Demographic Characteristics, Cigarette Smoking, and e-Cigarette Use Among US Adults | Lifestyle Behaviors | JAMA Network Open | JAMA Network
[Skip to Navigation]
Sign In
Table 1.  Prevalence of Current Vaping by Cigarette Smoking Status, 2018-2019 Tobacco Use Supplement to the Current Population Surveya
Prevalence of Current Vaping by Cigarette Smoking Status, 2018-2019 Tobacco Use Supplement to the Current Population Surveya
Table 2.  Self-reported Use of e-Cigarettes to Quit Smoking Among Current and Former Cigarette Smokers Who Currently Vape, 2018-2019 Tobacco Use Supplement to the Current Population Survey
Self-reported Use of e-Cigarettes to Quit Smoking Among Current and Former Cigarette Smokers Who Currently Vape, 2018-2019 Tobacco Use Supplement to the Current Population Survey
1.
US Department of Commerce, Census Bureau. National Cancer Institute and Food and Drug Administration co-sponsored Tobacco Use Supplement to the Current Population Survey, 2018-2019. Published 2020. Accessed May 29, 2020. https://cancercontrol.cancer.gov/brp/tcrb/tus-cps/
2.
Everard  CD, Silveira  ML, Kimmel  HL, Marshall  D, Blanco  C, Compton  WM.  Association of electronic nicotine delivery system use with cigarette smoking relapse among former smokers in the United States.   JAMA Netw Open. 2020;3(6):e204813. doi:10.1001/jamanetworkopen.2020.4813PubMedGoogle Scholar
3.
Gotts  JE, Jordt  SE, McConnell  R, Tarran  R.  What are the respiratory effects of e-cigarettes?   BMJ. 2019;366:l5275. doi:10.1136/bmj.l5275PubMedGoogle ScholarCrossref
4.
US Department of Health and Human Services. e-Cigarette use among youth and young adults: a report of the Surgeon General. Published 2016. Accessed May 29, 2020. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf
5.
Wang  TW, Gentzke  AS, Creamer  MR,  et al  Tobacco product use and associated factors among middle and high school students—United States, 2019.   MMWR Surveill Summ. 2019;68(12):1-22. doi:10.15585/mmwr.ss6812a1Google ScholarCrossref
6.
Dai  H, Leventhal  AM.  Prevalence of e-cigarette use among adults in the United States, 2014-2018.   JAMA. 2019;322(18):1824–1827. doi:10.1001/jama.2019.15331PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Research Letter
    Public Health
    October 13, 2020

    Demographic Characteristics, Cigarette Smoking, and e-Cigarette Use Among US Adults

    Author Affiliations
    • 1Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
    • 2Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
    • 3Metabolic Epidemiology Branch, Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
    JAMA Netw Open. 2020;3(10):e2020694. doi:10.1001/jamanetworkopen.2020.20694
    Introduction

    Understanding how electronic cigarettes (e-cigarettes) are used by current, former, and never cigarette smokers may inform public health actions and tobacco regulations. Therefore, we examined the distribution of e-cigarette use, also called vaping, in the 2018-2019 Tobacco Use Supplement to the Current Population Survey, the largest nationally representative tobacco use survey of US adults.

    Methods

    This cross-sectional study was determined to be exempt from review by an institutional review board at the National Institutes of Health because it was not human subjects research and used deidentified public use data. Informed consent was obtained prior to interviews by the US Census Bureau, which conducted the field work. In this study, adults aged 18 years and older were interviewed by phone (two-thirds of respondents) or in-home (one-third of respondents) once between July 2018 and May 2019 using probability-based multistage sampling.1 Among 137 471 self-respondents (self-response rate = 57.6%), we examined current e-cigarette use by demographic characteristics and cigarette smoking status. We also assessed whether former and current cigarette smokers who vape reported using e-cigarettes to help them quit smoking. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

    Weighted frequencies and proportions for statistical analysis were estimated with SAS-Callable SUDAAN (SAS version 9.4 [SAS Institute]; SUDAAN version 11.0.3 [RTI International]) using self-response survey weights. Data analysis was performed from October 2019 to July 2020.

    Results

    The 2018-2019 Tobacco Use Supplement to the Current Population Survey was weighted to reflect the demographic characteristics of the US adult population. Our analytic sample included an unweighted total of 135 211 individuals with information on both cigarette and e-cigarette use (73 853 women [weighted percentage, 51.9%], weighted mean [SE] age 47.5 years [0.0]), of which 16 570 were current smokers (11.4% [95% CI, 11.2%-11.6%]), 29 189 were former smokers (18.2% [95% CI, 18.0%-18.5%]), and 90 906 were never cigarette smokers (70.3% [95% CI, 70.0%-70.7%]).

    Overall, we estimate that more than 5.66 million adults in the US population reported current vaping (2.3% [95% CI, 2.2%-2.4%]). Among e-cigarette users, more than 2.21 million were current cigarette smokers (39.1% [95% CI, 36.8%-41.4%]), more than 2.14 million were former smokers (37.9% [95% CI: 35.6%-40.1%]), and more than 1.30 million were never smokers (23.1% [95% CI, 20.8%-25.4%]) (Table 1).

