youth in the contiguous United States: Insights from the Monitoring the Future Study (2018–2019)

Elizabeth K Do a,b,⁎, Kathleen Aarvig a, Hope Muller-Tabanera a, Sarah Mills a, Jake Ryann Sumibcay e, Howard K Koh e, Donna M Vallone a,c,d, Elizabeth C Hair a,c,d
PMCID: PMC10472302  PMID: 37662868

Highlights

  • •

    Literature on Asian American, Native Hawaiian, and Pacific Islander e-cigarette use is limited.

  • •

    Native Hawaiian and Pacific Islander youth report the highest current e-cigarette use.

  • •

    Asian American youth report more frequent e-cigarette use, relative to Black youth.

  • •

    Asian American youth report less frequent e-cigarette use, relative to other racial/ethnic groups.

  • •

    Continued monitoring of e-cigarette use is needed in this historically underrepresented population.

Keywords: Electronic cigarette use, Youth and young adults, Race/Ethnicity, Asian Americans, Native Hawaiians, Pacific Islanders

Abstract

This study examines e-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) youth, in relation to other racial/ethnic groups in the United States. Data were obtained from the 2018 and 2019 Monitoring the Future surveys, which include a random, probability-based sample of youth in 8th, 10th, and 12th grades surveyed annually across the contiguous United States. Respondents provided information on race/ethnicity and e-cigarette use (n = 42,980). Measures of e-cigarette use included current (1 + of past 30 days) and regular use (10 + of past 30 days). Chi-square tests were used to determine differences in e-cigarette use by race/ethnicity. Associations between race/ethnicity, other sociodemographic factors, and e-cigarette use were explored using logistic regression analyses. Approximately 5.1% (n = 2,410) of the sample identified as AANHPI. A greater proportion of Native Hawaiian and Pacific Islanders reported current e-cigarette use (NHPI, 28.0%), relative to Asian American (AA, 10.3%), Black (9.5%), Hispanic or Latino (15.0%), American Indian or Alaskan Native (AIAN, 16.5%), multiracial (22.3%), and non-Hispanic White (25.2%) youth. Regular e-cigarette use was highest among non-Hispanic White (12.3%), followed by multiracial (10.7%), AIAN (7.8%), Hispanic or Latino (5.0%), AA (4.3%), and Black (3.0%) youth. Associations between race/ethnicity and e-cigarette use remained significant, after controlling for other sociodemographic factors. Continued monitoring of e-cigarette use is needed among AANHPI, a historically underrepresented population in tobacco research. Special attention should be paid to NHPI, who reported the highest rates of e-cigarette use.

1. Introduction

Despite being the fastest-growing major racial/ethnic group in the United States (US) (Budiman and Ruiz, 2021), Asian American, Native Hawaiian, and Pacific Islanders (AANHPI) are underrepresented in survey research. In 2022, about 7% of the total US population – or 20.6 million individuals – reported AANHPI ancestry (Monte and Shin, 2022). Yet, only 3% of national survey respondents in the US identify as AANHPI (Rao et al., 2022). AANHPI are a diverse racial/ethnic group that includes Native Hawaiian and Pacific Islanders (NHPI) and individuals with Far East, Southeast Asian, or Indian subcontinent origins (United States Census Bureau, 2022), who are often left out of statistical reporting, due to the sample size limitations of existing data sources (Chau and Chan, 2021).

Electronic cigarettes (e-cigarettes) are the most commonly used nicotine and tobacco product among US youth (Cooper, 2022), including those who identify as AANHPI (Rao et al., 2022, Shi et al., 2020). E-cigarettes are handheld, battery-powered devices that heat e-liquids usually containing a mixture of nicotine, propylene glycol, vegetable glycerin, and flavorings (National Academies of Sciences et al., 2018). The aerosol produced can expose users and bystanders to nicotine and other harmful substances such as heavy metals, volatile organic compounds, and particulate matter (Office of the Surgeon General, 2018). Although there is some evidence to suggest that e-cigarettes can aid adult cigarette users in cessation (Balfour et al., 2021, Hartmann-Boyce et al., 2022), e-cigarettes represent a unique public health concern for youth. There is evidence to suggest that e-cigarettes are less harmful than cigarettes; however, that does not mean that there are no vaping associated risks (Marques et al., 2021). Vaping may worsen asthma, bronchitis, and cough (Wills et al., 2021) and nicotine from e-cigarettes may affect the parts of the developing brain that control attention, mood, and impulse control - even among those who have never smoked cigarettes (Colyer-Patel et al., 2023, England et al., 2015, Yuan et al., 2015). Further, the risk for vaping associated health effects may be increased in those who frequently vape. This is concerning, given that young people who use e-cigarettes have reported more frequent e-cigarette use over time (Glantz et al., 2022). Additionally, frequent vaping is substantially higher among current or former smokers relative to young people who have never smoked (Hammond et al., 2020).

