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. Author manuscript; available in PMC: 2025 Feb 1.
Published in final edited form as: Drug Alcohol Depend. 2023 Dec 14;255:111061. doi: 10.1016/j.drugalcdep.2023.111061

Sociodemographic Differences in use of Nicotine, Cannabis, and Non-Nicotine E-cigarette Devices

Devin Malloy McCauley a, Michael Baiocchi b, Shivani Mathur Gaiha a, Bonnie Halpern-Felsher a,*
PMCID: PMC10949227  NIHMSID: NIHMS1954602  PMID: 38134543

Abstract

Background.

Sociodemographic differences in e-cigarette use have been documented; however, disparities in use of specific e-cigarette types with various ingredients have yet to be thoroughly investigated. This study examines ever- and past-30-day-use of nicotine, cannabis, and non-nicotine e-cigarette device types by sex, sexual orientation, race/ethnicity, and financial comfort.

Methods.

Data were drawn from a 2021 national cross-sectional survey of adolescents, young adults, and adults (N = 6,131, ages 13–40 years old). Participants reported ever and past-30-day-use of (1) disposable nicotine e-cigarettes, (2) pod/cartridge-based nicotine e-cigarettes, (3) “other” nicotine e-cigarettes, (4) non-nicotine e-cigarettes, (5) e-cigarettes with THC, and (6) e-cigarettes with CBD. We constructed summary tables for each e-cigarette device type in which percentages of ever and past-30-day-use were calculated by birth year category and sociodemographic variables: (a) sex, (b) sexual orientation, (c) race/ethnicity, and (d) financial comfort.

Results.

Females born between 1996–2008 reported higher rates of past 30-day disposable e-cigarette use relative to males (females 26.4%; males 22.4%). Compared to their heterosexual counterparts, LGBTQ+ participants reported higher overall rates of past-30-day-use for disposable (LGBTQ+ 27.9%; Heterosexual 23.8%), THC (LGBTQ+ 30.8%; Heterosexual 24.1%), and CBD e-cigarettes (LGBTQ+ 20.0%; Heterosexual 16.9%). Hispanic/Latino participants generally reported higher rates of past-30-day-use across device types relative to those identifying as Black or White non-Hispanic, particularly disposable nicotine e-cigarettes.

Conclusions.

Findings highlight sociodemographic disparities in e-cigarette use, though differences varied based on e-cigarette device type and participant birth year category. Tailored preventive efforts may be necessary to mitigate e-cigarette use among populations at highest risk.

Keywords: E-cigarettes, Cannabis, Sociodemographic differences, Adolescents, Young Adults

1. Introduction

Since e-cigarettes first entered the U.S. market in 2007, industry innovations in combination with regulatory efforts have yielded a diversity of e-cigarette device types with varying ingredients, nicotine levels, and potential health harms (Jackler & Ramamurthi, 2019; McKelvey & Halpern-Felsher, 2019; World Health Organization, 2022). Early nicotine e-cigarettes resembled traditional combustible cigarettes (i.e., “cig-a-likes”), followed by vape pens and then larger, customizable e-cigarette devices (i.e., “mods”) (Walley & Wilson, 2021). The popularity of e-cigarettes increased substantially following the introduction of flavored pod/cartridge-based devices in 2015 (e.g., JUUL) followed by disposable e-cigarette devices, both of which feature sleek, concealable designs and contain high amounts of salt-based nicotine (Fadus et al., 2019; Goniewicz et al., 2019; Huang et al., 2019; King et al., 2018; Walley & Wilson, 2021; R. Williams, 2020). E-cigarettes also feature ingredients other than nicotine. For example, non-nicotine e-cigarettes are often marketed as wellness or “vitamin delivery” products with numerous unsubstantiated health claims (Basáñez et al., 2019; Gaiha, Lin, et al., 2022). E-cigarettes are also commonly used for inhaling cannabidiol (CBD) and tetrahydrocannabinol (THC) (Leas et al., 2021; Miech et al., 2020; Morean et al., 2015).

1.1. E-cigarette Use and Health Concerns

Nicotine e-cigarettes represent the most highly used tobacco product among adolescents (Park-Lee et al., 2022). Innovation of nicotine e-cigarette devices coincided with an increase in use among adolescents and young adults (Fadus et al., 2019; Huang et al., 2019; Vallone et al., 2020), with rates increasing dramatically in 2018 and 2019 after pod-based e-cigarettes became popular (Gentzke et al., 2019; Vallone et al., 2020). Recent national surveys estimate that 3% of middle schoolers and 14% of high schoolers had used nicotine e-cigarettes in the past 30 days in 2022 (Cooper et al., 2022; Park-Lee et al., 2022), although other studies suggest rates are higher (McCauley et al., 2022). National data also show that 12% of 12th graders reported vaping cannabis in the past 30 days (Johnston et al., 2022). Among young adults aged 19–30 years, approximately 16% and 12% reported past 30-day use of e-cigarettes with nicotine and marijuana, respectively (Patrick et al., 2022). Though nationally representative data on non-nicotine e-cigarettes are not yet available, emerging research estimates that 14% of 13–17-year-olds, 24% of 18–20-year-olds, and over 35% of adults 21–40 years old have tried these products at least once (Gaiha, Lin, et al., 2022).

Nicotine and cannabis e-cigarette use has become a public health concern within the United States due to documented health effects on the heart and lungs (Chadi et al., 2020; Graham et al., 2022; Hamberger & Halpern-Felsher, 2020; Tsai et al., 2020) and greater potential for nicotine and cannabis dependence among young people (Hall, Leung, & Linskey, 2020; Lin, 2022; Yuan et al., 2015). Though the health effects of non-nicotine e-cigarette use are not yet understood, listed ingredients including propylene glycol, vegetable glycerin, aldehydes, and others are known to be hazardous to health (Jensen et al., 2015; Woodall et al., 2020).

