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Research Article Research Article

Native Hawaiian and Pacific Islander American youth report high levels of e-cigarette use

Native Hawaiian and Pacific Islander youth in the U.S. report the highest prevalence of current e-cigarette use compared to other racial and ethnic groups, according to new Truth Initiative® research published in Preventive Medicine Reports.

Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations are underrepresented in tobacco research and have historically been combined into one group. However, combining AANHPI into one group may mask critical tobacco-related disparities between diverse and distinct subgroups. Understanding tobacco use prevalence within specific groups is an important first step in addressing tobacco-related disparities.

This study found that compared to Asian American youth, Native Hawaiian and Pacific Islander youth were over three times more likely to report current e-cigarette use on at least one of the past 30 days and nearly three times as likely to report regular e-cigarette use on 10 or more of the past 30 days.

E-cigarette use among Native Hawaiian and Pacific Islander youth is especially high

In this study, researchers analyzed data on tobacco use among 8th, 10th, and 12th graders in the contiguous U.S. by race/ethnicity, using results from the 2018-2019 Monitoring the Future survey. While most research to date has focused on geographic regions with high proportions of AANHPI, like Hawaii and California, few studies prior to the current study have examined nicotine and tobacco use behaviors among members of this population who reside across the contiguous U.S.

Researchers found that among youth living in the contiguous U.S., a greater proportion of Native Hawaiian and Pacific Islanders reported current e-cigarette use (28.0%), relative to Asian American (10.3%), Black (9.5%), Hispanic or Latino (15%), American Indian or Alaskan Native (16.5%), multiracial (22.3%), and non-Hispanic White (25.2%) groups.

Concerns about health disparities among AANHPI youth

Research shows that youth who use e-cigarettes have higher odds of going on to use cigars and cigarettes, exposing them to the many health harms of combustible tobacco products and contributing to health disparities between racial groups. E-cigarettes increasingly contain high levels of nicotine, and nicotine addiction and withdrawal can negatively impact mental health. The connection is especially worrying since suicide was the leading cause of death for young Asian American and Pacific Islander populations in 2021.

In addition, Big Tobacco has a history of advertising its products to people who identify with underrepresented racial and ethnic groups and sponsoring activities linked with cultural traditions. Examples include Chinese New Year and events related to Asian American and Pacific Islander Heritage month.

Representation matters

“Findings indicate the importance of monitoring e-cigarette use behaviors among AANHPI youth, as a considerable number report current use and regular use of e-cigarettes,” the authors write. In addition, they recommend that special attention should be paid to NHPI, who reported the highest prevalence of e-cigarette use. Researchers also call for increasing the sample sizes of AANHPI subgroups in national health surveys. Further research is needed to inform culturally specific prevention and cessation messaging and policies seeking to address tobacco-related health disparities.