Abstract
This survey study uses data from the 2018 Behavioral Risk Factor Surveillance System survey to evaluate e-cigarette use in young adults who have a history of cancer relative to young adults without cancer.
The use of e-cigarettes, known as vaping, has been increasing dramatically among young adults (YAs) relative to other age groups1 and has recently received increased attention because of a rise in vaping-related mortality that is not yet fully understood.2 Young adults with a history of cancer have previously been shown to engage in high-risk health behaviors (eg, smoking) more often than their healthy peers despite greater health risks and their susceptibility to late effects of treatment (eg, subsequent malignant tumors) after cancer.3,4 However, prior research has not evaluated e-cigarette use among YA cancer survivors relative to their peers without cancer.
Methods
We used data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey.5 The BRFSS survey is a telephone survey conducted annually in all 50 US states, the District of Columbia, and US territories and includes inquiries about health behaviors, long-term disease, and related health topics. A total of 54 931 individuals aged 18 to 39 years participated in the 2018 survey and had nonmissing data on cancer history and e-cigarette use, with 1444 (2.1%) reporting a history of cancer.
Our main outcomes were any (even once) and current (every or some days) use of e-cigarettes, evaluated by asking, “Have you ever used an e-cigarette or other electronic vaping product, even just one time, in your entire life?” and, “Do you now use e-cigarettes or other electronic vaping products every day, some days, or not at all?” The main exposure was a previous diagnosis of any cancer. We used SAS version 9.4 (SAS Institute) for descriptive statistics and logistic regression, using the BRFSS survey weights and adjusting for age, sex, self-reported race/ethnicity, education, income, employment status, partner status, and urbanicity to compare e-cigarette use by cancer history. The University of Minnesota institutional review board deemed the study exempt from review and participant informed consent requirements because deidentified data were used.
Results
Overall, YAs with a cancer history were more likely to report having ever used e-cigarettes than their peers without a cancer history (total with cancer history, 1444, any use, 658 [46.7%] vs total with no cancer history, 53 487, any use, 20 517 [39.1%], P < .001, Figure; adjusted odds ratio, 1.54; 95% CI, 1.24-1.92, P < .001, Table). Similarly, YAs with a cancer history were nonsignificantly more likely to remain current e-cigarette users (total with cancer history, 658, current use, 173 [31.3%] vs total with no cancer history, 20 470, current use, 5187 [26.9%], P = .19, adjusted odds ratio, 1.43; 95% CI, 1.00-2.04, P = .05). Across nearly all demographic subgroups, those with a cancer history reported higher rates of any use of e-cigarettes compared with those without a cancer history (Figure). In adjusted logistic regression analyses among all individuals, YAs who were non-Hispanic white, younger, male, and living in urban areas were more likely to have ever used or currently use e-cigarettes (Table). Limiting analyses to only those with a cancer history, YAs living in urban areas were more likely to have ever used e-cigarettes and those who were younger and male were more likely to continue e-cigarette use (Table).
Figure. Any Use and Current Use of e-Cigarettes Among Young Adults, 2018.
aAny use of e-cigarettes was based on the Behavioral Risk Factor Surveillance System question, “Have you ever used an e-cigarette or other electronic vaping product, even just one time, in your entire life?” Responses of yes were coded as indicative of e-cigarette use, while all other responses (no, don’t know/not sure, refused, or not asked/missing) were coded as no.
bCurrent use of e-cigarettes was based on the Behavioral Risk Factor Surveillance System question, “Do you now use e-cigarettes, every day, some days, or not at all?” Responses of every day or some days were coded as current use, while responses of not at all, don’t know/not sure, refused, or not asked/missing were coded as no current use.
cP < .05 (χ2 test).
Table. Odds Ratios of Any Use and Current Use of e-Cigarettes Among Young Adults, 2018.
