Contemporary data on the prevalence of e-cigarette use in the United States are limited.
To report the prevalence and distribution of current e-cigarette use among U.S. adults in 2016.
Behavioral Risk Factor Surveillance System, 2016.
Adults aged 18 years and older.
Prevalence of current e-cigarette use by sociodemographic groups, comorbid medical conditions, and states of residence.
Of participants with information on e-cigarette use (n = 466 842), 15 240 were current e-cigarette users, representing a prevalence of 4.5%, which corresponds to 10.8 million adult e-cigarette users in the United States. Of the e-cigarette users, 15% were never–cigarette smokers. The prevalence of current e-cigarette use was highest among persons aged 18 to 24 years (9.2% [95% CI, 8.6% to 9.8%]), translating to approximately 2.8 million users in this age range. More than half the current e-cigarette users (51.2%) were younger than 35 years. In addition, the age-standardized prevalence of e-cigarette use was high among men; lesbian, gay, bisexual, and transgender (LGBT) persons; current combustible cigarette smokers; and those with chronic health conditions. The prevalence of e-cigarette use varied widely among states, with estimates ranging from 3.1% (CI, 2.3% to 4.1%) in South Dakota to 7.0% (CI, 6.0% to 8.2%) in Oklahoma.
Data were self-reported, and no biochemical confirmation of tobacco use was available.
E-cigarette use is common, especially in younger adults, LGBT persons, current cigarette smokers, and persons with comorbid conditions. The prevalence of use differs across states. These contemporary estimates may inform researchers, health care policymakers, and tobacco regulators about demographic and geographic distributions of e-cigarette use.
Primary Funding Source:
American Heart Association Tobacco Regulation and Addiction Center, which is funded by the U.S. Food and Drug Administration and National Heart, Lung, and Blood Institute.
Bhatnagar A, Whitsel LP, Ribisl KM, Bullen C, Chaloupka F, Piano MR, et al; American Heart Association Advocacy Coordinating Committee. Council on Cardiovascular and Stroke Nursing. Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Electronic cigarettes: a policy statement from the American Heart Association. Circulation. 2014;130:1418-36. [PMID: 25156991] doi:10.1161/CIR.0000000000000107 CrossrefMedlineGoogle Scholar
Wackowski OA, Delnevo CD, Steinberg MB. Perspectives for clinicians on regulation of electronic cigarettes. Ann Intern Med. 2016;165:665-6. [PMID: 27571380]. doi:10.7326/M16-1345 LinkGoogle Scholar
Crowley RA; Health Public Policy Committee of the American College of Physicians. Electronic nicotine delivery systems: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2015;162:583-4. [PMID: 25894027]. doi:10.7326/M14-2481 LinkGoogle Scholar
Food and Drug Administration. HHS. 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; restrictions on the sale and distribution of tobacco products and required warning statements for tobacco products. Final rule. Fed Regist. 2016;81:28973-9106. [PMID: 27192730] MedlineGoogle Scholar
- 5. U.S. Department of Health and Human Services. E-cigarette use among youth and young adults: a report of the surgeon general. Accessed at https://e-cigarettes.surgeongeneral.gov/documents/2016_sgr_full_report_non-508.pdf on 8 August 2018. Google Scholar
Murthy VH. E-cigarette use among youth and young adults: a major public health concern. JAMA Pediatr. 2017;171:209-10. [PMID: 27928577] doi:10.1001/jamapediatrics.2016.4662 CrossrefMedlineGoogle Scholar
- 7. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System overview: BRFSS 2016. 2017. Accessed at www.cdc.gov/brfss/annual_data/2016/pdf/overview_2016.pdf on 3 June 2018. Google Scholar
- 8. Centers for Medicare & Medicaid Services. Federal poverty line. 2018. Accessed at www.healthcare.gov/glossary/federal-poverty-level-FPL on 8 August 2018. Google Scholar
- 9. Centers for Disease Control and Prevention. LLCP 2016 codebook report, Behavioral Risk Factor Surveillance System. 3 August 2017. Accessed at www.cdc.gov/brfss/annual_data/2016/pdf/codebook16_llcp.pdf on 1 January 2017. Google Scholar