1.2. Sociodemographic Differences in E-cigarette Use

To date, differential patterns of e-cigarette use have been found by sex, sexual orientation, race/ethnicity, and income. For example, e-cigarette use is typically more prevalent among males relative to females in both adolescents and adults (Gaiha et al., 2021a; Kong et al., 2017; Lanza et al., 2017; Mayer et al., 2020; Villarroel, 2020), though recent national data indicate slightly and non-significant higher levels of past-30-day-use among adolescent females relative to males (Park-Lee et al., 2022). General tobacco and cannabis use is more prevalent among sexual minority adolescents and adults relative to their heterosexual counterparts (Garcia et al., 2021; Liautaud et al., 2021; Marshal et al., 2008), including nicotine e-cigarettes (Azagba et al., 2019; Azagba & Shan, 2021; Gaiha et al., 2021a; Gaiha, Rao, et al., 2022; Rahmandar & Gribben, 2022). Racial and ethnic differences in e-cigarette use have been documented, although those results are less consistent. Some studies note higher rates of e-cigarette use among non-Hispanic, White adolescents relative to their Hispanic and non-Hispanic, Black counterparts (Gentzke et al., 2022). Other research highlights elevated rates of e-cigarette use among Hispanic youth relative to their Black and White peers, but emphasizes that racial/ethnic differences in use vary as a function of age (Lanza et al., 2017). Some evidence also suggests elevated rates of e-cigarette use among multi-racial adolescents and young adults relative to their peers (Gaiha, Rao, et al., 2022). Among adults 18 and over, White participants typically report higher rates of e-cigarette use relative to their Black, Asian, and Hispanic counterparts (Cornelius et al., 2022; Mayer et al., 2020; Villarroel, 2020). Finally, some studies report higher rates of e-cigarette use among lower income populations (Vallone et al., 2020; Villarroel, 2020).

Though prior research has uncovered sociodemographic differences in general e-cigarette use, studies examining sociodemographic patterns in use of specific e-cigarette device types (disposables, pod-based, and other), ingredients (i.e., nicotine, THC, CBD, and newer non-nicotine/non-cannabis), and across age groups (adolescents, young adults, and adults) are limited. The diversity of e-cigarette products, device types, and ingredients suggests that more subtle sociodemographic patterns of use may have yet to be detected. Indeed, recent inquiry in this domain suggests this topic warrants further study. For example, sociodemographic factors such as race and sexual orientation differentially predict risk for adolescents’ and young adults’ use of different nicotine e-cigarettes devices (Gaiha et al., 2021a; Gaiha, Rao, et al., 2022). Further study in this area is needed to corroborate nascent evidence, but also to expand the scope of inquiry to include adults and e-cigarettes with ingredients other than nicotine. Establishing a strong evidence base for sociodemographic differences in use of specific e-cigarette device types is essential to identify populations at elevated risk for use so that more targeted and equitable policy, prevention, and counter-marketing efforts can be developed and implemented in service of public health.

1.3. Current Study

The current study applies a descriptive approach to illuminate sociodemographic patterns in use of six different e-cigarette device types that are available on the market and commonly used by adolescents, young adults, and adults. Specifically, we examine ever- and past 30-day-use of (1) disposable nicotine e-cigarettes, (2) pod/cartridge-based nicotine e-cigarettes, (3) “other” nicotine e-cigarettes, (4) non-nicotine e-cigarettes, (5) e-cigarettes with THC, and (6) e-cigarettes with CBD by (a) sex, (b) sexual orientation, (c) race/ethnicity, and (d) financial comfort. Drawing upon a sample of participants ages 13 to 40 years old, we will evaluate sociodemographic differences in e-cigarette use by birth year to allow for results to be interpreted in the context of changes in e-cigarette device availability over time (Bell, 2020; Walley & Wilson, 2021). Assessing e-cigarette use by device type and key sociodemographic factors will highlight promising directions for future research into disparities in e-cigarette use, and aid policy and prevention efforts to mitigate e-cigarette use among populations at greatest risk.

2. Methods

2.1. Procedure

We deployed a cross-sectional, anonymous, self-administered online survey from November through December of 2021. Participants were recruited by Qualtrics, a survey administration service that draws upon online panels comprised of individuals who have agreed to participate in research. Study participants were recruited from these online panels through an email link distributed via social media, customer loyalty portals, and other websites. The convenience sampling plan included recruiting participants between the ages of 13 and 40, with a 1:1:1 ratio of 13-to-17-years-olds (adolescents), 18-to-20-years-olds (adolescents and young adults under the legal age of e-cigarette sales) and 21-to-40-year-olds (young adults and adults). Sampling of self-reported sex, race, and ethnicity was balanced to align with the US Census. Participants were required to speak English in order to be eligible to participate, and provided consent/assent prior to beginning the survey. The study protocol was approved by the institutional review board at Stanford Uni-versity. For more information, see Gaiha, Lin, et al. (2022).

2.2. Participants

Participant characteristics are shown in Table 1. The final sample included 6,131 participants, including 1,630 (26.6%) 13–17-year-olds, 2,033 (33.2%) 18–20-year-olds, 1,041 (17.0%) 21–24-year-olds, and 1,427 (23.3%) 25–40-year-olds. Among all participants, 56.3% identified as female, 37.9% as male, 4.7% as Non-binary/Other, and 1.0% preferred not to say; and 51.6% identified their race/ethnicity as White, non-Hispanic, 18.6% as Hispanic or Latino, 13.7% as African American or Black, non-Hispanic, 5.2% as Asian, Native Hawaiian, or Pacific, 3.7% as American Indian/Alaska Native , <1% as multiple races, and 6.8% preferred not to say. 69.3% reported their sexual orientation as heterosexual, 25.7% as LGBTQ+, <1% as not listed above, and 4.2% preferred not to say; 42.1% reported their financial comfort as ‘live comfortably’, 27.0% as ‘meet needs with a little left over’, 18.2% as ‘just meet expenses with nothing left over’, and 5.1% as ‘does not meet basic expenses’, and 7.6% preferred not to say (Williams et al., 2017). For more study sample information see Gaiha, Lin, et al. (2022).

Table 1.

