E-cigarette and Smokeless Tobacco Use and Switching Among Smokers: Findings From the National Adult Tobacco Survey

Published:February 08, 2018DOI:


      Assessing the extent that cigarette smokers use or switch to e-cigarettes and smokeless tobacco can help inform the population health impact of these products. This study estimated the prevalence of e-cigarette and smokeless tobacco use and switching among current and recent former adult cigarette smokers.


      Data from the 2012–2013 (n=8,891) and 2013–2014 (n=11,379) National Adult Tobacco Survey were analyzed in 2016. Response rates for this telephone survey were 44.9% and 36.1%, respectively. Tobacco product use was assessed by smoking status.


      Current e-cigarette use increased for all groups, with a greater increase among recent quitters, 9.1% (95% CI=7.1%, 11.1%) in 2012–2013 and 15.8% (95% CI=13.7%, 17.9%) in 2013–2014, than smokers with an unsuccessful quit attempt, 10.4% (95% CI=9.1%, 11.7%) in 2012–2013 and 14.8% (95% CI=13.5%, 16.1%) in 2013–2014, or smokers with no quit attempt, 5.9% (95% CI=4.8%, 6.9%) in 2012–2013 and 10.7% (95% CI=9.4%, 12.0%) in 2013–2014. Between 2012–2013 and 2013–2014, current use of smokeless tobacco remained steady for recent quitters (4.6% to 4.7%, p=0.92) and smokers with no quit attempt (4.0% to 4.3%, p=0.97), and decreased in smokers with an unsuccessful quit attempt (5.7% to 3.8%, p=0.004). More recent quitters completely switched to e-cigarettes in the past year (15.3% in 2012–2013, 25.7% in 2013–2014) than to smokeless tobacco (4.6% in 2012–2013, 4.5% in 2013–2014).


      Current and recent former adult smokers are more likely to use e-cigarettes than smokeless tobacco. Current e-cigarette use was most prevalent among unsuccessful quitters and recent quitters, who were substantially more likely to report complete switching to e-cigarettes than smokeless tobacco.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hu S.S.
        • Neff L.
        • Agaku I.T.
        • et al.
        Tobacco product use among adults—United States, 2013–2014.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 685-691
        • Chang J.T.
        • Levy D.T.
        • Meza R.
        Trends and factors related to smokeless tobacco use in the United States.
        Nicotine Tob Res. 2016; 18: 1740-1748
        • Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality
        The NSDUH Report: Trends in Smokeless Tobacco Use and Initiation: 2002 to 2012.
        SAMHSA; July 24, Rockville, MD2014
        • King B.A.
        • Patel R.
        • Nguyen K.H.
        • Dube S.R.
        Trends in awareness and use of electronic cigarettes among U.S. adults, 2010–2013.
        Nicotine Tob Res. 2015; 17: 219-227
        • McMillen R.C.
        • Gottlieb M.A.
        • Shaefer R.M.
        • Winickoff J.P.
        • Klein J.D.
        Trends in electronic cigarette use among U.S. adults: use is increasing in both smokers and nonsmokers.
        Nicotine Tob Res. 2015; 17: 1195-1202
      1. QuickStats: Cigarette smoking status among current adult e-cigarette users, by age group—National Health Interview Survey, United States, 2015.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 1177
        • Delnevo C.D.
        • Giovenco D.P.
        • Steinberg M.B.
        • et al.
        Patterns of electronic cigarette use among adults in the United States.
        Nicotine Tob Res. 2016; 18: 715-719
        • Weaver S.R.
        • Majeed B.A.
        • Pechacek T.F.
        • Nyman A.L.
        • Gregory K.R.
        • Eriksen M.P.
        Use of electronic nicotine delivery systems and other tobacco products among USA adults, 2014: results from a national survey.
        Int J Public Health. 2016; 61: 177-188
        • Pechacek T.F.
        • Nayak P.
        • Gregory K.R.
        • Weaver S.R.
        • Eriksen M.P.
        The potential that electronic nicotine delivery systems can be a disruptive technology: results from a national survey.
        Nicotine Tob Res. 2016; 18: 1989-1997
        • Rass O.
        • Pacek L.R.
        • Johnson P.S.
        • Johnson M.W.
        Characterizing use patterns and perceptions of relative harm in dual users of electronic and tobacco cigarettes.
        Exp Clin Psychopharmacol. 2015; 23: 494-503
        • Rutten L.J.
        • Blake K.D.
        • Agunwamba A.A.
        • et al.
        Use of e-cigarettes among current smokers: associations among reasons for use, quit intentions, and current tobacco use.
        Nicotine Tob Res. 2015; 17: 1228-1234
        • Pepper J.K.
        • Ribisl K.M.
        • Emery S.L.
        • Brewer N.T.
        Reasons for starting and stopping electronic cigarette use.
        Int J Environ Res Public Health. 2014; 11: 10345-10361
        • Pepper J.K.
        • Brewer N.T.
        Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions and beliefs: a systematic review.
        Tob Control. 2014; 23: 375-384
        • Schauer G.L.
        • Malarcher A.M.
        • Babb S.D.
        Prevalence and correlates of switching to another tobacco product to quit smoking cigarettes.
        Nicotine Tob Res. 2015; 17: 622-627
        • Zhu S.H.
        • Gamst A.
        • Lee M.
        • Cummins S.
        • Yin L.
        • Zoref L.
        The use and perception of electronic cigarettes and snus among the U.S. population.
        PLoS One. 2013; 8: e79332
      2. Family Smoking Prevention and Tobacco Control Act. U.S. Public Law 111–31, H.R. 1256.