- 10. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System: weighting BRFSS data. BRFSS 2016. 2017. Accessed at www.cdc.gov/brfss/annual_data/2016/pdf/weighting_the-data_webpage_content.pdf on 3 June 2018. Google Scholar
- 11. Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System, direct age adjustment, 2016. 2017. Accessed at www.cdc.gov/brfss/annual_data/2016/pdf/2016_DirAgeAdjDUsrsGde.pdf on 1 January 2017. Google Scholar
Kasza KA, Ambrose BK, Conway KP, Borek N, Taylor K, Goniewicz ML, et al. Tobacco-product use by adults and youths in the United States in 2013 and 2014. N Engl J Med. 2017;376:342-53. [PMID: 28121512] doi:10.1056/NEJMsa1607538 CrossrefMedlineGoogle Scholar
- 13. U.S. Census Bureau. Quick facts: United States. 2017. Accessed at www.census.gov/quickfacts/fact/table/US/PST045216 on 12 December 2017. Google Scholar
Muller CJ, MacLehose RF. Estimating predicted probabilities from logistic regression: different methods correspond to different target populations. Int J Epidemiol. 2014;43:962-70. [PMID: 24603316] doi:10.1093/ije/dyu029 CrossrefMedlineGoogle Scholar
Schoenborn CA, Gindi RM. Electronic cigarette use among adults: United States, 2014. NCHS Data Brief. 2015:1-8. [PMID: 26555932] MedlineGoogle Scholar
Coleman BN, Rostron B, Johnson SE, Ambrose BK, Pearson J, Stanton CA, et al. Electronic cigarette use among US adults in the Population Assessment of Tobacco and Health (PATH) study, 2013-2014. Tob Control. 2017;26:e117-26. [PMID: 28624763] doi:10.1136/tobaccocontrol-2016-053462 CrossrefMedlineGoogle Scholar
Jaber RM, Mirbolouk M, DeFilippis AP, Maziak W, Keith R, Payne T, et al. Electronic cigarette use prevalence, associated factors, and pattern by cigarette smoking status in the United States from NHANES (National Health and Nutrition Examination Survey) 2013-2014. J Am Heart Assoc. 2018;7. [PMID: 30007934] doi:10.1161/JAHA.117.008178 CrossrefMedlineGoogle Scholar
Shahab L, Goniewicz ML, Blount BC, Brown J, McNeill A, Alwis KU, et al. Nicotine, carcinogen, and toxin exposure in long-term E-cigarette and nicotine replacement therapy users: a cross-sectional study. Ann Intern Med. 2017;166:390-400. [PMID: 28166548]. doi:10.7326/M16-1107 LinkGoogle Scholar
Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, et al. Overview of electronic nicotine delivery systems: a systematic review. Am J Prev Med. 2017;52:e33-66. [PMID: 27914771] doi:10.1016/j.amepre.2016.10.036 CrossrefMedlineGoogle Scholar
Rigotti NA, Chang Y, Tindle HA, Kalkhoran SM, Levy DE, Regan S, et al. Association of E-cigarette use with smoking cessation among smokers who plan to quit after a hospitalization: a prospective study. Ann Intern Med. 2018;168:613-20. [PMID: 29582077]. doi:10.7326/M17-2048 LinkGoogle Scholar
Rigotti NA. Balancing the benefits and harms of E-cigarettes: A national academies of science, engineering, and medicine report. Ann Intern Med. 2018;168:666-667. [PMID: 29435573]. doi:10.7326/M18-0251 LinkGoogle Scholar
Apelberg BJ, Feirman SP, Salazar E, Corey CG, Ambrose BK, Paredes A, et al. Potential public health effects of reducing nicotine levels in cigarettes in the United States. N Engl J Med. 2018;378:1725-33. [PMID: 29543114] doi:10.1056/NEJMsr1714617 CrossrefMedlineGoogle Scholar
Delnevo CD, Giovenco DP, Steinberg MB, Villanti AC, Pearson JL, Niaura RS, et al. Patterns of electronic cigarette use among adults in the United States. Nicotine Tob Res. 2016;18:715-9. [PMID: 26525063] doi:10.1093/ntr/ntv237 CrossrefMedlineGoogle Scholar
Zhu SH, Zhuang YL, Wong S, Cummins SE, Tedeschi GJ. E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys. BMJ. 2017;358:j3262. [PMID: 28747333] doi:10.1136/bmj.j3262 CrossrefMedlineGoogle Scholar
Cobb NK, Abrams DB. E-cigarette or drug-delivery device? Regulating novel nicotine products. N Engl J Med. 2011;365:193-5. [PMID: 21774706] doi:10.1056/NEJMp1105249 CrossrefMedlineGoogle Scholar
Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016;4:116-28. [PMID: 26776875] doi:10.1016/S2213-2600(15)00521-4 CrossrefMedlineGoogle Scholar
Author, Article, and Disclosure Information
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Johns Hopkins University, Baltimore, Maryland (M.M., S.I.U., O.A.O., M.J.B.)
Johns Hopkins University, Baltimore, Maryland, and University of Michigan, Ann Arbor, Michigan (P.C.)