Participant Characteristics (N = 6,131)

Birth Year Total (N=6,131) Sex Race/Ethnicity Sexual Orientation Financial Comfort
Female (n=3,454) Male (n=2325) Hispanic/Latin o (n=1,140) Black, NH (n=841) White, NH (n=3,162) Hetero sexual (n=4,251) LGB TQ+(n=1,573) Do not meet (n=314) Just meet (n=1,114) Little left over (n=1,657) Live Comfortably (n=2,579)
1981–1985 505 (8.2) 244 (7.1) 256 (11.0) 52 (4.6) 58 (6.9) 330 (10.4) 449 (10.6) 48 (3.1) 51 (16.2) 139 (12.5) 166 (10.0) 129 (5.0)
1986–1990 398 (6.5) 235 (6.8) 160 (6.9) 50 (4.4) 59 (7.0) 245 (7.7) 321 (7.6) 59 (3.8) 39 (12.4) 98 (8.8) 94 (5.7) 150 (5.8)
1991–1995 331 (5.4) 214 (6.2) 112 (4.8) 58 (5.1) 62 (7.4) 167 (5.3) 247 (5.8) 77 (4.9) 27 (8.6) 69 (6.2) 98 (5.9) 125 (4.8)
1996–2000 1,234 (20.1) 806 (23.3) 371 (16.0) 282 (24.7) 214 (25.9) 555 (17.6) 844 (19.9) 336 (21.4) 60 (19.1) 237 (21.3) 330 (19.9) 527 (20.4)
2001–2005 3,295 (53.7) 1,849 (53.5) 1,212 (52.1) 645 (56.6) 420 (49.9) 1692 (53.5) 2,155 (50.7) 968 (61.5) 128 (40.8) 526 (47.2) 896 (54.1) 1,465 (56.8)
2006–2008 368 (6.0) 106 (3.1) 214 (9.2) 53 (4.6) 28 (3.3) 173 (5.5) 235 (5.5) 85 (5.4) 9 (2.9) 45 (4.0) 73 (4.4) 183 (7.1)
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Note. NH = Non-Hispanic.

2.3. Measures

All items were pilot tested with assistance from a group of 42 adolescents, young adults, and adults who provided ongoing feedback on survey items, images, clarity, and length. We also reviewed pilot testing responses to conduct range checks and verify that all survey logic functioned properly.

2.3.1. E-cigarette Use

To assess ever and past 30-day e-cigarette use, participants viewed images of disposable, pod/cartridge-based, other, non-nicotine, THC, and CBD e-cigarettes and were asked, “Have you ever used any of these products in your entire life? (please select Yes OR No)” in relation to: (a) Disposable nicotine vapes such as Puffbar or FOGG, even 1 or 2 puffs; (b) Pod-based nicotine vapes such as JUUL or Phix, even 1 or 2 puffs; (c) any other nicotine vape-like mods, even 1 or 2 puffs; (d) Non-nicotine vapes like Monq or Vitaminvape, even 1 or 2 puffs; (e) Vaping THC (wax or oil) or marijuana, even 1 or 2 puffs; (f) Vaping CBD, even 1 or 2 puffs. Participants could respond “Yes” to multiple devices.

If participants responded “yes” to any of the products listed above, they were then asked “During the last 30 days, on about how many days did you use each of the following products? (Put zero if you did not use the products in the last 30 days).” Participants could select a number from 0 to 30. Participants were categorized as having used in the past 30 days for any e-cigarette device type above for which they selected any response greater than zero.

If participants responded “yes” to having ever used non-nicotine e-cigarettes, they were asked “Which of the following ingredients were in a non-nicotine vape you ever used?”, with answer choices including CBD and THC. Participants who used CBD or THC in non-nicotine e-cigarette devices were also considered to have ever used CBD and THC e-cigarettes, respectfully.

2.4. Data Analysis

To address study aims, we constructed summary tables for each e-cigarette device type in which percentages of ever and past 30-day use were calculated by birth year category and key sociodemographic variables: sex, sexual orientation, race/ethnicity, and financial comfort. Each participant’s birth year was calculated by subtracting their self-reported age from 2021, the year the survey was administered. Then birth years were sorted into intervals of 5 years to form the following birth year categories, with biological ages at the time of the study included in parenthesis: 1981–1985 (36–40-year-olds), 1986–1990 (31–35-year-olds), 1991–1995 (26–30-year-olds), 1996–2000 (21–25-year-olds), 2001–2005 (16–20-year-olds), 2006–2008 (13–15-year-olds). No participants were born after 2008, therefore the youngest category included an interval of only three years. Birth year was used instead of biological age so that results can be interpreted in the context of changes in e-cigarette device availability over time (Bell, 2020; Walley & Wilson, 2021).

Limited representation of some sociodemographic groups in our sample precluded their inclusion in study analyses. We did not analyze a subgroup if they had fewer than 300 total cases. Therefore, our analyses focus on females and males (sex), heterosexual and LGBTQ+ participants (sexual orientation), Hispanic/Latino, Black, and White participants (race/ethnicity), and all levels of financial comfort.

The percentage of missing data was calculated for each sociodemographic group by e-cigarette device use pattern (e.g., female by ever disposable e-cigarette use), with zero cases exceeding 5%. SPSS v28 and R Studio v.2021.09.2 were used for all data preparation and analysis.

3. Results

3.1. Sex

Rates of ever- and past-30-day-use of e-cigarette device types by sex and birth year are shown in Table 2.

Table 2.