According to a systematic review of 40 studies on e-cigarette use among AANHPI, lifetime e-cigarette use is between 3.5% and 12.5% and current e-cigarette use rates are as high as 9.8% for Asian American youth (Shi et al., 2020). The systematic review further notes that while AANHPI are generally perceived as lower-risk group for nicotine and tobacco use, evidence supporting this claim is mixed – some studies have demonstrated either similar, or even higher, rates of current e-cigarette use among AANHPI, compared to Hispanic and Black youth (Cooper et al., 2018, Gorukanti et al., 2017, Sharapova et al., 2018). As suggested by the few regional studies examining heterogeneity within AANHPI subgroups, differences in e-cigarette use rates may be attributed to within-group differences (Maglalang et al., 2016, Wills et al., 2017). For example, few national studies – all using data prior to 2018 – have noted subgroup differences in the prevalence of past 30-day e-cigarette use for AANHPI adults, ranging from 3.0% among Asian Indian Americans to 7.8% among Korean Americans (Mirbolouk et al., 2018, Nguyen, 2019). No similar studies have been conducted among AANHPI youth samples. This is an important area of study given that data aggregation across culturally, demographically, linguistically, and socioeconomically diverse AANHPI subgroups may mask critical tobacco-related health disparities (Kanaya et al., 2022).

The present study expands on existing literature by examining current use (on at least 1 day of the past 30 days) and regular use (on at least 10 days of the past 30 days) among AANHPI youth residing in the contiguous United States. National survey data from 2018 and 2019 provide a more robust database than that previously available to document these trends. We also determine how current and regular e-cigarette use differs within AANHPI [e.g., non-Hispanic Asian Americans (AA), non-Hispanic Native Hawaiian and other Pacific Islanders (NHPI)] and across other racial/ethnic subgroups [e.g., non-Hispanic Black or African American (Black), non-Hispanic White or Caucasian (White), Hispanic or Latino, non-Hispanic American Indian or Alaskan Native (AIAN), and multiracial], adjusting for other sociodemographic and socioeconomic characteristics.

2. Methods

2.1. Data source

Cross-sectional data come from the Monitoring the Future (MTF) Study, a nationally representative study of students in the US which started in 1975 (Miech et al., 2016). The MTF Study uses a multistage, stratified research design. Students in 8th, 10th, and 12th grades are surveyed in approximately 110–120 public schools and 15–20 private schools throughout the 48 contiguous US states (i.e., excludes Alaska and Hawaii). Schools are sampled within primary sampling units that include 28 of the largest metropolitan areas representing about one-third of the nation’s population and an additional 136 other, smaller primary areas (Miech et al., 2019).

Given emphasis of the analysis on NHPI populations, it is noteworthy that while Hawaii has the largest NHPI population, more Native Hawaiians live outside of the Hawaiian Islands. As of 2021, an estimated 309,800 Native Hawaiians live in Hawaii, while 370,000 Native Hawaiians live in other US states (“More Native Hawaiians in Hawaiians Flock to mainland cities and leave Hawai’i,” 2023). The 10 US states with the largest NHPI populations are Hawaii, California, Washington, Texas, Utah, Florida, Nevada, Oregon, New York, and Arizona (Office of Minority Health, 2023). Consequently, NHPI in this study, who reside in the contiguous US, represent a range of ethnically diverse ecological settings that differ from the Hawaiian Islands (Agner et al., 2020).

Questionnaires are administered to a new set of students, in the spring of each year. Multiple questionnaire versions, or forms, are administered to students that include form-specific questions, as well as a core set of questions that appear on all forms. Each form is randomly distributed to a selected subset of respondents within schools, so that responses to each form are nationally representative. One of three students in each grade was randomly selected to receive forms that included questions on vaping (Miech et al., 2019).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments. Separate institutional review board (IRB) approval was not required for this secondary analysis of data from the Monitoring the Future Study, which is annually reviewed and approved by the University of Michigan’s IRB.

2.2. Inclusion and exclusion criteria

For these analyses, we utilized restricted-use data from the 2018 and 2019 Monitoring the Future questionnaires (unweighted N of all students surveyed = 87,013). The final analysis includes all respondents who received and responded to survey questions asking about vaping nicotine, JUUL, or flavors and who responded to questions about race/ethnicity (unweighted n = 42,980).

2.3. Measures

Current and regular e-cigarette use variables were created, based on responses to the following questions: 1) “During the last 30 days, on how many occasions (if any) have you used electronic cigarettes (e-cigarettes)?”, 2) “On how many days (if any) have you used a JUUL with a standard pod (that is, the types of pods for sale at most convenience stores) during the past 30 days?”, 3) “On how many days (if any) have you vaped nicotine during the past 30 days?”, and 4) “On how many days (if any) have you vaped just flavoring, without nicotine or marijuana in it during the past 30 days?” Responses for each of these questions included: 0 days, 1–2 days, 3–5 days, 6–9 days, 10–19 days, and 20 or more days. Questions 1, 3, and 4 were asked in 2018 and questions 2, 3, and 4 were asked in 2019.

The highest reported level of JUUL, vaping nicotine, or vaping flavors was used to code for current and regular e-cigarette use. Current e-cigarette use was coded as use on 0 days vs. 1 or more days of the past 30 days. Regular e-cigarette use was coded as use on 0–9 days vs. 10 or more days of the past 30 days. This threshold was chosen based on a previous study of other nationally representative surveys suggesting that a 10 + day threshold may be useful in assessing regular and stable e-cigarette use (Sánchez-Romero et al., 2021).

