Rates of electronic nicotine delivery systems use in middle school-aged adolescents and implications for continued health advocacy

Introduction/Objectives: Given the known rates of high school age electronic nicotine delivery systems (ENDS) usage, and the lack of reports for middle school (MS) aged ENDS usage, our primary objective is to assess ENDS usage by MS students using the Youth Risk Behavior Surveillance System (YRBSS) and assess trends among this group from 2015 through 2021. Our secondary objective is to identify disparities in ENDS usage by sex, educational grade level, and ethnoracial groups.

Methods: Our study pooled data from the 2015-2021 combined MS YRBSS and we were able to report the sample size of MS students who had ever used ENDS. Additionally, we estimated the weighted prevalence using 95% confidence intervals of ENDS use by YRBSS cycles occurring biennially from 2015- 2021. We approximated the frequency of ENDS use in the past 30 days before administration of the survey and reported sample size along with weighted prevalence of these variables. Further, weighted prevalence was calculated by sex, educational grade level, and ethnoracial groupings.

Results: Results indicated that between 2015-2021, 17.90% of MS students reported ever using an ENDS. Of those MS students who reported ever using an ENDS, 8.53% reported use in the past 30 days. The highest rates of electronic vapor product use occurred among Native Hawaiian/Other Pacific Islanders (20.12%) followed by American Indian/Alaska Natives (13.64%). Trends of ENDS use among MS students decreased in 2021 (15.1%) compared to the highest usage rate in 2019 (21.5%) with no significant difference between male and female total usage rates.

Conclusions: Research has shown that adolescents are more likely to initiate smoking combustible cigarettes when exposed to marketing. Regulating ENDS marketing could limit adolescent exposure; however, given that nearly 1 in 6 children reported using ENDS at some point, there is a need for comprehensive public health campaigns to vaping with cultural awareness and evidence based programs. Per the ENDS committee’s findings, ENDS not only pose the risk of lifelong nicotine dependence but are associated with adverse health outcomes such as pro-atherosclerotic effects, compromised lung defense mechanisms, and fatal poisoning associated with misuse of e-liquids, therefore prevention efforts are warranted at early ages. Further research is needed to explore possible causes for ethnoracial disparities in ENDS usage including targeting marketing, and to provide more culturally informed resources to these people groups.