Trends in E-Cigarette Use by Age Group and Combustible Cigarette Smoking Histories, U.S. Adults, 2014–2018

Published:October 05, 2020DOI:


      The trends in e-cigarette prevalence and population count of users according to cigarette smoking histories are unknown. These data are needed to inform public health actions against a rapidly changing U.S. e-cigarette market.


      Data collected between 2014 and 2018 (analyzed in 2020) from cross-sectional, nationally representative National Health Interview Surveys were used to estimate current e-cigarette prevalence, adjusted prevalence differences (percentage points), and population counts of users. Analyses were stratified by age group (younger, 18–29 years, n=25,445; middle age, 30–49 years, n=47,745; older, ≥50 years, n=79,517) and cigarette smoking histories (current smokers, recent quitters [quit <1 year ago], near-term quitters [quit 1–8 years ago], long-term quitters [quit >8 years ago], never smokers).


      Among younger adults, e-cigarette use increased in all groups of smokers, with notable increases between 2014 and 2018 among never smokers (1.3%–3.3%, adjusted prevalence difference=2%, p<0.001) and near-term quitters (9.1%–19.2%, adjusted prevalence difference=8.8%, p=0.024). Conversely, the only substantial increase in e-cigarette use between 2014 and 2018 among middle-aged (5.8%–14.4%, adjusted prevalence difference=8.2%, p<0.001) and older (6.3%–9.5%, adjusted prevalence difference=3.3%, p=0.045) adults was among near-term quitters. The largest absolute population increase in e-cigarette users between 2014 and 2018 was among younger-adult never smokers (0.49–1.35 million), followed by near-term quitters among middle-aged (0.36–0.95 million), younger (0.23–0.57 million), and older (0.35–0.50 million) adults.


      The continuous increase among younger-adult never smokers suggests a rise in primary nicotine initiation with e-cigarettes. The concomitant increase among near-term quitters of all age groups suggests continuing e-cigarette use among smokers who may have switched from cigarettes previously.
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        • Keamy-Minor E
        • McQuoid J
        • Ling PM
        Young adult perceptions of JUUL and other pod electronic cigarette devices in California: a qualitative study.
        BMJ Open. 2019; 9e026306
        • Case KR
        • Hinds JT
        • Creamer MR
        • Loukas A
        • Perry CL
        Who is JUULing and why? An examination of young adult electronic nicotine delivery systems users.
        J Adolesc Health. 2020; 66: 48-55
        • Glantz SA
        • Bareham DW
        E-cigarettes: use, effects on smoking, risks, and policy implications.
        Annu Rev Public Health. 2018; 39: 215-235
        • Barrington-Trimis JL
        • Leventhal AM.
        Adolescents’ use of “pod mod” e-cigarettes - urgent concerns.
        N Engl J Med. 2018; 379: 1099-1102
        • Hajek P
        • Phillips-Waller A
        • Przulj D
        • et al.
        A randomized trial of e-cigarettes versus nicotine-replacement therapy.
        N Engl J Med. 2019; 380: 629-637
        • Berry KM
        • Reynolds LM
        • Collins JM
        • et al.
        E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013-2015.
        Tob Control. 2019; 28: 42-49
        • National Academies of Sciences, Engineering, and Medicine
        Public Health Consequences of E-Cigarettes.
        The National Academies Press, Washington, DC2018
        • Delnevo CD
        • Giovenco DP
        • Steinberg MB
        • et al.
        Patterns of electronic cigarette use among adults in the United States.
        Nicotine Tob Res. 2016; 18: 715-719
        • Creamer MR
        • Wang TW
        • Babb S
        • et al.
        Tobacco product use and cessation indicators among adults - United States, 2018.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 1013-1019
        • Bao W
        • Xu G
        • Lu J
        • Snetselaar LG
        • Wallace RB
        Changes in electronic cigarette use among adults in the United States, 2014-2016.
        JAMA. 2018; 319: 2039-2041
        • Dai H
        • Leventhal AM.
        Prevalence of e-cigarette use among adults in the United States, 2014-2018.
        JAMA. 2019; 322: 1824-1827
        • Mirbolouk M
        • Charkhchi P
        • Kianoush S
        • et al.
        Prevalence and distribution of e-cigarette use among U.S. adults: Behavioral Risk Factor Surveillance System, 2016.
        Ann Intern Med. 2018; 169: 429-438
        • Boyle RG
        • Richter S
        • Helgertz S
        Who is using and why: prevalence and perceptions of using and not using electronic cigarettes in a statewide survey of adults.
        Addict Behav Rep. 2019; 10100227
      1. National Center for Health Statistics. National Health Interview Survey: questionnaires, datasets, and related documentation. Updated May 6, 2019. Accessed August 7, 2020.