Respondents were asked to select all options that best described their race/ethnicity, according to the following question: “How do you describe yourself? (Select one or more response)”: Black or African American; Mexican American or Chicano; Cuban American; Puerto Rican; Other Hispanic or Latino; Asian American; White (Caucasian); American Indian or Alaskan Native; and Native Hawaiian or Other Pacific Islander. We categorized responses into the following groups: non-Hispanic Asian American (AA), non-Hispanic Native Hawaiian or Pacific Islander (NHPI), Hispanic or Latino (inclusive of any individual who indicated Mexican American or Chicano; Cuban American; Puerto Rican; other Hispanic or Latino ancestry), non-Hispanic Black or African American (Black), non-Hispanic White (White), non-Hispanic American Indian or Alaskan Native (AIAN), and multiracial, which includes all other race/ethnicity combinations. Other sociodemographic measures were used to characterize the sample, including sex (female; male), grade (8th; 10th; 12th), mother’s education (less than high school; high school graduate; some college; college graduate), and US Census region (Midwest; Northeast; South; West).

2.4. Analytic strategy

Survey weights accounting for multistage random sampling procedures were applied to all analyses, with stage 1 being the selection of geographic areas, stage 2 being the selection of one or more schools in each geographic area, and stage 3 being the selection of students within each school. Additional survey weights were assigned to compensate for differential probabilities of selection at each stage of sampling. Final survey weights are normalized to average 1.0.

Individual-level sociodemographic and socioeconomic characteristics (e.g., grade, sex, mother’s education level, and geographic region) and current and regular e-cigarette use prevalence are presented as unweighted frequencies and weighted percentages. Chi-square tests were used to determine whether current and regular e-cigarette use differed by racial/ethnic population subgroup, with p-values < 0.05 indicating statistical significance. Logistic regression was used to estimate the probability of current and regular e-cigarette use, based upon racial/ethnic subgroup, controlling for individual-level sociodemographic characteristics. All analyses applied survey weights and were conducted using the survey, dplyr, ggplot2, janitor, scales, forcats, and haven packages in RStudio (2020.02.3).

3. Results

Shown on Table 1 are unweighted n and weighted %. Table 1 shows that among 42,980 respondents, 2410 (5.1%) were AANHPI – including 2,198 (4.7%) AA and 212 (0.5%) NHPI; 4,535 (11.4%) were Black; 10,343 (25.2%) were Hispanic or Latino; 21,945 (49.1%) were White, and 3,747 (9.1%) were of another race/ethnicity – including 496 (1.3%) American Indian or Alaskan Native (AIAN) and 3,251 (7.8%) multiracial youth. More than half (n = 21,388; 51.4%) identified as female. Respondents were evenly split by grade level [i.e., 12,874 (30.7%) in 8th grade; 13,564 (33.4%) in 10th grade; and 16,542 (35.9%) in 12th grade]. A greater proportion of respondents lived in the South [i.e., 10,291 (22.6%) lived in the Midwest; 9,813 (19.8%) lived in the Northeast; 14,017 (35.3%) lived in the South; and 8,859 (22.2%) lived in the West)]. Nearly half (n = 19,828, 49.0%) had mothers who obtained a college education or higher. Regarding e-cigarette use, 9,026 (19.8%) of respondents reported current use and 4,105 (8.8%) reported regular e-cigarette use.

Table 1.

Sample Characteristics of Youth in the United States (Monitoring the Future, 2018–2019).

Unweighted n Weighted %
Total 42,980 100.0
Race/ethnicity
Non-Hispanic Asian American (AA) 2,198 4.7
Non-Hispanic Native Hawaiian or Pacific Islander (NHPI) 212 0.5
Non-Hispanic Black or African American (Black) 4,535 11.4
Hispanic or Latino 10,343 25.2
Non-Hispanic White (White) 21,945 49.1
Non-Hispanic American Indian or Alaskan Native (AIAN) 496 1.3
Multiracial 3,251 7.8
Grade
8th 12,874 30.7
10th 13,564 33.4
12th 16,542 35.9
Sex
Female 21,388 51.4
Male 20,684 48.6
Missing 908
Mother’s Education Level
Less than high school 5,002 14.2
High school graduate 7,351 19.7
Some college 6,536 17.1
College graduate 19,828 49.0
Missing 4,263
Region
Midwest 10,291 22.6
Northeast 9,813 19.8
South 14,017 35.3
West 8,859 22.2
Current E-cigarette Use
No (use on 0 days of the past 30 days) 33,954 80.2
Yes (use on at least 1 day of the past 30 days) 9,026 19.8
Regular e-cigarette Use
No (use on 0–9 days of the past 30 days) 38,875 91.2
Yes (use on at least 10 days of the past 30 days) 4,105 8.8
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As shown in Fig. 1, the prevalence of current and regular e-cigarette use differed across racial/ethnic subgroups (p-values < 0.05). Specifically, youth who identified as NHPI reported the highest prevalence of current e-cigarette use (n = 52, 28.0%). Following NHPI youth, were White (n = 5785, 25.2%), multiracial (n = 752, 22.3%), AIAN (n = 85, 16.5%), Hispanic or Latino (n = 1676, 15.0%), AA (n = 218, 10.3%), and Black youth (n = 458, 9.5%).

Fig. 1.