Johns Hopkins University, Baltimore, Maryland, and Yale University School of Medicine, New Haven, Connecticut (S.K.)
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Florida International University, Miami, Florida (R.J.)
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Louisville, Louisville, Kentucky (A.B., A.P.D.)
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and Boston University, Boston, Massachusetts (E.J.B.)
The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas, and University of Mississippi Medical Center, Jackson, Mississippi (M.E.H.)
Florida International University, Miami, Florida, and Syrian Center for Tobacco Studies, Aleppo, Syria (W.M.)
Johns Hopkins University, Baltimore, Maryland, Yale University School of Medicine, New Haven, Connecticut, and Florida International University, Miami, Florida and Population Health & Health Systems Research, Center for Outcomes Research and Evaluation (CORE), Section of Cardiovascular Medicine, Yale University School of Medicine. (K.N.)
Grant Support: By A-TRAC grant 1P50HL120163.
Disclosures: Drs. Mirbolouk, Uddin, and Orimoloye report grants from A-TRAC during the conduct of the study. Dr. Benjamin reports grants from the National Institutes of Health (NIH) and American Heart Association, served as associate editor for the journal Circulation, and was a member of the NIH/National Center for Biotechnology Information Observational Study Monitoring Board for the CARDIA (Coronary Artery Risk Development in Young Adults) trial outside the submitted work. Dr. DeFilippis reports grants from the National Institute of General Medical Sciences and NIH during the conduct of the study. Dr. Blaha reports grants from the FDA during the conduct of the study and grants from the NIH, FDA, Amgen Foundation, and Aetna Foundation and personal fees from the FDA, American College of Cardiology, Amgen Foundation, Aetna Foundation, MedImmune, Novartis, Sanofi/Regeneron, and Akcea outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3440.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available from Dr. Mirbolouk (e-mail, hassan.
Corresponding Author: Michael J. Blaha, MD, MPH, 600 North Wolfe Street, Blalock 524D1, Baltimore, MD 21287; e-mail, mblaha1@jhmi.
Current Author Addresses: Drs. Mirbolouk, Charkhchi, Kianoush, Uddin, and Orimoloye: 600 North Wolfe Street, Blalock 501, Baltimore, MD 21287.
Drs. Jaber, Maziak, and Nasir: 11200 Southwest 8th Street, AHC5, Miami, FL 33199.
Drs. Bhatnagar and DeFilippis: 550 South Jackson Street, 3rd Floor, Louisville, Kentucky 40202.
Dr. Benjamin: 88 East Newton Street, 8th Floor, Suite C, Boston, MA 02118.
Dr. Hall: 2500 North State Street, Jackson, MS 39216.
Dr. Blaha: 600 North Wolfe Street, Blalock 524D1, Baltimore, MD 21287.
Author Contributions: Conception and design: M. Mirbolouk, P. Charkhchi, S. Kianoush, O.A. Orimoloye, A. Bhatnagar, A.P. DeFilippis, W. Maziak, M.J. Blaha.
Analysis and interpretation of the data: M. Mirbolouk, P. Charkhchi, S. Kianoush, S.M.I. Uddin, O.A. Orimoloye, A. Bhatnagar, A.P. DeFilippis, M.J. Blaha.
Drafting of the article: M. Mirbolouk, P. Charkhchi, S. Kianoush, S.M.I. Uddin, O.A. Orimoloye, A.P. DeFilippis, W. Maziak, K. Nasir, M.J. Blaha.
Critical revision for important intellectual content: M. Mirbolouk, P. Charkhchi, S. Kianoush, S.M.I. Uddin, O.A. Orimoloye, R. Jaber, A. Bhatnagar, E.J. Benjamin, M.E. Hall, A.P. DeFilippis, W. Maziak, K. Nasir, M.J. Blaha.
Final approval of the article: M. Mirbolouk, P. Charkhchi, S. Kianoush, S.M.I. Uddin, O.A. Orimoloye, R. Jaber, A. Bhatnagar, E.J. Benjamin, M.E. Hall, A.P. DeFilippis, W. Maziak, K. Nasir, M.J. Blaha.
Provision of study materials or patients: M. Mirbolouk, P. Charkhchi, M.J. Blaha.
Statistical expertise: M. Mirbolouk, P. Charkhchi, S.M.I. Uddin, M.J. Blaha.
Obtaining of funding: A. Bhatnagar, M.J. Blaha.
Administrative, technical, or logistic support: M. Mirbolouk, P. Charkhchi, M.J. Blaha.
Collection and assembly of data: M. Mirbolouk, P. Charkhchi, M.J. Blaha.
This article was published at Annals.org on 28 August 2018.