Prevalence and Sources of E-Cigarette Use: Findings From a Rapid-Response Survey in High-Tobacco-Burden U.S. States, 2023-2024.

Abstract

The overall effectiveness of E-cigarette regulations may be undermined by access to unregulated sources for obtaining E-cigarettes. Data on sources of E-cigarettes are limited, particularly in places with the highest tobacco burden in the U.S. Data were from a rapid-response survey of a probability sample of 9,100 adults (aged 18-65 years) in 13 high-tobacco-burden U.S. states collected in April-May 2023 and April-May 2024. Weighted bivariate analyses and multinomial logistic regression were used to examine E-cigarette prevalence and correlates of E-cigarette sources. In high-tobacco-burden states, 16.6% of adults reported current E-cigarette use, purchasing mostly from retail stores (75.9%), followed by receiving/purchasing from informal sources; for example, family, friends, free samples, others (16.6%); and purchasing online (7.5%). The likelihood of obtaining E-cigarettes from informal sources over store purchases was higher among adults aged 18-20 years (RRR=3.26, 95% CI=1.27, 8.35 versus among those aged 45-65 years), Hispanics (RRR=2.26, 95% CI=1.09, 4.69 versus non-Hispanic Whites), individuals who were not employed (RRR=1.79, 95% CI=1.01, 3.18 versus employed individuals), and individuals reporting nondaily use (RRR=2.78, 95% CI=1.66, 4.64 versus those reporting daily use). The likelihood of purchasing E-cigarettes online over store purchases was higher among college graduates (RRR=2.09, 95% CI=1.14, 3.82 than among those with less than a 4-year college degree) and individuals who use refillable (RRR=3.06, 95% CI=1.38, 6.76 than among those who use disposable E-cigarettes) or those who use mod E-cigarettes (RRR=3.55, 95% CI=1.54, 8.20 than those who use disposable E-cigarettes). Informal sources and online retailers remain largely unregulated, yet they account for a quarter of E-cigarette use and are disproportionately high among certain population subgroups. Enhanced E-cigarette market surveillance is critical for uncovering and closing regulatory loopholes in both high-tobacco-burden states and nationally.