Ever and Past 30-Day E-Cigarette Use by Sex (n = 5,779)

2A. Ever Use
DISPOSABLE POD/CARTRIDGE OTHER E-CIGARETTES
Birth Year Female Male Total Female Male Total Female Male Total
1981–1985 32.4% 25.4% 28.8% 38.9% 33.2% 36.0% 32.8% 27.3% 30.0%
1986–1990 40.4% 50.6% 44.6% 41.7% 53.1% 46.3% 34.5% 46.9% 39.5%
1991–1995 38.8% 53.6% 43.9% 39.7% 66.1% 48.8% 38.3% 47.3% 41.4%
1996–2000 47.0% 43.9% 46.0% 48.9% 52.0% 49.9% 41.1% 42.3% 41.5%
2001–2005 38.5% 31.4% 35.7% 37.0% 32.6% 35.2% 27.7% 25.7% 26.9%
2006–2008 24.5% 9.8% 14.7% 23.6% 8.9% 13.8% 15.1% 7.9% 10.3%
Total 39.8% 33.2% 37.1% 40.0% 36.6% 38.6% 31.9% 29.4% 30.9%
NON-NICOTINE THC CBD
Birth Year Female Male Total Female Male Total Female Male Total
1981–1985 21.7% 26.6% 24.2% 34.28% 31.3% 33.0% 27.5% 30.9% 29.2%
1986–1990 26.4% 53.1% 37.2% 46.8% 61.9% 52.9% 38.3% 60.6% 47.3%
1991–1995 28.0% 54.5% 37.1% 48.6% 62.5% 53.4% 39.7% 51.8% 43.9%
1996–2000 36.2% 44.2% 38.7% 49.8% 51.8% 50.4% 39.8% 46.6% 42.0%
2001–2005 21.7% 19.7% 20.9% 35.5% 35.5% 35.5% 28.6% 27.1% 28.0%
2006–2008 12.3% 8.4% 9.7% 20.8% 6.5% 11.3% 12.3% 6.5% 8.4%
Total 25.5% 27.3% 26.3% 39.9% 38.1% 39.2% 32.0% 32.3% 32.1%
2B. Past 30-Day Use
DISPOSABLE POD/CARTRIDGE OTHER E-CIGARETTES
Birth Year Female Male Total Female Male Total Female Male Total
1981–1985 16.8% 17.6% 17.2% 24.2% 22.3% 23.2% 19.3% 18.8% 19.0%
1986–1990 24.3% 38.8% 30.1% 28.9% 40.0% 33.4% 22.6% 37.5% 28.6%
1991–1995 25.2% 41.1% 30.7% 22.0% 50.0% 31.6% 25.2% 35.7% 28.8%
1996–2000 33.9% 32.6% 33.5% 33.0% 37.7% 34.5% 26.7% 30.5% 27.9%
2001–2005 23.6% 21.9% 22.9% 19.4% 18.2% 18.9% 14.3% 13.9% 14.1%
2006–2008 18.9% 7.5% 11.3% 13.2% 3.3% 6.6% 9.4% 1.9% 4.4%
Total 25.5% 23.9% 24.9% 23.5% 23.4% 23.5% 18.6% 18.6% 18.6%
NON-NICOTINE THC CBD
Birth Year Female Male Total Female Male Total Female Male Total
1981–1985 13.9% 21.1% 17.6% 18.0% 21.9% 20.0% 13.5% 19.1% 16.4%
1986–1990 20.9% 43.8% 30.1% 29.8% 42.5% 34.9% 24.7% 41.3% 31.4%
1991–1995 20.6% 42.9% 28.2% 28.5% 43.8% 33.7% 22.4% 36.6% 27.3%
1996–2000 25.3% 34.2% 28.1% 33.1% 36.7% 34.2% 22.3% 28.0% 24.1%
2001–2005 10.9% 11.4% 11.1% 22.6% 23.8% 23.0% 14.3% 15.0% 14.6%
2006–2008 7.5% 4.2% 5.3% 14.2% 2.8% 6.6% 7.5% 1.9% 3.8%
Total 15.7% 19.2% 17.1% 25.3% 25.9% 25.6% 17.1% 19.2% 18.0%
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Note. Missing values accounted for between 0.8% and 2.9% of all responses (mode = 1.6%).

3.1.1. Ever Use

In general, females reported higher overall rates of ever use for disposable (female 39.8%, male 33.2%), pod/cartridge-based (female 40.0%; male 36.6%), other e-cigarettes (female 31.9%, male 29.4%), and THC e-cigarette device types (female 39.9%; male 38.1%) relative to males. Males reported higher rates of ever use for non-nicotine e-cigarettes (female 25.5%, male 27.3%)1. For females, rates of ever use of disposable, pod/cartridge-based, other e-cigarettes, and non-nicotine e-cigarettes were highest among those born within the years 1996 to 2000 (21–25-years-old at the time of the study). For males, rates of ever use for the aforementioned devices were highest among those born from 1991–1995 (26–30-year-olds at the time of the study).

3.1.2. Past-30-Day-Use

For past-30-day-use, males and females reported similar rates of use for all device types with the exception of non-nicotine e-cigarettes (female 15.7%; male 19.2%) and CBD e-cigarettes (17.1% female, male 19.2%). For disposable e-cigarettes, females born from 1996–2008 reported higher rates of past 30-day use relative to males, whereas males born from 1981–1995 reported higher rates relative to females. For all device types, females born from 2006–2008 reported higher rates of past-30-day-use relative to males.

3.2. Sexual Orientation

Rates of ever and past 30-day use of e-cigarette device types by sexual orientation are shown in Table 3.

Table 3.

Ever and Past 30-Day E-Cigarette Use by Sexual Orientation (n = 5,824)