Fig. 1

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Current and Regular E-cigarette Use of Youth in the United States by Race/Ethnicity (Monitoring the Future, 2018–2019). Note. Current use is defined as use on at least 1 day of the past 30 days. Regular use is defined as use on at least 10 days of the past 30 days. Prevalence is reported as the weighted % of each racial/ethnic group that have indicated endorsement of either current use or regular use of e-cigarettes. Unweighted N indicates the number of respondents who identified with each racial/ethnic group. The overall difference across racial/ethnic subgroups was statistically significant at p-value < 0.05. Calculated 95% confidence interval bars are shown, in addition to the estimated point prevalence of e-cigarette use. Estimated prevalence of regular e-cigarette use for Native Hawaiian or Pacific Islanders (NHPI) is not shown, due to restrictions on reporting small sample sizes.

White youth reported the highest prevalence of regular e-cigarette use (n = 2848, 12.3%), followed by multiracial (n = 367, 10.7%), AIAN (n = 39, 7.8%), Hispanic or Latino (n = 579, 5.0%), AA (n = 95, 4.3%), and Black (n = 155, 3.0%) youth. Regular e-cigarette use prevalence of NHPI could not be reported and/or directly compared to other racial/ethnic subgroups, due to restrictions on reporting for small sample sizes using restricted-use data from the Monitoring the Future Study.

As shown in Table 2, race/ethnicity, sex, and grade were associated with current e-cigarette use. Youth who were NHPI (OR: 3.3, 95% CI: 2.1, 5.3), White (OR: 2.6, 95% CI: 2.1, 3.3), AIAN (OR: 1.8, 95% CI: 1.1, 2.9), Hispanic or Latino (OR: 1.4, 95% CI: 1.1., 1.8), or multiracial (OR: 2.3, 95% CI: 1.8, 3.0) had greater odds of being current e-cigarette users, relative to AA youth, even when controlling for the effects of sex, grade, mother’s education, and region. Relative to AA youth, NHPI (OR: 2.9, 95% CI: 1.5, 6.0), White (OR: 2.8, 95% CI: 2.1, 3.8), multiracial (OR: 2.6, 95% CI: 1.9, 3.7), and AIAN (OR: 1.9, 95% CI: 1.0, 3.5) youth had greater odds of reporting regular e-cigarette use, while Black youth had lower odds of reporting regular e-cigarette use (OR: 0.6, 95% CI: 0.4, 0.9), when controlling for the effects of sociodemographic and socioeconomic characteristics.

Table 2.

Logistic Regression Models Predicting Current and Regular E-cigarette Use (Monitoring the Future, 2018–2019).

Current E-cigarette Use Regular E-cigarette Use
Odds Ratio Lower 95% CI Upper 95% CI Odds Ratio Lower 95% CI Upper 95% CI
Race/ethnicity
Non-Hispanic Asian American (AA) Reference Reference Reference Reference Reference Reference
Non-Hispanic Native Hawaiian or Pacific Islander (NHPI) 3.3 2.1 5.3 2.9 1.5 6.0
Non-Hispanic Black or African American (Black) 0.8 0.6 0.1 0.6 0.4 0.9
Hispanic or Latino 1.4 1.1 1.8 1.1 0.8 1.5
Non-Hispanic White (White) 2.6 2.1 3.3 2.8 2.1 3.8
Non-Hispanic American Indian or Alaskan Native (AIAN) 1.8 1.1 2.9 1.9 1.0 3.5
Multiracial 2.3 1.8 3.0 2.6 1.9 3.7
Grade
8th Reference Reference Reference Reference Reference Reference
10th 2.2 1.9 2.6 3.0 2.4 3.6
12th 2.7 2.3 3.2 4.1 3.3 5.0
Sex
Female Reference Reference Reference Reference Reference Reference
Male 1.1 1.0 1.2 1.5 1.4 1.7
Mother’s Education Level
Less than high school Reference Reference Reference Reference Reference Reference
High school graduate 1.0 0.9 1.1 1.0 0.8 1.1
Some college 1.1 0.9 1.2 1.0 0.8 1.1
College graduate 0.9 0.8 1.0 0.9 0.7 1.0
Region
Midwest Reference Reference Reference Reference Reference Reference
Northeast 1.1 0.9 1.2 1.0 0.9 1.3
South 1.0 0.9 1.2 1.1 0.9 1.3
West 1.0 0.8 1.2 1.1 0.9 1.4
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Note. Italicized values indicate statistical significance at p-value < 0.05.

4. Discussion

The current study contributes to understanding of current and regular e-cigarette use among AANHPI youth by describing how use among Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) youth in the contiguous United States compare to other racial/ethnic subgroups. Estimates of current e-cigarette use in this study (e.g., 10.3% in AA youth and 28.0% in NHPI in 2018–2019) are higher than that reported by another study which used aggregated data from the National Youth Tobacco Survey (2014–2017) demonstrating an estimated 3.6% (95% CI: 2.9–4.4%) of Asian youth and 18.0% (95% CI: 13.1–22.9%) of Native Hawaiian and Pacific Islander youth report current e-cigarette use (Odani et al., 2018). Study results also show that a greater proportion of NHPI youth report current e-cigarette use, relative to AA, Hispanic or Latino, Black, and White youth. Additionally, results show that the odds of current e-cigarette and regular e-cigarette use are increased for NHPI, relative to AA, even adjusting for other sociodemographic characteristics such as grade, sex, mother’s education level, and region.

