e-Cigarette Use Rises Among Young Adults Who Have Not Smoked Combustible Cigarettes, Study Finds


Research from the American Cancer Society suggests that more young people are being introduced to nicotine via e-cigarettes.

A new study of trends in e-cigarette use from 2014 to 2018 found higher use among adults aged 18 to 29 who have never smoked combustible cigarettes.1 The study from the American Cancer Society, published Monday in the American Journal of Preventive Medicine, assessed trends based on age group and cigarette smoking histories.

Researchers examined data from the National Health Institute to pinpoint trends in younger (18-29 years), middle-aged (30-49 years), and older (≥ 50 years) populations, with cigarette smoking histories classified as current smokers, recent quitters (quit < 1 year ago), near-term quitters (quit 1-8 years ago), and never smokers.

E-cigarette use increased across the board among younger adults, with never smokers and near-term quitters seeing the most significant increases (1.3%–3.3% and 9.1%–19.2%, respectively). Middle-aged and older adults only saw notable increases in prevalence among near-term quitters, with e-cigarette use in middle-aged near-quitters jumping from 5.8% to 14.4% and older near-quitters climbing from 6.3% to 9.5%.

The findings suggest that near-term quitters continue to use e-cigarettes after transitioning from combustible cigarettes. More alarmingly, the rise in use among younger people who did not smoke previously suggests that this population is being introduced to nicotine with e-cigarettes. Since the number of non-smokers is growing, the absolute population increase in this demographic was the largest, jumping from 0.49 million to 1.35 million. Middle-aged (0.36 to 0.95 million), younger (0.23 to 0.57 million), and older (0.35 to 0.50 million) near-term quitters saw the next largest jumps. Both trends are concerns for researchers.

“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,” Priti Bandi, PhD, principal scientist, Risk Factors Surveillance Research for the American Cancer Society, said in a press release.

The CDC acknowledges that e-cigarettes have potential as an alternative to combustible cigarettes to help adult smokers quit, but cautions that these devices still typically contain nicotine and a host of other potentially harmful aerosols.2 E-cigarettes are under continual scrutiny by researchers, but as a relatively new product, their long-term health effects have yet to be confirmed.

Previous studies have also suggested that the number of younger people using e-cigarettes is growing. One recent study published in JAMA Pediatrics found this to be particularly true in the United States and Canada, where the sale and marketing of e-cigarettes faces less restrictions than in England.3

E-cigarettes generally contain fewer harmful aerosols than combustible cigarettes, but nicotine is addictive and known to harm brain development in youth and young adults. For its part, the CDC advises those who have not smoked or used tobacco products in the past, no matter their age, not to start using e-cigarettes.


1. Bandi P, Cahn Z, Sauer AG. Trends in e-cigarette use by age group and combustible cigarette smoking histories, U.S. adults, 2014–2018. Am J Prev Med. Published online October 5, 2020. doi:10.1016/j.amepre.2020.07.026

2. About Electronic Cigarettes (E-Cigarettes). CDC. Accessed October 5, 2020.

3. Hammond D, Rynard VL, Reid JL. Changes in prevalence of vaping among youths in the United States, Canada, and England from 2017 to 2019. JAMA Pediatrics. Published online May 4, 2020. doi:10.1001/jamapediatrics.2020.0901

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