The Association Between Household Income and Electronic Cigarette Use in Adolescents and Adults

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Background:  Use of e-cigarettes (e-cigs) have caused detrimental health issues as well as nicotine addiction in teens and adults. E-cigs are an attractive alternative to cigarettes for numerous reasons including their concealability, variety of flavors, and relative ease of accessibility. Due to the increased prevalence of e-cig use over the past few years, more information is needed to better direct cessation interventions.

Objective: The purpose of this study is to evaluate the association between household income and e-cig use in a cohort of adolescents and adults.

Design/Methods: This is a retrospective cross-sectional cohort study using the National Health and Nutrition Examination Survey (NHANES) data from 2013-18 (most recent surveys). Inclusion criteria were subjects 13 years and older who answered the e-cig questions (younger subjects were not asked e-cig questions); while subjects who did not answer the e-cig items were excluded. Data abstracted included demographic characteristics, median household income, and reported use of e-cigs at least once in the past five days and number of days of e-cig use in the past five days. Household income was categorized as low (≤$64,999) and high (≥$65,000) based on the US Census Bureau average median income from 2013-18. Prevalence of e-cig use was assessed using a range of values 1-5 for the number of days subjects smoked an e-cig in the last five days. Data was analyzed using a weighted chi-squared test with a p-value < 0.05 considered significant.

Results: 311 participants met inclusion criteria (Table 1). In both age groups there were more male than female participants. The adolescent mean age was 17.8 years with an equal distribution of white and nonwhite participants. In adults there was a slightly higher proportion of men (60%) with 57.4% being Caucasian. There were higher reported days of e-cig use in the past five days in adults (3.5 days) compared to adolescents (2.7 days), p=0.003. There were significant differences in overall e-cig use by median income with over half of all reported users in the lower income group irrespective of age (p=0.008). Adolescents reported significantly more recent use in the low-income group (57.8%) compared to high-income group (42.2%). Adults had similar higher reported use in the low-income group.

Conclusion: E-cigarette use is reported significantly more often in the previous five days by adolescents in low-income groups. This suggests that interventions targeted to lower income communities are an important step in decreasing e-cig usage and preventing the sequalae associated with their use.

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Connecticut Childrens Medical Center / UConn School of Medicine
University of Connecticut
University of Connecticut
Connecticut Children's

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