Recent Trends in Vaping, Cigarette Use Interview with:

Dr-Mahmoud Al Rifai

Dr. Al Rifai

Mahmoud Al Rifai, MD, MPH
Cardiovascular Disease Fellow
Baylor College of Medicine Houston, TX

Salim S. Virani, MD, PhD Section of Cardiology Michael E. DeBakey Veterans Affairs Medical Center

Dr. Virani

Salim S. Virani, MD, PhD, FACC, FAHA, FASPC
Professor, Section of Cardiovascular Research
Director, Cardiology Fellowship Training Program
Baylor College of Medicine
Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center
Co-Director, VA Advanced Fellowship in Health Services Research & Development at the Michael E. DeBakey VA Medical Center
Investigator, Health Policy, Quality and Informatics Program
Michael E. DeBakey Veterans Affairs Medical Center HSR&D Center of Innovation Houston, TX What is the background for this study? What are the main findings?

Response: E-cigarettes have gained popularity since their introduction in the U.S. market nearly 20 years ago and their use has increased especially among younger adults. On the other hand, public health efforts aimed at curbing tobacco use over the past few decades have resulted in a decrease in cigarette use. However, state-specific laws and regional cultural differences with regards to perception of these products may result in variability in tobacco use patterns. We therefore evaluate temporal changes in e-cigarette and cigarette use in each U.S. state between the years 2016 to 2018. What should readers take away from your report?

Response: Our results demonstrate a 6% (standard deviation 10%) relative increase in prevalence of e-cigarette use and a corresponding 5% relative decrease (standard deviation 6%) in prevalence of cigarette use between the years 2016 to 2018. Within that time period, there was a concomitant increase in e-cigarette and cigarette use in 5 states (15%), while 6 states demonstrated a concomitant decrease in both these products. A total of 21 states showed a relative increase in e-cigarette despite a decrease in cigarette use, while only 1 state demonstrated a relative increase in cigarette use and a decrease in e-cigarette use. What recommendations do you have for future research as a result of this work?

Response: The present study shows that there may be important state-level factors explaining differences in e-cigarette and cigarette use. Such differences may be related to state policies (for e.g. raising the minimum age for sale of e-cigarette products) or geographical differences in the perceptions regarding safety of cigarettes and e-cigarettes. Further studies evaluating these differences are required to understand the growing prevalence of e-cigarette over time in most U.S states and also factors related to their decrease in some U.S. states. It is also important to assess marketing strategies used in different states to promote the use of tobacco products given that cultural messaging may differ by U.S. state. Other factors related to social determinants of health may also have an effect on use of these products. Is there anything else you would like to add?

Response: It is important to note that there is more variability in e-cigarette than cigarette use across U.S. states. This variability is not only related to the aforementioned factors (i.e. state-specific laws, cultural differences) but also intrinsic factors such as cost of these products which is quite variable for e-cigarettes given a wide variety of these products in the market and other extrinsic factors such as social determinants of health. Careful consideration of all these factors is required to make a comprehensive assessment on reasons for variation in tobacco use patterns across the U.S.

Dr. Salim S. Virani reports the following disclosures:

Research support: Department of Veterans Affairs, World Heart Federation, Tahir and Jooma Family
Honorarium: American College of Cardiology (Associate Editor for Innovations,


Temporal Trends in E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016 to 2018

Al Rifai, Mahmoud et al.
The American Journal of Medicine, Volume 133, Issue 9, e508 – e511



Last Modified: [last-modified]

The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.


Last Updated on November 11, 2020 by Marie Benz MD FAAD