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.
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.
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).
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.
Corresponding Author: Helen M. Parsons, PhD, MPH, Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, MC 729, Minneapolis, MN 55455 (pars0100@umn.edu).
Published Online: April 9, 2020. doi:10.1001/jamaoncol.2020.0384
Author Contributions: Drs Parsons and Jewett had full access to all the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Parsons, Blaes.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Parsons, Jewett, Blaes.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Jewett.
Obtained funding: Blaes.
Administrative, technical, or material support: Sadak, Blaes.
Supervision: Parsons, Blaes.
Conflict of Interest Disclosures: Dr Vogel reported grants from National Institutes of Health during the conduct of the study. No other disclosures were reported..
Funding/Support: This work was supported in part by grant P30 CA77598 from the National Institutes of Health Masonic Cancer Center.
Role of the Funder/Sponsor: The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.