Electronic Nicotine Delivery Systems (ENDS)

Background

ENDS are electronic nicotine delivery systems, also known as e-cigarettes or vapes. When people use ENDS, they are vaping. Studies show that many young adults who have never smoked start using nicotine products by using ENDS (Bandi et al., 2021). They are then more likely to begin smoking combustible cigarettes (Berry et al., 2019; Hair et al., 2021).

Although ENDS use is less common among adults than smoking cigarettes or chewing tobacco, their recent emergence on the market and surging use among youth and young adults make them a key tobacco prevention issue. In 2018, the U.S. Surgeon General officially called youth and young adult vaping an epidemic (USDHHS, 2018).

ENDS Use in Wyoming

A limitation of the ATS is difficulty getting young adults to respond. With a small subset of the respondents being young adults, it is necessary to report on the full adult population. That may hide some key findings that would be clearer in a survey of young adults.

Most Wyoming adults (68%) have never tried ENDS, and few are current ENDS users (8%, Figure 1). For this report, current ENDS users are the respondents who said they use ENDS every day or some days.

ENDS use was about as common in 2021 as it was in 2015 (Figure 2), the first time this question was asked on the ATS. The two-percentage-point increase from 2019 to 2021 was not significant.

Flavored ENDS Use

In 2020, the FDA partially banned ENDS flavors except menthol and tobacco. However, the ban has large loopholes. It only applies to the cartridge-style ENDS, like JUUL. These products have closed, pre-filled e-liquid cartridges that the user replaces when empty. The ban does not include ENDS with refillable e-liquid tanks or single-use or disposable products, like Puff Bar. According to the FDA, these exceptions avoided restricting all flavor options for adults who may be using ENDS to stop smoking (FDA, 2020). However, research shows that youth and young adults are using menthol instead of mint and are switching to the types of ENDS that can still have flavors (Truth Initiative, 2020).

In 2021, the use of flavored ENDS was common for Wyoming adults:

• 82% of current ENDS users had used products flavored to taste like mint, candy, fruit, chocolate, or other flavors besides tobacco in the past 30 days.
• 46% of adults who had tried ENDS in their lifetime did so for reasons related to flavor.

Wyoming adults’ use of flavored ENDS products has not significantly changed between 2017 and 2021. Because the use of flavored ENDS is common among Wyoming adult ENDS users, it will be important to monitor how the use of ENDS among Wyoming adults changes in response to the FDA ban.

Preferred ENDS Type

In 2021, the most popular type of ENDS was a customized commercial juice from a vape shop. Most adult ENDS users (74%) said they had used that type of ENDS in the past 30 days. The FDA’s 2020 flavor ban did not cover these types of ENDS.

JUUL was by far the most preferred cartridge-style ENDS brand; 27% of ENDS users reported using JUUL most often in the previous 30 days. The next most frequently used brand was Vuse at 19% of users.

Reasons for Trying ENDS

Curiosity was the most popular reason for trying ENDS (61%) among all adults who had ever tried ENDS. Reasons for trying ENDS show a different pattern for current users.

For current ENDS users, the top four reasons for trying ENDS were to reduce cigarette use (52%), for the flavoring (51%), ENDS taste better (50%), and to quit smoking cigarettes (49%; Figure 3). These results have not changed significantly since these questions were first asked in 2015.

However, comparisons of 2019 and 2021 data may indicate emerging trends. There was a significant decrease for current ENDS users trying ENDS to reduce cigarette use, from 76% to 52%. There was a significant decrease for current ENDS users trying ENDS to quit smoking cigarettes, from 72% to 49%.

Some research suggests that use of ENDS with nicotine is associated with quitting smoking. The CDC has said that smokers may see benefits from completely switching from smoking to ENDS (CDC, 2022a). However, there is not enough evidence to be sure (CDC, 2020). More research is needed to learn if ENDS are a broadly successful tobacco-related harm reduction tool. The FDA has not approved ENDS as a cessation aid (FDA, 2022).

Do People Think ENDS Use is Harmful?

The 2021 ATS included a series of questions regarding how harmful people think ENDS use is. Perceived harmfulness of ENDS has significantly increased since 2017 (Figure 4). 

One reason for this change may be that the public health community, including the SUTPP and county partners, sponsored media messaging about the harms of ENDS use after 2017.

In 2021, compared to 2017, more adults said that vaping was at least as harmful as smoking (Table 1).

Starting ENDS Use

Current smokers (see Table 2 for a summary of the four smoking status categories) who had also tried ENDS were asked whether they used cigarettes or ENDS first. For about half of these smokers (51%), this question was not applicable because ENDS were not on the market (to their knowledge) when they started smoking. Most current smokers reported using ENDS before cigarettes (Figure 5). There was no significant difference from 2017 to 2021.

Although a different research approach would provide stronger evidence, the 2021 ATS data support emerging research (such as Berry et al., 2019 and Hair et al., 2021) that vaping may lead people to smoke, including some people who would not otherwise have started smoking.

Quitting ENDS Use

In 2021, 34% of adults who were current ENDS users tried to quit in the past year or in their lifetime (Figure 6). 

Conclusion

These findings reflect the full adult population of Wyoming. Surveys focused on young adults or youth may find different patterns.

Many current ENDS users tried ENDS for the flavor or to try to quit or cut back on smoking. Current research (CDC, 2022a; CDC, 2020) does not show a consistent benefit of using ENDS to quit smoking. The FDA has not approved ENDS as a cessation aid (FDA, 2022).

Perceived harm of ENDS has grown over time. Compared to 2017, more Wyoming adults say vaping is at least as harmful as smoking.

Many ENDS users want to quit. Just over one third of current ENDS users had tried to quit ENDS in the past year or in their lifetime.