3A. Ever Use
DISPOSABLE POD/CARTRIDGE OTHER E-CIGARETTES
Birth Year Heterosexual LGBTQ+ Total Heterosexual LGBTQ+ Total Heterosexual LGBTQ+ Total
1981–1985 27.6% (39.6%) 28.8% 34.5% (52.1%) 36.2% 28.3% (45.8%) 30.0%
1986–1990 42.4% 57.6% 44.7% 45.5% 55.9% 47.1% 40.8% 39.0% 40.5%
1991–1995 42.5% 48.1% 43.8% 49.4% 46.8% 48.8% 41.7% 40.3% 41.4%
1996–2000 44.2% 52.1% 46.4% 49.6% 51.8% 50.3% 39.0% 48.2% 41.6%
2001–2005 34.0% 40.2% 35.9% 33.1% 39.8% 35.2% 25.0% 31.3% 27.0%
2006–2008 12.8% 28.2% 16.9% 10.2% 23.5% 13.8% 8.1% 21.2% 11.6%
Total 35.3% 43.1% 37.4% 37.1% 42.8% 38.7% 29.4% 35.5% 31.0%
NON-NICOTINE THC CBD
Birth Year Heterosexual LGBTQ+ Total Heterosexual LGBTQ+ Total Heterosexual LGBTQ+ Total
1981–1985 24.1% (25.0%) 24.1% 37.6% (54.2%) 39.2% 28.7% (35.4%) 29.4%
1986–1990 36.1% 45.8% 37.6% 52.3% 64.4% 54.2% 47.4% 54.2% 48.4%
1991–1995 38.5% 32.5% 37.0% 52.2% 55.8% 53.1% 43.7% 42.9% 43.5%
1996–2000 38.4% 39.3% 38.6% 49.3% 55.7% 51.1% 40.3% 47.0% 42.2%
2001–2005 20.0% 22.5% 20.7% 32.8% 42.7% 35.9% 25.2% 35.1% 28.2%
2006–2008 7.7% 21.2% 11.3% 8.5% 23.5% 12.5% 5.1% 20.0% 9.1%
Total 25.7% 27.5% 26.2% 37.8% 46.2% 40.1% 30.2% 38.0% 32.3%
3B. Past 30-Day Use
DISPOSABLE POD/CARTRIDGE OTHER E-CIGARETTES
Birth Year Heterosexual LGBTQ+ Total Heterosexual LGBTQ+ Total Heterosexual LGBTQ+ Total
1981–1985 16.7% (22.9%) 17.3% 23.6% (20.8%) 23.3% 18.0% (29.2%) 19.1%
1986–1990 29.9% 33.9% 30.5% 33.3% 37.3% 33.9% 29.9% 25.4% 29.2%
1991–1995 31.2% 28.6% 30.6% 33.6% 23.4% 31.2% 30.0% 26.0% 29.0%
1996–2000 31.3% 39.0% 33.5% 34.1% 36.9% 34.9% 26.3% 31.5% 27.8%
2001–2005 22.1% 24.5% 22.8% 17.7% 20.1% 18.5% 13.2% 15.1% 13.8%
2006–2008 9.4% 21.2% 12.5% 4.7% 14.1% 7.2% 3.0% 11.8% 5.3%
Total 23.8% 27.9% 24.9% 23.0% 24.2% 23.3% 18.0% 19.8% 18.5%
NON-NICOTINE THC CBD
Birth Year Heterosexual LGBTQ+ Total Heterosexual LGBTQ+ Total Heterosexual LGBTQ+ Total
1981–1985 17.6% (16.7%) 17.5% 18.5% (35.4%) 20.1% 16.0% (20.8%) 16.5%
1986–1990 29.3% 35.6% 30.3% 34.9% 39.0% 35.5% 30.5% 40.7% 32.1%
1991–1995 30.0% 23.4% 28.4% 35.2% 27.3% 33.3% 28.3% 22.1% 26.9%
1996–2000 28.0% 26.5% 27.5% 33.3% 40.2% 35.3% 23.0% 27.1% 24.2%
2001–2005 10.5% 10.8% 10.6% 20.9% 28.3% 23.2% 13.0% 16.6% 14.2%
2006–2008 3.8% 14.1% 6.6% 3.8% 17.6% 7.5% 1.7% 14.1% 5.0%
Total 16.9% 16.1% 16.7% 24.1% 30.8% 25.9% 16.9% 20.0% 17.8%
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Note. Percentages in parentheses are based on cells with counts < 50. Missing values accounted for between 0.5% and 2.7% of all responses (mode = 1.4%).

3.2.1. Ever Use

LGBTQ+ participants reported higher overall rates of ever use for disposable (LGBTQ+ 27.9%; Heterosexual 23.8%), pod/cartridge-based (LGBTQ+ 42.8%; Heterosexual 37.1%), other e-cigarettes (LGBTQ+ 35.5%; Heterosexual 29.4%), THC (LGBTQ+ 46.2%; Heterosexual 37.8%), and CBD e-cigarettes (LGBTQ+ 38.0%; Heterosexual 30.2%), relative to their heterosexual counterparts.

3.2.2. Past 30-Day Use

LGBTQ+ participants reported higher overall rates of past 30-day use for disposable (LGBTQ+ 27.9%; Heterosexual 23.8%), THC (LGBTQ+ 30.8%; Heterosexual 24.1%), and CBD e-cigarettes (LGBTQ+ 20.0%; Heterosexual 16.9%) relative to their heterosexual counterparts. For LGBTQ+ participants born in 2001–2008 (i.e., 13–20-year-olds), rates of past-30-day-use were higher than heterosexual counterparts for all e-cigarette device types with the exception of non-nicotine e-cigarettes. For LGBTQ+ participants, rates of past 30-day use for pod/cartridge-based, non-nicotine, and CBD e-cigarettes were highest among those born from 1986–1990, whereas rates for disposable e-cigarettes, other e-cigarettes, and THC e-cigarettes, rates were highest among those born from 1996–2000.

3.3. Race/Ethnicity

3.3.1. Ever Use

In general, Hispanic/Latino participants reported higher rates of ever use for disposable (Hispanic 41.4%; Black 32.0%; White 39.0%), pod/cartridge-based (Hispanic 41.1%; Black 34.7%; White 39.9%) other e-cigarettes (Hispanic 34.3%; Black 26.2%; White 32.4%), non-nicotine (Hispanic 38.3%; Black 30.1%; White 20.9%), THC (Hispanic 45.4%; Black 40.1%; White 38.4%), and CBD e-cigarettes (Hispanic 38.5%; Black 33.5%; White 31.2%) relative to their Black and White, Non-Hispanic counterparts. For Hispanic/Latino participants, rates of ever e-cigarette use across device types were highest among those born between 1986–1995 (26–35-year-olds), with the exception of pod/cartridge-based e-cigarettes (1996–2000, 57.4%). For more information on ever e-cigarette use by device and race/ethnicity, see supplemental table S1.

