Underage E-Cigarette Purchasing and Vaping Progression Among Young Adults



      Despite laws prohibiting sale of e-cigarettes to individuals aged less than 21 years, many underage young adults purchase e-cigarettes from retail stores, which may increase likelihood of continued use due to a greater access to vaping products and exposure to point-of-sale marketing.


      Data are from a prospective cohort of young adults aged 18–20 years in Los Angeles who had ever used e-cigarettes at baseline (N = 1,029). We evaluated the association of underage e-cigarette purchasing behavior (owned and purchased vs. owned but never purchased vs. never owned an e-cigarette) with subsequent vaping frequency, intensity, and dependence symptoms one year later, adjusting for vaping behaviors prior to baseline; additional models evaluated whether associations differed by purchase location or product type.


      At baseline, 332 (32%) had purchased e-cigarettes while underage, 227 (22%) owned but never purchased e-cigarettes themselves, and 470 (46%) never owned an e-cigarette. Compared to never owning e-cigarettes, those who had purchased their own e-cigarettes vaped more days in the past month (rate ratio [RR] = 2.97; 95% confidence interval [CI]: 2.15–4.09), had more vaping episodes per day (RR: 2.58; 95% CI: 2.12–3.14), vaped more puffs per vaping episode (RR: 1.90; 95% CI: 1.61–2.23), and had greater odds of dependence (odds ratio: 3.68; 95% CI: 2.51–5.40); elevated estimates were also observed for those who owned but never purchased e-cigarettes (vs. never owned). Vaping dependence was greatest among participants who purchased JUULs or other pod-mods.


      Participants who purchased e-cigarettes underage subsequently vaped more intensely and had greater vaping dependence. Regulations that reduce underage retail access to e-cigarettes may help prevent vaping progression among those most at risk of dependence.