    The prevalence of vaping was higher among men (2.8%; 95% CI, 2.7%-3.0%) and among non-Hispanic White (2.8% [95% CI, 2.6%-2.9%]), American Indian/Alaskan Native (4.2% [95% CI, 2.8%-6.4%]), and multiracial (4.5% [95% CI, 3.3%-6.2%]) individuals. There was higher prevalence with increasing education level (less than high school: 2.2% [95% CI, 1.8%-2.6%]; high school degree: 3.0% [95% CI, 2.7%-3.2%]; and some college: 3.1% [95% CI, 2.8%-3.3%]), except for individuals with a college degree (1.2% [95% CI, 1.1%-1.4%]), who had the lowest prevalence. Across all categories of sex, race/ethnicity, and education, the majority of vapers were current or former smokers. There were, however, differences by age. Among never smokers who vaped, 63.4% (95% CI, 58.2%-68.7%) were between 18 and 24 years old, and 23.8% (95% CI, 19.6%-28.1%) were between 25 and 34 years old. In contrast, e-cigarette users who were current or former smokers tended to be older (Table 1).

    Among current dual users of cigarettes and e-cigarettes, 69.3% (95% CI, 65.7%-72.7%) reported using e-cigarettes to try to quit smoking. However, among former smokers who currently vape, 80.7% (95% CI, 77.4%-83.5%) reported that they had used e-cigarettes to help them quit smoking (Table 2).

    Discussion

    We estimate a vaping prevalence of 2.3% among US adults. An estimated 39.1% of e-cigarette users were current smokers and 37.9% were former smokers. A majority of both groups reported using or having used e-cigarettes to help them quit cigarette smoking. Whether vaping actually helps smokers quit is unclear, however, and cannot be evaluated using cross-sectional data. Longitudinal studies and trials are needed to answer this important question and to determine the long-term health effects of dual use, which was the most common pattern of use reported. The large number of former smokers who currently vape is additionally worrisome, given recent reports that former smokers who vape are more likely to experience a smoking relapse.2

    Additionally, 23.1% of e-cigarette users reported never smoking, and most were younger than 35 years. In addition to the potential health effects of vaping,3 the young age of many users is concerning, particularly as nicotine is highly addictive and can negatively affect brain development, which continues until age 25 years.4

    Limitations of this study include a cross-sectional design and self-reported data. Strengths of these analyses include recency of the data and a large nationally representative sample, which makes the findings generalizable.

    e-Cigarettes are now used by large numbers of never, former, and current cigarette smokers in the US population. Given the rapidly changing e-cigarette marketplace and recent increases in the prevalence of use among youth5 and young adults,6 continued surveillance is needed.

    Back to top
    Article Information

    Accepted for Publication: August 5, 2020.

    Published: October 13, 2020. doi:10.1001/jamanetworkopen.2020.20694

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Mayer M et al. JAMA Network Open.

    Corresponding Author: Margaret Mayer, PhD, MPH, Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, 3E560, Bethesda, MD 20892-9761 (margaret.mayer@nih.gov).

    Author Contributions: Dr Mayer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Mayer, Reyes-Guzman, Choi, Freedman.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Mayer, Grana, Freedman.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Mayer, Choi.

    Administrative, technical, or material support: Grana, Freedman.

    Supervision: Reyes-Guzman, Choi, Freedman.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: Dr Choi’s effort was supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities.

    Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Disclaimer: The views and opinions expressed in this study are those of the authors only and do not necessarily represent the views, official policy, or position of the US Department of Health and Human Services or any of its affiliated institutions or agencies.

    References
    1.
    US Department of Commerce, Census Bureau. National Cancer Institute and Food and Drug Administration co-sponsored Tobacco Use Supplement to the Current Population Survey, 2018-2019. Published 2020. Accessed May 29, 2020. https://cancercontrol.cancer.gov/brp/tcrb/tus-cps/
    2.
    Everard  CD, Silveira  ML, Kimmel  HL, Marshall  D, Blanco  C, Compton  WM.  Association of electronic nicotine delivery system use with cigarette smoking relapse among former smokers in the United States.   JAMA Netw Open. 2020;3(6):e204813. doi:10.1001/jamanetworkopen.2020.4813PubMedGoogle Scholar
    3.
    Gotts  JE, Jordt  SE, McConnell  R, Tarran  R.  What are the respiratory effects of e-cigarettes?   BMJ. 2019;366:l5275. doi:10.1136/bmj.l5275PubMedGoogle ScholarCrossref
    4.
    US Department of Health and Human Services. e-Cigarette use among youth and young adults: a report of the Surgeon General. Published 2016. Accessed May 29, 2020. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf
    5.
    Wang  TW, Gentzke  AS, Creamer  MR,  et al  Tobacco product use and associated factors among middle and high school students—United States, 2019.   MMWR Surveill Summ. 2019;68(12):1-22. doi:10.15585/mmwr.ss6812a1Google ScholarCrossref
    6.
    Dai  H, Leventhal  AM.  Prevalence of e-cigarette use among adults in the United States, 2014-2018.   JAMA. 2019;322(18):1824–1827. doi:10.1001/jama.2019.15331PubMedGoogle ScholarCrossref
    ×