        • Food and Drug Administration, U.S. DHHS
        Deeming tobacco products to be subject to the Federal Food, Drug, and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Control Act.
        Fed Regist. 2016; 81 ( 28974-29106
        • Adriaens K.
        • Van Gucht D.
        • Declerck P.
        • Baeyens F.
        Effectiveness of the electronic cigarette: an eight-week Flemish study with six-month follow-up on smoking reduction, craving and experienced benefits and complaints.
        Int J Environ Res Public Health. 2014; 11: 11220-11248
        • Polosa R.
        • Morjaria J.B.
        • Caponnetto P.
        • et al.
        Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study.
        Intern Emerg Med. 2014; 9: 537-546
        • Caponnetto P.
        • Campagna D.
        • Cibella F.
        • et al.
        EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study.
        PLoS One. 2013; 8: e66317
        • Bullen C.
        • Howe C.
        • Laugesen M.
        • et al.
        Electronic cigarettes for smoking cessation: a randomised controlled trial.
        Lancet. 2013; 382: 1629-1637
        • Grana R.A.
        • Popova L.
        • Ling P.M.
        A longitudinal analysis of electronic cigarette use and smoking cessation.
        JAMA Intern Med. 2014; 174: 812-813
        • Hartmann-Boyce J.
        • McRobbie H.
        • Bullen C.
        • Begh R.
        • Stead L.
        • Hajek P.
        Electronic cigarettes for smoking cessation.
        Cochrane Database Syst Rev. 2016; 9: CD010216
        • Carpenter M.J.
        • Wahlquist A.E.
        • Burris J.L.
        • et al.
        Snus undermines quit attempts but not abstinence: a randomised clinical trial among U.S. smokers.
        Tob Control. 2017; 26: 202-209
        • Fagerstrom K.
        • Rutqvist L.E.
        • Hughes J.R.
        Snus as a smoking cessation aid: a randomized placebo-controlled trial.
        Nicotine Tob Res. 2012; 14: 306-312
        • Joksic G.
        • Spasojevic-Tisma V.
        • Antic R.
        • Nilsson R.
        • Rutqvist L.E.
        Randomized, placebo-controlled, double-blind trial of Swedish snus for smoking reduction and cessation.
        Harm Reduct J. 2011; 8: 25
        • Tonnesen P.
        • Mikkelsen K.
        • Bremann L.
        Smoking cessation with smokeless tobacco and group therapy: an open, randomized, controlled trial.
        Nicotine Tob Res. 2008; 10: 1365-1372
        • Giovenco D.P.
        • Delnevo C.D.
        Prevalence of population smoking cessation by electronic cigarette use status in a national sample of recent smokers.
        Addict Behav. 2018; 76: 129-134
      3. CDC. 2012–2013 National Adult Tobacco Survey sample design and methodology summary. Published January 2015.

      4. CDC. 2013–2014 National Adult Tobacco Survey (NATS) sample design and methodology report. Published January 2016.

        • Babb S.
        • Malarcher A.
        • Schauer G.
        • Asman K.
        • Jamal A.
        Quitting smoking among adults—United States, 2000–2015.
        MMWR Morb Mortal Wkly Rep. 2017; 65: 1457-1464
        • Mendez D.
        • Tam J.
        • Giovino G.A.
        • Tsodikov A.
        • Warner K.E.
        Has smoking cessation increased? An examination of the U.S. adult smoking cessation rate 1990–2014.
        Nicotine Tob Res. 2017; 19: 1418-1424
        • Gitchell J.G.
        • Shiffman S.
        • Sembower M.A.
        Trends in serious quit attempts in the United States, 2009–14.
        Addiction. 2017; 112: 897-900
        • Berg C.J.
        • Haardoerfer R.
        • Escoffery C.
        • Zheng P.
        • Kegler M.
        Cigarette users’ interest in using or switching to electronic nicotine delivery systems for smokeless tobacco for harm reduction, cessation, or novelty: a cross-sectional survey of U.S. adults.
        Nicotine Tob Res. 2015; 17: 245-255
        • Tam J.
        • Day H.R.
        • Rostron B.L.
        • Apelberg B.J.
        A systematic review of transitions between cigarette and smokeless tobacco product use in the United States.
        BMC Public Health. 2015; 15: 258