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        • Patrick M.E.
        • Schulenberg J.E.
        • Miech R.A.
        • et al.
        Monitoring the future panel study annual report: National data on substance use among adults ages 19 to 60, 1976-2021. Monitoring the future monograph series.
        University of Michigan Institute for Social Research, Ann Arbor, MI2022
        • Kosmider L.
        • Sobczak A.
        • Fik M.
        • et al.
        Carbonyl compounds in electronic cigarette vapors: Effects of nicotine solvent and battery output voltage.
        Nicotine Tob Res. 2014; 16: 1319-1326
        • Cheng T.
        Chemical evaluation of electronic cigarettes.
        Tob Control. 2014; 23: ii11-ii17
        • Fernández E.
        • Ballbè M.
        • Sureda X.
        • et al.
        Particulate matter from electronic cigarettes and conventional cigarettes: A systematic review and observational study.
        Curr Environ Health Rep. 2015; 2: 423-429
        • National Academies of Sciences Engineering and Medicine
        Stratton K. Kwan L.Y. Eaton D.L. Public health consequences of E-cigarettes. National Academies Press, Washington DC2018
        • England L.J.
        • Bunnell R.E.
        • Pechacek T.F.
        • et al.
        Nicotine and the developing human: A neglected element in the electronic cigarette debate.
        Am J Prev Med. 2015; 49: 286-293
        • Soneji S.
        • Barrington-Trimis J.L.
        • Wills T.A.
        • et al.
        Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults.
        JAMA Pediatr. 2017; 171: 788
        • Barrington-Trimis J.L.
        • Urman R.
        • Berhane K.
        • et al.
        E-cigarettes and future cigarette use.
        Pediatrics. 2016; 138: e20160379
        • Goldenson N.I.
        • Leventhal A.M.
        • Stone M.D.
        • et al.
        Associations of electronic cigarette nicotine concentration with subsequent cigarette smoking and vaping levels in adolescents.
        JAMA Pediatr. 2017; 171: 1192-1199
        • Leventhal A.M.
        • Stone M.D.
        • Andrabi N.
        • et al.
        Association of e-cigarette vaping and progression to heavier patterns of cigarette smoking.
        JAMA. 2016; 316: 1918-1920
        • Berry K.M.
        • Fetterman J.L.
        • Benjamin E.J.
        • et al.
        Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths.
        JAMA Netw Open. 2019; 2: e187794
        • Barrington-Trimis J.L.
        • Kong G.
        • Leventhal A.M.
        • et al.
        E-cigarette use and subsequent smoking frequency among adolescents.
        Pediatrics. 2018; 142: e20180486
        • Leventhal A.M.
        • Strong D.R.
        • Kirkpatrick M.G.
        • et al.
        Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence.
        JAMA. 2015; 314: 700-707
        • Cwalina S.N.
        • Braymiller J.L.
        • Leventhal A.M.
        • et al.
        Prevalence of young adult vaping, substance vaped, and purchase location across five categories of vaping devices.
        Nicotine Tob Res. 2021; 23: 829-835
        • Gaiha S.M.
        • Lempert L.K.
        • Halpern-Felsher B.
        Underage youth and young adult e-cigarette use and access before and during the coronavirus disease 2019 pandemic.
        JAMA Netw Open. 2020; 3: e2027572
        • Schiff S.
        • Liu F.
        • Cruz T.B.
        • et al.
        E-cigarette and cigarette purchasing among young adults before and after implementation of California’s tobacco 21 policy.
        Tob Control. 2021; 30: 206-211
        • Pepper J.K.
        • Coats E.M.
        • Nonnemaker J.M.
        • Loomis B.R.
        How do adolescents get their E-cigarettes and other electronic vaping devices?.
        Am J Health Promot. 2019; 33: 420-429
        • Kong G.
        • Morean M.E.
        • Cavallo D.A.
        • et al.
        Sources of electronic cigarette acquisition among adolescents in Connecticut.
        Tob Regul Sci. 2016; 3: 10-16
        • Hsu G.
        • Gamst A.C.
        • Zhuang Y.L.
        • et al.
        A comparison of E-cigarette use patterns and smoking cessation behavior among vapers by primary place of purchase.
        Int J Environ Res Public Health. 2019; 16: 724
        • Morewedge C.K.
        Psychological ownership: Implicit and explicit.
        Curr Opin Psychol. 2021; 39: 125-132
        • Braak D.
        • Michael Cummings K.
        • Nahhas G.J.
        • et al.
        How are adolescents getting their vaping products? Findings from the international tobacco control (ITC) youth tobacco and vaping survey.
        Addict Behav. 2020; 105: 106345
        • Kim J.H.
        • Noh J.W.
        • Kim S.J.
        • et al.
        Association between possibility of purchasing cigarettes and E-cigarette experience among Korean adolescent smokers.
        Korean J Fam Med. 2018; 39: 225
        • Harrison P.
        • Fulkerson J.A.
        • Harrison P.A.
        • Park E.
        The relative importance of social versus commercial sources in youth access to tobacco, alcohol, and other drugs.
        Prev Med. 2000; 31: 39-48
        • Smart R.G.
        • Adlaf E.M.
        • Walsh G.W.
        Procurement of alcohol and underage drinking among adolescents in Ontario.
        J Stud Alcohol. 1996; 57: 419-424
        • Naudé G.P.
        • Foster R.N.S.
        • Bartley M.
        • et al.
        Predicting adverse consequences of alcohol consumption in underage college students using a novel Fake ID Purchase Task.
        Exp Clin Psychopharmacol. 2020; 28: 669-676
        • Kong A.Y.
        • King B.A.
        Boosting the tobacco control vaccine: Recognizing the role of the retail environment in addressing tobacco use and disparities.
        Tob Control. 2021; 0: 1-7
        • Wheeler K.C.
        • Fletcher K.E.
        • Wellman R.J.
        • Difranza J.R.
        Screening adolescents for nicotine dependence: The hooked on nicotine checklist.
        J Adolesc Health. 2004; 35: 225-230
        • Vogel E.A.
        • Cho J.
        • McConnell R.S.
        • et al.
        Prevalence of electronic cigarette dependence among youth and its association with future use.
        JAMA Netw Open. 2020; 3: e1921513
        • Barrington-Trimis J.L.
        • Leventhal A.M.
        Adolescents’ use of “pod mod” E-cigarettes — urgent concerns.
        N Engl J Med. 2018; 379: 1099-1102
        • U.S. Department of Health and Human Services
        Preventing tobacco use among youth and young adults: A report of the surgeon general.
        U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2012
        • Travis N.
        • Levy D.T.
        • McDaniel P.A.
        • Henriksen L.
        Tobacco retail availability and cigarette and e-cigarette use among youth and adults: A scoping review.
        Tob Control. 2021; 0: 1-14
        • Astor R.L.
        • Urman R.
        • Barrington-Trimis J.L.
        • et al.
        Tobacco retail licensing and youth product use.
        Pediatrics. 2019; 143: e20173536
        • Hasin D.S.
        • O’Brien C.P.
        • Auriacombe M.
        • et al.
        DSM-5 criteria for substance use disorders: Recommendations and rationale.
        Am J Psychiatry. 2013; 170: 834
        • Roesler A.
        • Vuong T.
        • Henriksen L.
        • Zhange X.
        Assessment of underage sales violations in tobacco stores and vape shops.
        JAMA Pediatr. 2019; 173: 795-797
        • Roodbeen R.T.J.
        • Schelleman-Offermans K.
        • Lemmens P.H.H.M.
        Alcohol and tobacco sales to underage buyers in Dutch supermarkets: Can the use of age verification systems increase seller’s compliance?.
        J Adolesc Health. 2016; 58: 672-678
        • Kong G.
        • Morean M.E.
        • Cavallo D.A.
        • et al.
        Reasons for electronic cigarette experimentation and discontinuation among adolescents and young adults.
        Nicotine Tob Res. 2015; 17: 847-854
        • Bauld L.
        • Mackintosh A.M.
        • Ford Phd A.
        • Mcneill Phd A.
        E-cigarette uptake amongst UK youth: Experimentation, but little or No regular use in nonsmokers.
        Nicotine Tob Res. 2016; 18: 102-103
        • Bondy S.J.
        • Victor J.C.
        • Diemert L.M.
        • Bondy S.
        Origin and use of the 100 cigarette criterion in tobacco surveys.
        Tob Control. 2009; 18: 317-323
        • Zhu S.H.
        • Sun J.Y.
        • Bonnevie E.
        • et al.
        Four hundred and sixty brands of e-cigarettes and counting: Implications for product regulation.
        Tob Control. 2014; 23: 3-9