        • Khan T
        • Barker DC
        • Quinn CM
        • Huang J
        • Chaloupka FJ
        Changes in e-cigarette availability over time in the United States: 2010-2012 – a BTG research brief.
        Bridging the Gap Program, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, ILPublished March. 2014
        • Parker JD
        • Talih M
        • Malec DJ
        • et al.
        National Center for Health Statistics data presentation standards for proportions.
        Vital Health Stat. 2017; 2 (Accessed May 11, 2020): 1-22
        • Ingram DD
        • Malec DJ
        • Makuc DM
        • et al.
        National Center for Health Statistics guidelines for analysis of trends.
        Vital Health Stat. 2018; 2 (Accessed May 11, 2020): 1-71
        • Berry KM
        • Fetterman JL
        • Benjamin EJ
        • et al.
        Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in U.S. youths.
        JAMA Netw Open. 2019; 2e187794
        • Levy DT
        • Warner KE
        • Cummings KM
        • et al.
        Examining the relationship of vaping to smoking initiation among U.S. youth and young adults: a reality check.
        Tob Control. 2019; 28: 629-635
        • Etter JF
        Gateway effects and electronic cigarettes.
        Addiction. 2018; 113: 1776-1783
        • Kozlowski LT
        • Warner KE
        Adolescents and e-cigarettes: objects of concern may appear larger than they are.
        Drug Alcohol Depend. 2017; 174: 209-214
        • Spindle TR
        • Eissenberg T
        Pod mod electronic cigarettes-an emerging threat to public health.
        JAMA Netw Open. 2018; 1e183518
        • McKelvey K
        • Baiocchi M
        • Halpern-Felsher B
        Adolescents’ and young adults’ use and perceptions of pod-based electronic cigarettes.
        JAMA Netw Open. 2018; 1e183535
        • Miech RA
        • Patrick ME
        • O'Malley PM
        • Johnston LD
        • Bachman JG
        Trends in reported marijuana vaping among U.S. adolescents, 2017-2019.
        JAMA. 2019; 323: 475-476
        • Nardone N
        • Helen GS
        • Addo N
        • Meighan S
        • Benowitz NL
        JUUL electronic cigarettes: nicotine exposure and the user experience.
        Drug Alcohol Depend. 2019; 203: 83-87
        • Benmarhnia T
        • Pierce JP
        • Leas E
        • et al.
        Can e-cigarettes and pharmaceutical aids increase smoking cessation and reduce cigarette consumption? Findings from a nationally representative cohort of American smokers.
        Am J Epidemiol. 2018; 187: 2397-2404
        • Patel M
        • Cuccia A
        • Willett J
        • et al.
        JUUL use and reasons for initiation among adult tobacco users.
        Tob Control. 2019; 28: 681-684
        • Majeed BA
        • Weaver SR
        • Gregory KR
        • et al.
        Changing perceptions of harm of e-cigarettes among U.S. adults, 2012-2015.
        Am J Prev Med. 2017; 52: 331-338
        • Berg CJ
        • Stratton E
        • Schauer GL
        • et al.
        Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win.
        Subst Use Misuse. 2015; 50: 79-89
        • Huang J
        • Feng B
        • Weaver SR
        • Pechacek TF
        • Slovic P
        • Eriksen MP
        Changing perceptions of harm of e-cigarette vs cigarette use among adults in 2 U.S. national surveys from 2012 to 2017.
        JAMA Netw Open. 2019; 2e191047
      2. FDA warns JUUL labs for marketing unauthorized modified risk tobacco products, including in outreach to youth. Food and Drug Administration. Updated September 9, 2019. Accessed January 14, 2020.

        • Gomajee R
        • El-Khoury F
        • Goldberg M
        • et al.
        Association between electronic cigarette use and smoking reduction in France.
        JAMA Intern Med. 2019; 179: 1193-1200
        • Du P
        • Fan T
        • Yingst J
        • et al.
        Changes in e-cigarette use behaviors and dependence in long-term e-cigarette users.
        Am J Prev Med. 2019; 57: 374-383
        • Edwards KC
        • Kasza KA
        • Tang Z
        • et al.
        Correlates of tobacco product reuptake and relapse among youth and adults in the USA: findings from the PATH study waves 1-3 (2013-2016).
        Tob Control. 2020; 29: s216-s226
        • Loukas A
        • Marti CN
        • Perry CL
        Trajectories of tobacco and nicotine use across young adulthood, Texas, 2014-2017.
        Am J Public Health. 2019; 109: 465-471
        • Niaura R
        • Rich I
        • Johnson AL
        • et al.
        Young adult tobacco and e-cigarette use transitions: examining stability using multistate modeling.
        Nicotine Tob Res. 2020; 22: 647-654
        • Truth initiative
        Behind the explosive growth of JUUL: social influences and flavors drive rising teen use of top e-cigarette.
        Truth initiative, Washington, DCPublished December 2018
      3. Subscription plans. ECigIntelligence.

        • HHS
        • NIH
        • National Cancer Institute. Tobacco use supplement
        Current population survey: 2018-2019 TUS-CPS initial release*: July 2018 data now avaiable!.
        Published October 2019
        • Miech R
        • Johnston L
        • O'Malley PM
        • Bachman JG
        • Patrick ME
        Trends in adolescent vaping, 2017-2019.
        N Engl J Med. 2019; 381: 1490-1491