Examining Adult E-cigarette Use in Kentucky and Its Appalachian Region Using the Behavioral Risk Factor Surveillance System, 2016-2017

W. Jay Christian, Nimish R. Valvi, Courtney J. Walker

Research output: Contribution to journalArticlepeer-review


Objectives: Electronic cigarette (e-cigarette) use has increased steadily in the United States, but little research has examined its prevalence in states comprising Appalachia, a rural region known for high rates of tobacco use. This study assessed lifetime and current e-cigarette use among adults by sociodemographic characteristics, geographic region, and cigarette smoking in Kentucky, with a focus on the Appalachian region. Methods: We used data from the 2016-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys to calculate the prevalence of lifetime and current e-cigarette use, and we used weighted multivariable logistic regression analyses to examine the relative influence of other factors. Results: Among adults in Kentucky, 5.8% (95% CI, 5.2%-6.4%) were current e-cigarette users and 27.0% (95% CI, 25.9%-28.0%) were lifetime users, compared with state medians of 4.6% (95% CI, 4.0%-5.1%) and 21.4% (95% CI, 19.4%-23.5%) for the United States. Multivariable regression models showed similar patterns for all regions: higher prevalence odds of current e-cigarette use among adults aged 18-24, current conventional smokers, and adults unable to work. Generally, Appalachian residents of Kentucky did not have significantly higher rates of lifetime or current e-cigarette use as compared with other non-Appalachian residents of Kentucky. Hispanic residents of Appalachian Kentucky, however, had higher rates of e-cigarette use than Hispanic residents of other regions of Kentucky. Conclusions: Rates of e-cigarette use were higher in Kentucky than in the United States but were not further elevated in Kentucky’s Appalachian region. High rates of e-cigarette use among Hispanic residents of Appalachia indicate a need to focus future interventions in the region.

Original languageEnglish
Pages (from-to)878-887
Number of pages10
JournalPublic Health Reports
Issue number5
StatePublished - Sep 2022

Bibliographical note

Funding Information:
The authors acknowledge the efforts of Sarojini Kanotra, PhD, MPH, and the Kentucky BRFSS Program, Kentucky Cabinet for Health and Family Services. Furthermore, the authors appreciate the work of anonymous reviewers who contributed insightful comments that helped to improve this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by a grant from the Foundation for a Healthy Kentucky. The Foundation’s mission is to address the unmet health care needs of Kentucky, by developing and influencing health policy, improving access to care, reducing health risks and disparities, and promoting health equity.

Publisher Copyright:
© 2021, Association of Schools and Programs of Public Health.


  • Appalachia
  • Kentucky
  • e-cigarette
  • electronic cigarette
  • tobacco

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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