Have e-cigarettes created a new crop of young adult substance users? Overlap between e-cigarette, traditional cigarette, and alcohol use

Background Electronic cigarette use has increased among U.S. young adults since the early 2000s, but it is unclear whether use overlaps with traditional substance use or has produced a new at-risk population. Our goal was to compare trends in use of different legal substances and examine the association between e-cigarette use, demographic factors, and the use of other substances. Methods Data from the nationally-representative 2016-2019 U.S. Behavioral Risk Factor Surveillance System (BRFSS) from adults aged 18-24 were used (N = 64,604). Results Over the study period, e-cigarette use increased significantly, but traditional cigarette smoking and alcohol consumption decreased. Those who had ever used e-cigarettes were significantly more likely to be single, White or Native American, and report high school being their highest level of education. The majority of current daily e-cigarette users reported never having smoked traditional cigarettes (62.3%), not being a current traditional cigarette smoker (75.9%), and not being a binge drinker (59.3%). Conclusions As young adult e-cigarette use has increased, users are largely individuals who are not otherwise engaging in legal substance use. Future studies should examine factors leading to uptake of e-cigarette use among young adults in order to address this growing public health concern.