To date, much of the research on NHPI has been limited to geographic regions with high proportions of AANHPI (i.e., Hawaii and California) and focused on young adult/college samples (Rosario et al., 2021). Few studies have examined nicotine and tobacco use behaviors among NHPI residing in the contiguous US. One study conducted among large NHPI communities residing in Los Angeles County – representing the urban West Coast – and rural Arkansas – representing the rural South – found that 39% of young adults (aged 18–30 years) had reported current use of e-cigarettes (Subica et al., 2020). This estimate is higher than that found in the present study (28.0%), potentially due to the differences in the age of the samples.

Consistent with other studies (Alcalá et al., 2016, Levy et al., 2017, Seo and Chang, 2022, Sharapova et al., 2018, Villarroel et al., 2020), AA demonstrated one of the lowest current e-cigarette use rates, relative to other racial/ethnic groups. Prior literature has suggested that higher education, income, and lower prevalence of behavioral risk factors among AA might explain why AA has the lowest substance use rates, relative to other racial/ethnic groups (Budiman and Ruiz, 2021, Ra et al., 2022, Wu and Blazer, 2015). However, mother’s level of education was not found to be associated with current or regular e-cigarette use in these analyses, suggesting that future research needs to look at other possible explanations for why AA might have lower e-cigarette rates relative to other racial/ethnic subgroups.

For example, results may signal the need to further disaggregate AA subgroups. AANHPI subgroups were initially aggregated into one category to align with the statistical reporting standard set by the first Office of Management and Budget (OMB) Race and Ethnic Standards for Federal Statistics and Administrative Reporting, issued in 1977. Many public and private agencies and programs continue to group together Asian Americans, Native Hawaiians, and Pacific Islanders into one category. Consequently, diversity within AANHPI in terms of cultural traditions, histories, and modes of incorporation into the US have not been fully captured by existing data sources.

Efforts to change this OMB standard are ongoing at the community, research, and federal levels and it remains imperative that disaggregated data be collected, analyzed, and disseminated in ways that are culturally appropriate and widely accessible (AAPI Data and National Council of Asian Pacific Americans, 2022). As such, future data collection efforts and research should include measures of social factors and determinants that may influence current and regular e-cigarette use among AANHPI subgroups, such as: acculturation (An et al., 2008, Choi et al., 2008), perceived discrimination (Spencer et al., 2023), psychological distress (Narcisse et al., 2020), historical context (Pokhrel and Herzog, 2014), immigration-related factors like nativity, English-language proficiency, and age at time of immigration, and indicators of mental health (Takeuchi et al., 2007). However, conducting such research will require extensive data collection efforts, focused on increasing sample sizes, aggregating data across multiple years and surveys, or meta-analyses to achieve adequate sample sizes to conduct meaningful subgroup analyses (AAPI Data and National Council of Asian Pacific Americans, 2022).

4.1. Limitations

Self-reported survey responses of e-cigarette use, based on endorsement of items measuring vaping nicotine, JUUL, or flavors, may be subject to social desirability bias. However, biological confirmation studies suggest that survey responses related to tobacco use do not seem to be significantly influenced (Fendrich et al., 2005). Further, data was obtained from samples across the contiguous United States, which does not include Alaska or Hawaii. Although it is possible that the e-cigarette use behaviors of NHPI youth who reside in Hawaii differ from those who live in the contiguous United States, we are unable to report on these differences in the current study. Additionally, the prevalence of current e-cigarette use among NHPI is likely either under- or overestimated due to this limitation of the available data. Further, data was collected when JUUL was the most popular e-cigarette brand in the US (Fadus et al., 2019). Given that the popularity of JUUL among youth has since changed (Cooper et al., 2022, Park-Lee et al., 2021), more research is needed to determine what affect this market change has on reported e-cigarette use among youth. The current study is also unable to provide insights into prevention and intervention targets for youth vaping.

Despite these limitations, our study presents a national estimate for the prevalence of current e-cigarette use among AA and NHPI residing in the contiguous US that can be tracked over time, as Monitoring the Future Study has conducted cross-sectional surveys since 1975. Unfortunately, the limited sample size of Native Hawaiian and Pacific Islanders (NHPI) did not allow for the examination of differences in regular e-cigarette use with other racial/ethnic subgroups. Additionally, results did not provide information on multiracial AANHPI. Future surveys will need to increase sampling efforts of AANHPI subgroups to further assess within-group differences (Koh and Park, 2017) and examine the effect that historical context, national origin, citizenship, immigrant status, and acculturation towards American culture might have on e-cigarette use among AANHPI subgroups.

5. Conclusion

Findings indicate the importance of monitoring e-cigarette use behaviors among AANHPI youth, as a considerable number report current use and regular use of e-cigarettes. Given that AANHPI have been historically underrepresented in tobacco and nicotine-related research, future efforts will also need to work towards increasing the sample sizes of AANHPI subgroups, including AA and NHPI, in national health surveys.

6. Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments. Separate institutional review board (IRB) approval was not required for this secondary analysis of restricted-use data from the Monitoring the Future Study, which is annually approved by the University of Michigan’s IRB.

7. Consent to participate

Informed consent and assent were obtained from parents/guardians and youth participants included in the study.

