The use of e-cigarettes and vaping continues to
be a novel phenomena affecting our business. Vaping is the use of an inhalant
apparatus to deliver nicotine without combustion of tobacco products, also
known as electronic nicotine delivery systems, or ENDS.
Gen Re collaborated with Johns Hopkins
University experts in the School of Public Health to research this topic. I
will share what we learned in a series of three blogs. This first blog will
focus on the e-cigarette user population, characterizing who vapes and how they
use the products. As the news has widely reported, the use of ENDS has risen
dramatically in recent years and prevalence varies widely by age, sex and
geography around the world. A rough estimate of the overall prevalence in the
U.S. is 4% of the population.
The most detailed assessments of vaping habits
are two longitudinal studies of the U.S. population - the Population Assessment
of Tobacco and Health Study (PATH), which covers the period 2010-2017, and
the National Health Interview Survey (NHIS), which has monitored most
aspects of the health of the nation since 1957. In addition, there are online
and traditional surveys of the U.S. population, summaries of which are
shown in the first three figures below. Many of the surveys reported serial
results, shown as symbols of the same shape and color. In 2011 about 1% of
people in the U.S. smoked e-cigarettes; the numbers increased to between 3% and
6% and stabilized after 2015.
Vaping is far more prevalent among smokers of
combustible tobacco as shown in the next figure. Prevalence leveled off at
approximately 15% to 25%.
“Never smokers,” unfortunately, have also
adopted the vaping habit. Their usage is much lower, around 1%-2% as the next
figure shows.
Vaping habits vary by age. In the total U.S.
population, according to the National Health Interview Survey (NHIS), the
highest use is in ages 18-24 where it has risen to almost 8%. On the other
hand, older people have shown stable or decreasing use since 2014.
Subsequent blogs will review the health
consequences of ENDS on an individual level, we know the aggregate impact of
e-cigarettes depends upon the balance of current, former, and never use of
combustible tobacco. The PATH found that among current adult users of
e-cigarettes, 69.7% were also current smokers; 8.6% quit smoking combustible
tobacco cigarettes within the past year; 5.7% were former smokers (abstained
from smoking for more than one year), and 16% reported having never smoked
combustible tobacco cigarettes.1
Much regulatory attention has focused on youths
under age 18. The federal government and many states have banned flavored
vaping solutions that particularly appeal to adolescents.
The CDC’s Office on Smoking and Health, in
collaboration with the FDA’s Center for Tobacco Products, analyzed data from
the 2019 National Youth Tobacco Survey (NYTS) to assess tobacco product
use patterns and associated factors among U.S. middle and high
school students.2
Their analysis shows that among users of all
tobacco or nicotine products, e-cigarettes claim the highest share by far in
both high school and middle school. The prevalence of e-cigarette use within
the past 30 days was 27.5% in high school and 10.5% in middle school.
Other surveys have discovered somewhat lower
prevalence, with increases since 2017 and projections for much higher use in
the next 10 years.
The most recent U.S. data was in a report
from the National Center for Health Statistics (April 2020) reporting results
from 2018. At that time, 14.9% of adults had ever vaped. The chart indicates
patterns of use by gender and age.
Worldwide, frequency of vaping falls below the
U.S. rates. Euromonitor International reported 1.2% of adults globally.
Across WHO regions, vaping is lowest in Southeast Asia at 0.2% and highest in
western Pacific at 2.4%. However, the extent of reporting
varies considerably.3
The main conclusion is that e-cigarette use is
common and increasing. A key dynamic is the route to acquire this habit. Will
uptake by never smokers outweigh any harm reduction from cessation of
combustible tobacco consumption?
In my next blog posts, I will review the health
impact of vaping alone and in conjunction with combustible tobacco, with a
focus on lung disease, cancer and disability. I’ll also discuss the way this
will affect Life and Disability insurance industries.
Endnotes
1. Osei AD, Mirbolouk M,
Orimoloye OA, et al. Association between e-cigarette use and
cardiovascular disease among never and current combustible-cigarette smokers
[published online ahead of print March 8, 2019]. Am J Med. https://doi.org/10.1016/j.amjmed.2019.02.016.
2. TW Wang et al., Tobacco Product Use
and Associated Factors Among Middle and High School Students - United States.
MMWR Surveill Summ. 2019 Nov 6;68(12):1-22.
doi: 10.15585/mmwr.ss6812a1.
3. Euromonitor International, 2018.
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