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.