3.3.2. Past-30-Day-Use

Past 30-day use of e-cigarette device types by race/ethnicity are shown in Table 4. In general, Hispanic/Latino participants reported higher rates of past 30-day use across device types relative to Black and White participants. For Hispanic/Latino participants, rates of past 30-day-use were highest for disposable e-cigarettes (30.4%) and THC e-cigarettes (30.0%), and lowest for CBD e-cigarettes (22.3%). Rates of past 30-day use were typically highest among Hispanic participants born between 1986–1995. For Black participants, rates of past 30-day use were highest for THC e-cigarettes (28.7%) and lowest for other e-cigarettes (18.9%). For White participants, rates of past 30-day use were highest for disposable (24.5%), THC (24.3%), and pod/cartridge-based e-cigarettes (23.4%), and lowest for non-nicotine e-cigarettes (12.2%).

Table 4.

Past 30-Day E-Cigarette Use by Race/Ethnicity (n = 5,143)

DISPOSABLE POD/CARTRIDGE
Birth Year Hispanic Black (NH) White (NH) Total Hispanic Black (NH) White (NH) Total
1981–1985 26.9% 6.9% 17.9% 17.5% 34.6% 15.5% 23.6% 23.9%
1986–1990 30.0% 18.6% 31.8% 29.4% 42.0% 32.2% 31.8% 33.3%
1991–1995 43.1% 24.2% 28.1% 30.3% 41.4% 27.4% 31.7% 32.8%
1996–2000 38.7% 29.4% 31.5% 33.0% 40.8% 30.8% 33.2% 34.7%
2001–2005 26.2% 21.4% 23.7% 23.9% 18.1% 18.3% 20.0% 19.3%
2006–2008 26.4% 17.9% 8.7% 13.4% 11.3% 14.3% 5.2% 7.5%
Total 30.4% 22.4% 24.5% 25.5% 26.4% 22.8% 23.4% 24.0%
OTHER E-CIGARETTE NON-NICOTINE
Birth Year Hispanic Black (NH) White (NH) Total Hispanic Black (NH) White (NH) Total
1981–1985 26.9% 10.3% 19.4% 19.1% 28.8% 15.5% 17.3% 18.4%
1986–1990 38.0% 18.6% 29.8% 29.1% 60.0% 20.3% 25.7% 29.7%
1991–1995 46.6% 19.4% 27.5% 29.6% 50.0% 24.2% 19.8% 26.8%
1996–2000 36.2% 24.8% 25.0% 28.0% 40.1% 32.7%
19.8%		 27.9%
2001–2005 14.9% 18.1% 12.9% 14.2% 15.8% 16.2% 7.2% 10.6%
2006–2008 13.2% 3.6% 2.9% 5.1% 15.1% 10.7% 1.2% 5.1%
Total 23.2% 18.9% 17.3% 18.9% 26.1% 21.0% 12.2% 16.7%
THC CBD
Birth Year Hispanic Black (NH) White (NH) Total Hispanic Black (NH) White (NH) Total
1981–1985 26.9% 20.7% 19.4% 20.5% 17.3% 12.1% 17.3% 16.6%
1986–1990 48.0% 28.8% 35.1% 35.9% 56.0% 22.0% 30.2% 32.5%
1991–1995 37.9% 35.5% 29.9% 32.8% 43.1% 21.0% 24.0% 27.2%
1996–2000 38.7% 36.4% 33.2% 35.3% 29.8% 23.8% 21.6% 24.3%
2001–2005 25.6% 26.2% 22.3% 23.7% 15.8% 19.0% 13.3% 14.8%
2006–2008 15.1% 7.1% 4.0% 6.7% 11.3% 0.0% 3.5% 4.7%
Total 30.0% 28.7% 24.3% 26.3% 22.3% 19.5% 16.5% 18.3%
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Note. NH = Non-Hispanic. Missing values accounted for between 0.9% and < 4.3% of all responses (mode = 1.3%).

3.4. Financial Comfort

3.4.1. Ever Use

Ever use of non-nicotine was highest among participants who reported they lived comfortably (29.0%) relative to lower levels of financial comfort (do not meet 23.9%; just meet 24.1%; little left over 26.3%). Among those who reported they lived comfortably, ever non-nicotine e-cigarette use was highest among participants born between 1986–2000 (21–35-year-olds). Ever use of THC e-cigarettes was highest among those who reported their financial comfort as not meeting needs (48.4%) relative to higher levels of financial comfort (just meet 44.9%; little left over 41.2%; live comfortably 36.8%). Ever use of disposable (35.3%), pod/cartridge-based (37.7%), other e-cigarettes (29.4%), and CBD e-cigarettes (30.5%) were all lowest among participants who reported they lived comfortably. For more information on ever use of e-cigarette devices by financial comfort, see supplemental table S2.

3.4.2. Past-30-Day-Use

Past-30-day-use of e-cigarette device types by financial comfort are shown in Table 5. Past-30-day-use of non-nicotine e-cigarettes was highest among participants who reported they lived comfortably (19.6%) relative to lower levels of financial comfort (do not meet 11.1%; just meet 14.8%; little left over 16.8%). Among those who reported they lived comfortably, past 30-day non-nicotine e-cigarette use was highest among participants born between 1986–2000 (21–35-year-olds). Conversely, past 30-day THC e-cigarette use was highest among those indicating that their financial situation did not meet basic expenses (30.6%) relative to higher levels of financial comfort (just meet 28.3%; little left over 26.1%, live comfortably 25.6%).

Table 5.

