New study finds largest population increase among US adult ecigarette users is in younger adults

A new study from the American Cancer Society assessed trends between 2014 and 2018 in the prevalence of e-cigarette use and population count of e-cigarette users, according to combustible cigarette smoking histories, in younger (18-29 years), middle-aged (30-49 years), and older (50 years and older) U.S. adults. The study appears in the American Journal of Preventive Medicine.

The most notable finding was an increase in e-cigarette use among younger adult never smokers of combustible cigarettes, whose use nearly tripled (1.3% to 3.3%) between 2014-2018, potentially suggesting increasing primary nicotine initiation with e-cigarettes. While this two-percentage point increase appears modest, when combined with a large and growing prevalence and population of never-smokers nationally, this increase represented the largest absolute increase in e-cigarette users—an estimated 0.87 million more never smoking younger adults users in 2018 (1.35 million) than in 2014 (0.49 million). The authors also note substantial increases in e-cigarette use among near-term quitters (i.e. those that quit combustible cigarettes 1-8 years ago, when e-cigarettes proliferated the US retail market) across all age groups. This trend suggests continued use of e-cigarette devices among those who may have switched from cigarettes previously, potentially for nicotine maintenance.

"Urgent efforts are needed to address the potential rise in primary nicotine initiation with e-cigarettes among younger adults. It is also important to aid the transition of e-cigarette users—particularly among younger adults—to non-use of all tobacco or nicotine products given that the long-term consequences of e-cigarette use are mostly unknown," said Priti Bandi, Ph.D., Principal Scientist, Risk Factors Surveillance Research for The American Cancer Society.