Have e-cigarettes created a new crop of young adult substance users? Overlap between e-cigarette, traditional cigarette, and alcohol use

Background: Electronic cigarette use has increased among U.S. young adults since the early 2000s, but it is unclear whether use overlaps with traditional substance use or has produced a new at-risk population. Our goal was to compare trends in use of different legal substances and examine the association between e-cigarette use, demographic factors, and the use of other substances. Methods: Data from the nationally-representative 2016–2019 U.S. Behavioral Risk Factor Surveillance System (BRFSS) from adults aged 18–24 were used (N = 64,604). Results: Over the study period, e-cigarette use increased significantly, but traditional cigarette smoking and alcohol consumption decreased. Those who had ever used e-cigarettes were significantly more likely to be single, White or Native American, and report high school being their highest level of education. The majority of current daily e-cigarette users reported never having smoked traditional cigarettes (62.3%), not being a current traditional cigarette smoker (75.9%), and not being a binge drinker (59.3%). Conclusions: As young adult e-cigarette use has increased, users are largely individuals who are not otherwise engaging in legal substance use. Future studies should examine factors leading to uptake of e-cigarette use among young adults in order to address this growing public health concern.