8. Data availability

The data that support the findings of this study are available through the Monitoring the Future Study. Restrictions apply to the availability of these data, which are used under license for this study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

CRediT authorship contribution statement

Elizabeth K. Do: Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing, Visualization, Project administration. Kathleen Aarvig: Writing – original draft, Writing – review & editing. Hope Muller-Tabanera: Formal analysis, Visualization. Sarah Mills: Writing – original draft, Writing – review & editing. Jake Ryann Sumibcay: Writing – original draft, Writing – review & editing. Howard K. Koh: Formal analysis, Writing – original draft, Writing – review & editing, Supervision. Donna M. Vallone: Writing – original draft, Writing – review & editing, Supervision. Elizabeth C. Hair: Formal analysis, Writing – original draft, Writing – review & editing, Supervision.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data availability

The authors do not have permission to share data.

References

  1. Agner J., Pirkle C.M., Irvin L., Maddock J.E., Buchthal O.V., Yamauchi J., Starr R., Sentell T. The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state. BMC Public Health. 2020;20:141. doi: 10.1186/s12889-019-8078-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alcalá H.E., Albert S.L., Ortega A.N. E-cigarette use and disparities by race, citizenship status and language among adolescents. Addict. Behav. 2016;57:30–34. doi: 10.1016/j.addbeh.2016.01.014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. An N., Cochran S.D., Mays V.M., McCarthy W.J. Influence of American Acculturation on Cigarette Smoking Behaviors Among Asian American Subpopulations in California. Nicotine Tob. Res. 2008;10:579–587. doi: 10.1080/14622200801979126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Balfour D.J.K., Benowitz N.L., Colby S.M., Hatsukami D.K., Lando H.A., Leischow S.J., Lerman C., Mermelstein R.J., Niaura R., Perkins K.A., Pomerleau O.F., Rigotti N.A., Swan G.E., Warner K.E., West R. Balancing Consideration of the Risks and Benefits of E-Cigarettes. Am. J. Public Health. 2021;111:1661–1672. doi: 10.2105/AJPH.2021.306416. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Budiman, A., Ruiz, N.G., 2021. Key facts about Asian origin groups in the U.S. [WWW Document]. URL https://www.pewresearch.org/fact-tank/2021/04/29/key-facts-about-asian-origin-groups-in-the-u-s/ (accessed 8.19.22).
  6. Chau, V., Chan, P., 2021. One size does not fit all: Appreciating the diversity of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) and the Implications for Mental Health.
  7. Choi S., Rankin S., Stewart A., Oka R. Effects of Acculturation on Smoking Behavior in Asian Americans: A Meta-Analysis. J. Cardiovasc. Nurs. 2008;23:67. doi: 10.1097/01.JCN.0000305057.96247.f2. [DOI] [PubMed] [Google Scholar]
  8. Colyer-Patel K., Kuhns L., Weidema A., Lesscher H., Cousijn J. Age-dependent Effects of Tobacco Smoke and Nicotine on Cognition and the Brain: A Systematic Review of the Human and Animal Literature Comparing Adolescents and Adults. Neurosci. Biobehav. Rev. 2023;146:105038. doi: 10.1016/j.neubiorev.2023.105038. [DOI] [PubMed] [Google Scholar]
  9. Cooper M., Loukas A., Case K.R., Marti C.N., Perry C.L. A longitudinal study of risk perceptions and e-cigarette initiation among college students: Interactions with smoking status. Drug Alcohol Depend. 2018;186:257–263. doi: 10.1016/j.drugalcdep.2017.11.027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Cooper M., Park-Lee E., Ren C., Cornelius M., Jamal A., Cullen K.A. Notes from the Field: E-cigarette Use Among Middle and High School Students — United States, 2022. MMWR. Morbidity Mortality Weekly Report. 2022;71(40):1283–1285. doi: 10.15585/mmwr.mm7140a3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. AAPI Data, National Council of Asian Pacific Americans, 2022. 2022 Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) Roadmap for Data Equity in Federal Agencies.
  12. England L.J., Bunnell R.E., Pechacek T.F., Tong V.T., McAfee T.A. Nicotine and the Developing Human: A Neglected Element in the Electronic Cigarette Debate. Am. J. Prev. Med. 2015;49:286–293. doi: 10.1016/j.amepre.2015.01.015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Fadus M.C., Smith T.T., Squeglia L.M. The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects. Drug Alcohol Depend. 2019;201:85–93. doi: 10.1016/j.drugalcdep.2019.04.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Fendrich M., Mackesy-Amiti M.E., Johnson T.P., Hubbell A., Wislar J.S. Tobacco-reporting validity in an epidemiological drug-use survey. Addict. Behav. 2005;30:175–181. doi: 10.1016/j.addbeh.2004.04.009. [DOI] [PubMed] [Google Scholar]