Past 30-Day E-Cigarette Use by Financial Comfort (n = 5,664)

DISPOSABLE POD/CARTRIDGE
Birth Year Do not meet Just meet Little left Over Live Comfortably Total Do not meet Just meet Little left Over Live Comfortably Total
1981–1985 13.7% 17.3% 19.9% 17.1% 17.7% 19.6% 20.1% 19.9% 33.3% 23.5%
1986–1990 (23.1%) 36.7% 19.1% 36.7% 31.0% (20.5%) 37.8% 26.6% 40.0% 34.1%
1991–1995 (25.9%) 29.0% 24.5% 36.8% 30.4% (7.4%) 26.1% 30.6% 40.8% 31.7%
1996–2000 30.0% 30.4% 36.7% 34.9% 34.2% 26.7% 30.0% 36.1% 39.1% 35.7%
2001–2005 25.0% 28.1% 24.3% 20.8% 23.3% 16.4% 22.8% 18.6% 18.2% 19.1%
2006–2008 (22.2%) (11.1%) 15.1% 8.7% 11.0% (22.2%) (8.9%) 6.8% 5.5% 6.8%
Total 23.9% 27.4% 25.6% 24.4% 25.3% 18.8% 25.0% 22.9% 24.7% 23.9%
OTHER E-CIGARETTE NON-NICOTINE
Birth Year Do not meet Just meet Little left Over Live Comfortably Total Do not meet Just meet Little left Over Live Comfortably Total
1981–1985 13.7% 14.4% 19.9% 25.6% 19.2% 7.8% 12.2% 15.7% 31.0% 17.9%
1986–1990 (17.9%) 34.7% 19.1% 34.7% 29.1% (17.9%) 25.5% 21.3% 44.0% 31.0%
1991–1995 (18.5%) 18.8% 26.5% 38.4% 28.8% (11.1%) 20.3% 27.6% 38.4% 28.8%
1996–2000 30.0% 25.3% 25.5% 32.1% 28.7% 13.3% 17.7% 30.6% 34.2% 28.7%
2001–2005 18.8% 17.1% 13.8% 13.0% 14.2% 9.4% 11.6% 11.2% 11.3% 11.2%
2006–2008 (11.1%) (8.9%) 5.5% 2.7% 4.5% (11.1%) (13.3%) 6.8% 3.8% 6.1%
Total 19.7% 19.8% 17.4% 19.3% 18.9% 11.1% 14.8% 16.8% 19.6% 17.4%
THC CBD
Birth Year Do not meet Just meet Little left Over Live Comfortably Total Do not meet Just meet Little left Over Live Comfortably Total
1981–1985 11.8% 22.3% 19.3% 24.0% 20.6% 3.9% 16.5% 16.3% 22.5% 16.7%
1986–1990 (38.5%) 35.7% 30.9% 40.0% 36.5% (28.2%) 29.6% 27.7% 38.7% 32.5%
1991–1995 (25.9%) 27.5% 29.6% 40.8% 33.2% (22.2%) 20.3% 26.5% 32.8% 27.3%
1996–2000 35.0% 30.4% 36.7% 38.3% 36.0% 25.0% 21.9% 23.3% 27.3% 25.0%
2001–2005 35.2% 29.1% 24.1% 21.0% 23.9% 16.4% 18.6% 14.5% 13.5% 14.8%
2006–2008 (22.2%) (11.1%) 6.8% 5.5% 7.1% (22.2%) (8.9%) 5.5% 2.2% 4.5%
Total 30.6% 28.3% 26.1% 25.6% 26.6% 18.2% 19.7% 17.5% 18.4% 18.4%
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Note. Percentages in parentheses are based on cells with counts < 50. Missing values accounted for between 1.0% and 4.1% of all responses (mode = 1.3%).

4. Discussion

This study highlights sociodemographic patterns in use of specific types of e-cigarettes by examining ever and past-30-day-use of nicotine, non-nicotine, and cannabis e-cigarette device types by sex, sexual orientation, race/ethnicity, financial comfort, and birth year. Findings generally showed higher rates of ever and past 30-day e-cigarette use among Hispanic and LGBTQ+ participants, as well as some differences by sex and financial comfort. However, more nuanced patterns emerged when examining sociodemographic differences in e-cigarette use by e-cigarette device type and participant birth year.

Extant research typically indicates that males use e-cigarettes at higher rates than females (e.g., Kong et al., 2017; Villarroel et al., 2020). However, examining sex differences in past 30-day e-cigarette use by birth year revealed a nuanced pattern. Males born before 2000 tended to use all e-cigarette devices at higher rates than their female counterparts. However, younger females born between 2001–2008 (i.e., 13–20-year-olds at the time of data collection) reported use of disposable and pod/cartridge e-cigarette device types at higher rates than their male counterparts. This finding is aligned with 2022 national data showing that adolescent males were no longer using e-cigarettes at higher rates than females (Park-Lee et al., 2022), and may be explained by several reasons. Research suggests that women may prefer smaller, sleeker e-cigarettes relative to the larger, tank-style devices that were more common in earlier generations (Yimsaard et al., 2021). The current availability of slim, concealable devices with styles intended to appeal specifically to young females (Kong et al., 2017), may have made e-cigarettes more appealing to this demographic. Additionally, some research suggests that females are more susceptible to targeted tobacco advertising and social influences relative to males (Kong et al., 2017; Piñeiro et al., 2016). The ubiquitous presence of youth-appealing e-cigarette marketing and promotions on social media (Huang et al., 2019; Padon et al., 2017; Zheng et al., 2021) combined with high levels of social media engagement by adolescents (Rideout et al., 2018) may heighten young females’ susceptibility for e-cigarette initiation and use. Future research should continue to examine sex differences in e-cigarette use and related risk factors (e.g., reasons for use, perceptions of health harms, susceptibility), particularly in the context of innovations in e-cigarette designs and marketing.

Similar to prior studies (Azagba & Shan, 2021; Gaiha et al., 2021b; Garcia et al., 2021), our findings generally indicate higher rates of ever- and past-30-day e-cigarette use among LGBTQ+ participants relative to their heterosexual peers. However, disparities in use varied by e-cigarette device type and birth year. Past-30-day-use of disposable, THC, and CBD e-cigarettes was higher among LGBTQ+ participants, whereas differences in past-30-day-use of pod/cartridge-based, other, and non-nicotine e-cigarettes were less pronounced. These findings partially contrast with a recent study highlighting higher rates of pod/cartridge but not disposable e-cigarette use among LGBTQ+ participants (Gaiha, Rao, et al., 2022). This difference may be explained by the rising popularity of disposable e-cigarettes following FDA targeted enforcement against flavored pod/cartridge devices (McCauley et al., 2022). Examining patterns of use by birth year highlighted additional patterns. First, approximately 40% of LGBTQ+ participants born between 1996–2000 (i.e., ages 21–25) reported past-30-day-use of disposable e-cigarettes and e-cigarettes with THC, underscoring young adulthood as a time of particularly heightened risk for use of these device types. Second, LGBTQ+ youth born between 2001–2008 reported markedly higher rates of all e-cigarette use relative to their similarly aged heterosexual peers, with the exception of non-nicotine e-cigarettes. Given the risks of early use for both nicotine and cannabis (Lanza & Vasilenko, 2015; Richmond-Rakerd et al., 2017), tailored prevention efforts are needed to reach LGBTQ+ youth at early ages to curtail growing disparities in use across the lifetime.