| Characteristic | No. (weighted %) | Odds ratio (95% CI)a | |||
|---|---|---|---|---|---|
| No cancer history | Cancer history | All participants | No cancer history | Cancer history | |
| Any use of e-cigarettesb | |||||
| Total No. | 53 487 | 1444 | NA | NA | NA |
| Cancer status | |||||
| Cancer history | NA | 1444 | 1.54 (1.24-1.92) | NA | NA |
| No cancer history | 53 487 | NA | 1 [Reference] | NA | NA |
| Age, y | |||||
| 18-24 | 14 167 (33.4) | 165 (16.7) | 1.82 (1.62-2.04) | 1.83 (1.62-2.05) | 1.97 (0.98-3.97) |
| 25-29 | 11 762 (20.6) | 247 (17.2) | 1.67 (1.51-1.85) | 1.67 (1.51-1.86) | 1.74 (1.06-2.87) |
| 30-34 | 13 110 (24.5) | 420 (31.5) | 1.25 (1.13-1.38) | 1.25 (1.12-1.38) | 1.36 (0.88-2.10) |
| 35-39 | 14 448 (21.5) | 612 (34.6) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Sex | |||||
| Male | 26 853 (49.5) | 450 (33.0) | 1.57 (1.45-1.70) | 1.58 (1.46-1.71) | 1.44 (0.98-2.11) |
| Female | 26 524 (50.5) | 988 (67.0) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Race/ethnicity | |||||
| Non-Hispanic white | 34 354 (57.0) | 1077 (71.9) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Non-Hispanic black | 5220 (15.2) | 75 (10.0) | 0.49 (0.44-0.55) | 0.49 (0.43-0.55) | 0.68 (0.36-1.30) |
| Other | 5998 (8.4) | 131 (6.1) | 0.53 (0.46-0.60) | 0.52 (0.46-0.60) | 0.98 (0.47-2.01) |
| Hispanic | 7200 (19.4) | 134 (12.0) | 0.70 (0.61-0.81) | 0.69 (0.60-0.80) | 1.50 (0.53-4.24) |
| Urbanicity | |||||
| Urbanc | 46 341 (93.2) | 1231 (91.2) | 1.18 (1.03-1.35) | 1.16 (1.01-1.33) | 1.87 (1.09-3.21) |
| Rural | 6694 (6.8) | 208 (8.8) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Current use of e-cigarettesd | |||||
| Total No. | 20 470 | 658 | NA | NA | NA |
| Cancer status | |||||
| Cancer history | NA | 658 | 1.43 (1.00-2.04) | NA | NA |
| No cancer history | 20 470 | NA | 1 [Reference] | NA | NA |
| Age, y | |||||
| 18-24 | 6733 (39.6) | 92 (18.9) | 1.47 (1.21-1.78) | 1.38 (1.13-1.67) | 11.61 (5.60-24.08) |
| 25-29 | 4998 (22.3) | 127 (18.2) | 0.98 (0.81-1.20) | 0.94 (0.76-1.14) | 3.39 (1.72-6.69) |
| 30-34 | 4523 (21.7) | 193 (31.9) | 0.99 (0.82-1.20) | 0.94 (0.78-1.14) | 3.24 (1.68-6.24) |
| 35-39 | 4216 (16.4) | 246 (31.0) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Sex | |||||
| Male | 12 068 (58.6) | 221 (35.1) | 1.41 (1.23-1.62) | 1.39 (1.21-1.60) | 1.88 (1.20-2.97) |
| Female | 8366 (41.4) | 435 (64.9) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Race/ethnicity | |||||
| Non-Hispanic white | 14 013 (65.0) | 488 (70.6) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Non-Hispanic black | 1528 (11.9) | 29 (9.2) | 0.70 (0.55-0.88) | 0.67 (0.53-0.84) | 1.51 (0.82-2.77) |
| Other | 2416 (7.4) | 74 (8.2) | 0.91 (0.72-1.15) | 0.90 (0.71-1.15) | 1.40 (0.69-2.80) |
| Hispanic | 2245 (15.7) | 55 (12.0) | 1.12 (0.91-1.38) | 1.09 (0.88-1.35) | 1.77 (0.62-5.01) |
| Urbanicity | |||||
| Urbanc | 17 794 (92.9) | 566 (93.7) | 1.08 (0.84-1.40) | 1.10 (0.84-1.43) | 0.55 (0.25-1.19) |
| Rural | 2495 (7.0) | 90 (6.3) | 1 [Reference] | 1 [Reference] | 1 [Reference] |
Abbreviation: NA, not applicable.
Results from multivariable logistic regression models. In addition to the covariates in the table, all models adjusted for income (<$15K vs $15K-<$25K vs $25K-<$35K vs $35K-<$50K vs $50k-<$75K vs≥$75K), education (no high school degree vs high school degree vs some college vs at least a college degree), partner status (married/member of unmarried couple vs divorced/widowed/separated/never married), and employment status (employed or self-employed vs out of work or unable to work vs homemaker vs student vs retired).
Based on the Behavioral Risk Factor Surveillance System question, “Have you ever used an e-cigarette or other electronic vaping product, even just one time, in your entire life?” Responses of yes were coded as indicative of e-cigarette use; no was coded as never use; and don’t know/not sure, refused, or not asked/missing were set to missing.
Based on the Behavioral Risk Factor Surveillance System Urban/Rural Status variable, which is based on the 2013 National Center for Health Statistics urban-rural classification scheme for counties.
Based on the Behavioral Risk Factor Surveillance System question, “Do you now use e-cigarettes, every day, some days, or not at all?” Responses of every day or some days were coded as current use; not at all was coded as no current use; and don’t know/not sure, refused, or not asked/missing were set to missing.
Discussion
Almost half of YA cancer survivors indicated they had ever used e-cigarettes and, among these, more than one-quarter indicated they were currently using e-cigarettes. Further, we identified higher rates of use among YAs with a history of cancer relative to their peers without cancer. Similar to previously reported US trends in e-cigarette use, we found that any use and current use of e-cigarettes were highest among men,1 non-Hispanic white participants,1 and younger adults with a history of cancer.1,6 Limitations include use of only self-reported data, the small overall proportion of YA cancer survivors, and possible response/recall bias that may underestimate e-cigarette use.
In summary, we found disproportionally higher rates of vaping among YA cancer survivors across nearly all demographic subgroups. These results suggest that current efforts to reduce vaping may benefit from targeted interventions among YA cancer survivors.
References
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