  15. Glantz S., Jeffers A., Winickoff J.P. Nicotine Addiction and Intensity of e-Cigarette Use by Adolescents in the US, 2014 to 2021. JAMA Netw. Open. 2022;5(11):e2240671. doi: 10.1001/jamanetworkopen.2022.40671. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gorukanti A., Delucchi K., Ling P., Fisher-Travis R., Halpern-Felsher B. Adolescents’ attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation. Prev. Med. 2017;94:65–71. doi: 10.1016/j.ypmed.2016.10.019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hammond D., Rynard V.L., Reid J.L. Changes in Prevalence of Vaping Among Youths in the United States, Canada, and England from 2017 to 2019. JAMA Pediatr. 2020;174:797–800. doi: 10.1001/jamapediatrics.2020.0901. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hartmann-Boyce J., Lindson N., Butler A.R., McRobbie H., Bullen C., Begh R., Theodoulou A., Notley C., Rigotti N.A., Turner T., Fanshawe T.R., Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst. Rev. 2022 doi: 10.1002/14651858.CD010216.pub7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. More Native Hawaiians in Hawaiians Flock to mainland citites and leave Hawai’i, 2023.
  20. Kanaya A.M., Hsing A.W., Panapasa S.V., Kandula N.R., Araneta M.R.G., Shimbo D., Wang P., Gomez S.L., Lee J., Narayan K.M.V., Mau M.K.L.M., Bose S., Daviglus M.L., Hu F.B., Islam N., Jackson C.L., Kataoka-Yahiro M., Kauwe J.S.K., Liu S., Ma G.X., Nguyen T., Palaniappan L., Setiawan V.W., Trinh-Shevrin C., Tsoh J.Y., Vaidya D., Vickrey B., Wang T.J., Wong N.D., Coady S., Hong Y. Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop. Ann. Intern. Med. 2022;175:574–589. doi: 10.7326/M21-3729. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Koh H., Park J.J. Health Equity Matters for Asian Americans, Native Hawaiians, and Pacific Islanders. JAMA Forum Arch. 2017;A6 doi: 10.1001/jamahealthforum.2017.0008. [DOI] [Google Scholar]
  22. Levy D.T., Yuan Z., Li Y. The Prevalence and Characteristics of E-Cigarette Users in the U.S. Int. J. Environ. Res. Public Health. 2017;14:1200. doi: 10.3390/ijerph14101200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Maglalang D.D., Brown-Johnson C., Prochaska J.J. Associations with E-cigarette use among Asian American and Pacific Islander young adults in California. Prev. Med. Rep. 2016;4:29–32. doi: 10.1016/j.pmedr.2016.05.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Marques P., Piqueras L., Sanz M.-J. An updated overview of e-cigarette impact on human health. Respir. Res. 2021;22:151. doi: 10.1186/s12931-021-01737-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Miech R., Johnston L., O’Malley P.M., Bachman J.G., Patrick M.E. Trends in Adolescent Vaping, 2017–2019. N. Engl. J. Med. 2019;381:1490–1491. doi: 10.1056/NEJMc1910739. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Miech R.A., O’Malley P.M., Johnston L.D., Patrick M.E. E-Cigarettes and the Drug Use Patterns of Adolescents. Nicotine Tob. Res. 2016;18:654–659. doi: 10.1093/ntr/ntv217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Mirbolouk M., Charkhchi P., Kianoush S., Uddin S.M.I., Orimoloye O.A., Jaber R., Bhatnagar A., Benjamin E.J., Hall M.E., DeFilippis A.P., Maziak W., Nasir K., Blaha M.J. Prevalence and Distribution of E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann. Intern. Med. 2018;169:429–438. doi: 10.7326/M17-3440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Monte, L.M., Shin, H.B., 2022. 20.6 Million People in the U.S. Identify as Asian, Native Hawaiian or Pacific Islander [WWW Document]. Census.gov. URL https://www.census.gov/library/stories/2022/05/aanhpi-population-diverse-geographically-dispersed.html (accessed 8.19.22).
  29. Narcisse M.-R., Dobbs P., Long C.R., Purvis R.S., Kimminau K.S., McElfish P.A. Electronic cigarette use and psychological distress in the Native Hawaiian and Pacific Islander adults compared with other racial/ethnic groups: Data from the National Health Interview Survey, 2014. J. Community Psychol. 2020;48:225–236. doi: 10.1002/jcop.22248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. National Academies of Sciences, E., Division, H. and M., Practice, B. on P.H. and P.H., Systems, C. on the R. of the H.E. of E.N.D., Eaton, D.L., Kwan, L.Y., Stratton, K., 2018. Toxicology of E-Cigarette Constituents, Public Health Consequences of E-Cigarettes. National Academies Press (US). [PubMed]
  31. Nguyen A.B. Disaggregating Asian American and Native Hawaiian and Other Pacific Islander (AANHOPI) Adult Tobacco Use: Findings from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study, 2013–2014. J. Racial Ethn. Health Disparities. 2019;6:356–363. doi: 10.1007/s40615-018-00532-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Odani S., Armour B.S., Agaku I.T. Racial/Ethnic Disparities in Tobacco Product Use Among Middle and High School Students — United States, 2014–2017. Morb. Mortal. Wkly Rep. 2018;67:952–957. doi: 10.15585/mmwr.mm6734a3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Office of Minority Health, 2023. Native Hawaiians/Other Pacific Islanders [WWW Document]. URL https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=65 (accessed 3.20.23).
  34. Office of the Surgeon General, 2018. Surgeon General’s advisory on e-cigarette use among youth. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Washington, DC.