Examination of racial and ethnic differences in e-cigarette use suggest that Hispanic or Latino participants, relative to their Black and White Non-Hispanic counterparts, were at greatest risk for past 30-day e-cigarette use across birth years and device types. This finding aligns with some past work illustrating elevated use of nicotine e-cigarettes (Lanza et al., 2017) and non-nicotine e-cigarettes (Gaiha, Lin, et al., 2022) among Hispanic/Latino participants, but conflicts with other findings which indicate White youth use e-cigarettes at higher rates (Gentzke et al., 2022). However, this study is among the first to our knowledge that suggests elevated rates of e-cigarette use among the Hispanic/Latino population from adolescence through adulthood, with particularly elevated rates of use among those born between 1986 and 2000. These findings suggests the need to examine risk factors (e.g., perceptions of risk, targeted marketing, susceptibility to use) that are specific to Hispanic/Latino individuals at different developmental stages to inform interventions that are both developmentally and culturally tailored.

Finally, ever- and past-30-day-use of e-cigarettes with THC were relatively higher than e-cigarettes with CBD across sociodemographic factors, suggesting that future e-cigarette research should continue to distinguish measurement of these cannabis products. Furthermore, use of e-cigarettes with THC tended to be higher among LGBTQ+, Hispanic, Black, and low income participants. These results stress the need for further research on malleable risk factors specific to these populations in order to inform tailored prevention and health care efforts that can mitigate potential health disparities resulting from cannabis use, particularly as the potency of THC continues to increase over time (Freeman et al., 2021).

4.1. Limitations and Future Directions

This study included several limitations which may inform future research on sociodemographic differences in e-cigarette device type use. First, our convenience sample did not include a sufficient number of Asian, Hawaiian/Pacific Islander, and American Indian/Alaskan Native participants to examine rates of e-cigarette use by birth year among these racial groups. More research with these populations is needed to comprehensively inform policy and prevention efforts aimed at mitigating racial disparities in e-cigarette use.

Second, we relied upon a dichotomized measure of sexual orientation in which participants identified themselves as either heterosexual or LGBTQ+. Prior research indicates that tobacco use is particularly high among certain sexual minority subpopulations, such as bisexual adolescents assigned female at birth (Azagba et al., 2019). Collecting more specific data on sexual identity (e.g., bisexual, lesbian, asexual) and transgender identity would help identify variation in use of difference e-cigarette device types within the general LGBTQ+ population, which in turn could inform more tailored prevention efforts for individuals within the broader LGBTQ+ community.

Third, as a descriptive study we provide point estimates for rates of e-cigarette use but do not include statistical tests for hypothesis testing. The exclusion of tests of statistical significance was due to the high number of tests which would have been required and the elevated risk of false discoveries (Bender & Lange, 2001), as well as the potential for misinterpretation of values provided by such statistical tests (Greenland et al., 2016). Consequently, our results are suggestive of general patterns which may guide the focus of future empirical evaluation, but do not provide conclusive statements about statistical significance. If researchers wish to apply statistical tests in future investigation of this topic, we advise using chi-square tests for any pairwise hypothesis testing related to differences in e-cigarette use by dichotomous sociodemographic categories (e.g., sex).

4.2. Conclusions

The current study drew upon a large cross-sectional dataset of 13–40-year-olds to describe sociodemographic patterns in use of nicotine, non-nicotine, and cannabis e-cigarettes. Findings suggest discrepancies in use exist by device type, sex, sexual orientation, race/ethnicity, financial comfort, and birth year, and provide a compelling foundation for further explication of these patterns. Research in this domain is vital for guiding targeted policy and prevention efforts aimed at addressing risk factors that perpetuate disparities in e-cigarette use, particularly among youth. It is also important to consider developing tailored interventions for specific demographic populations. Furthermore, given the rapid evolution of e-cigarette devices since 2007, continued monitoring of industry innovations and marketing is necessary to detect novel e-cigarette devices and identify specific populations at greatest risk for initiation and use.

Supplementary Material

1

Highlights.

  • Young females’ past-30-day-use of disposable e-cigarettes was higher than males.

  • LGBTQ participants reported higher rates of disposable, THC, and CBD e-cigarettes.

  • Past-30-day-use of all e-cigarette devices was highest among Hispanic participants.

Acknowledgments:

We would like to thank Agamroop Kaur for her assistance piloting the survey with adolescents and adults, and for organizing all feedback. We would also like to thank David Cash, BA, Research Director, and Juanita Greene, BA, Research Coordinator, in the Reach Lab for their support with the online survey used in this study. They were not compensated for their time.

Funding sources:

The research reported in this publication was supported by the Taube Research Faculty Scholar Endowment to Bonnie Halpern-Felsher and through additional support from grant U54 HL147127 from the National Heart, Lung, and Blood Institute (NHLBI) and the Food and Drug Administration Center for Tobacco Products (Bonnie Halpern-Felsher, Co-PI). Research reported in this publication was also supported by the National Cancer Institute of the National Institutes of Health under Award Number K99CA267477 and the Stanford Maternal and Child Health Research Institute to Shivani Mathur Gaiha. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Conflict of Interest:

Dr. Halpern-Felsher is the Founder and Executive Director of the Stanford Tobacco Prevention Toolkit. She is also a paid expert scientist in some litigation against the e-cigarette industry and an unpaid scientific advisor and expert regarding some tobacco-related policies. The authors have no other conflicts of interest to disclose.

1

Raw values used for this calculation are also presented in Gaiha, Lin, Lempert, & Halpern-Felsher (2022)

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