  35. Park-Lee E., Ren C., Sawdey M.D., Gentzke A.S., Cornelius M., Jamal A., Cullen K.A. Notes from the Field: E-Cigarette Use Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Morb. Mortal. Wkly Rep. 2021;70(39):1387–1389. doi: 10.15585/mmwr.mm7039a4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Pokhrel P., Herzog T.A. Historical Trauma and Substance Use among Native Hawaiian College Students. Am. J. Health Behav. 2014;38:420–429. doi: 10.5993/AJHB.38.3.11. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Ra C.K., Pehlivan N., Kim H., Sussman S., Unger J.B., Businelle M.S. Smoking prevalence among Asian Americans: Associations with education, acculturation, and gender. Prev. Med. Rep. 2022;30 doi: 10.1016/j.pmedr.2022.102035. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Rao M., Bar L., Yu Y., Srinivasan M., Mukherjea A., Li J., Chung S., Venkatraman S., Dan S., Palaniappan L. Disaggregating Asian American Cigarette and Alternative Tobacco Product Use: Results from the National Health Interview Survey (NHIS) 2006–2018. J. Racial Ethn. Health Disparities. 2022;9:856–864. doi: 10.1007/s40615-021-01024-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Rosario M.H., Johnson D.L., Manglallan K.S., Phillips K.T., Pokhrel P., Okamoto S.K. Tobacco use among native Hawaiian and Pacific Islander youth in the U.S. and USAPI: a systematic review of the literature. J. Ethn. Subst. Abuse. 2021;22(3):500–515. doi: 10.1080/15332640.2021.1965934. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Sánchez-Romero L.M., Cadham C.J., Hirschtick J.L., Mattingly D.T., Cho B., Fleischer N.L., Brouwer A., Mistry R., Land S.R., Jeon J., Meza R., Levy D.T. A comparison of tobacco product prevalence by different frequency of use thresholds across three US surveys. BMC Public Health. 2021;21:1203. doi: 10.1186/s12889-021-11283-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Seo Y.S., Chang Y.-P. Racial and Ethnic Differences in E-Cigarette and Cigarette Use Among Adolescents. J. Immigr. Minor. Health. 2022;24:713–720. doi: 10.1007/s10903-021-01229-0. [DOI] [PubMed] [Google Scholar]
  42. Sharapova S.R., Singh T., Agaku I.T., Kennedy S.M., King B.A. Patterns of E-cigarette Use Frequency—National Adult Tobacco Survey, 2012–2014. Am. J. Prev. Med. 2018;54:284–288. doi: 10.1016/j.amepre.2017.09.015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Shi M., Gette J.A., Gissandaner T.D., Cooke J.T., Littlefield A.K. E-cigarette use among Asian Americans: a systematic review. J. Ethn. Subst. Abuse. 2020;21(4):1165–1198. doi: 10.1080/15332640.2020.1861495. [DOI] [PubMed] [Google Scholar]
  44. Spencer S.D., Pokhrel P., Helm S., Wilczek K., Galimov A., Sussman S. Emerging adulthood attributes, discrimination, mental health, and substance use in a sample of Asian, Native Hawaiian/Pacific Islander, and White college students. Asian Am. J. Psychol. 2023;14:51–62. doi: 10.1037/aap0000254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Subica A.M., Guerrero E., Wu L.-T., Aitaoto N., Iwamoto D., Moss H.B. Electronic Cigarette Use and Associated Risk Factors in U.S.-Dwelling Pacific Islander Young Adults. Subst. Use Misuse. 2020;55:1702–1708. doi: 10.1080/10826084.2020.1756855. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Takeuchi D.T., Zane N., Hong S., Chae D.H., Gong F., Gee G.C., Walton E., Sue S., Alegría M. Immigration-Related Factors and Mental Disorders Among Asian Americans. Am. J. Public Health. 2007;97:84–90. doi: 10.2105/AJPH.2006.088401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. United States Census Bureau, 2022. Asian American and Pacific Islander Heritage Month: May 2022 [WWW Document]. Census.gov. URL https://www.census.gov/newsroom/facts-for-features/2022/asian-american-pacific-islander.html (accessed 8.19.22).
  48. Villarroel M.A., Cha A.E., Vahratian A. Electronic cigarette use among U.S. adults, 2018 (NCHS Data Brief. 2020;No. 365) [PubMed] [Google Scholar]
  49. Wills T.A., Knight R., Sargent J.D., Gibbons F.X., Pagano I., Williams R.J. Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii. Tob. Control. 2017;26:34–39. doi: 10.1136/tobaccocontrol-2015-052705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Wills T.A., Soneji S.S., Choi K., Jaspers I., Tam E.K. E-cigarette use and respiratory disorders: an integrative review of converging evidence from epidemiological and laboratory studies. Eur. Respir. J. 2021;57(1):1901815. doi: 10.1183/13993003.01815-2019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Wu L.-T., Blazer D.G. Substance use disorders and co-morbidities among Asian Americans and Native Hawaiians/Pacific Islanders. Psychol. Med. 2015;45:481–494. doi: 10.1017/S0033291714001330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Yuan M., Cross S.J., Loughlin S.E., Leslie F.M. Nicotine and the adolescent brain. J. Physiol. 2015;593:3397–3412. doi: 10.1113/JP270492. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available through the Monitoring the Future Study. Restrictions apply to the availability of these data, which are used under license for this study.

The authors do not have permission to share data.

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