E-Cigarette Use Prevalent Among Men, People With Comorbidities, Survey Finds

E-cigarette use in the United States is more prevalent in people who are younger, have comorbid conditions, or are former or current conventional cigarette smokers, according to results from a recent Behavioral Risk Factor Surveillance System (BRFSS) national report.

When e-cigarettes were first introduced in the United States in the 1980s, there were 2 different viewpoints: one from the general population and one from the medical community. The general population viewed e-cigarettes as safer substitutes for current tobacco smokers because e-cigarettes were thought to “expose users to a lower level and smaller number of the harmful components of cigarette smoke, such as carcinogens and oxidant gases” than conventional cigarettes.¹ The medical community, however, remained skeptical because e-cigarettes’ safety and their utility in smoking cessation had not yet been proved.

To determine the national and state-level impacts of e-cigarettes in the United States, the CDC together with all 50 states conducted the BRFSS survey, including data on 466,842 people.² The study population was categorized into subgroups including e-cigarette use, sexual orientation, gender identity, current/former/nonsmoker, comorbidities, and other socioeconomic parameters.

Do current or former smokers use more e-cigarettes most?

Among the population, current e-cigarette use was 4.5%, with 33.5% of smokers’ reporting daily use. The study’s current usage percentage translates to an estimated 10.8 million e-cigarette users across the entire population. Usage was highest in the 18-to-24 age group and decreased with increasing age. Of the estimated 10.8 million e-cigarette users in the US extrapolated from this data, an estimated 2.8 million adults would be 18 to 24 years old. Former and current cigarette users were more likely to use e-cigarettes than never-smokers, with 15% of current e-cigarette users being non—cigarette smokers, 30.4% being former smokers, and 54.6% being current cigarette smokers.

The survey also revealed that 60% of current e-cigarette users were men and usage was higher among lesbian, gay, bisexual, and transgender adults. Groups with comorbid conditions, such as cardiovascular disease, cancer, asthma, and chronic obstructive pulmonary disease, also had higher e-cigarette use compared with those without the same conditions. By region, Southern and Western states had high prevalence (>6%) of e-cigarette use, except for California (3.3%); Northeastern states had low current use (3%-5%), except for New Hampshire (6.1%); and the Midwest region varied from 3.0% to 6.2%.

The prevalence of e-cigarette use has increased since a previous study in 2013-2014 (3.7%-4.5%). Findings from this study were similar to those of previous reports, whose results showed the most prevalent e-cigarette users were younger in age and once smoked or were currently smoking conventional cigarettes. Overall, this study has helped identify an estimate of e-cigarette use in the US and could inform health policy experts on the current size and distribution of e-cigarette users as they develop research programs, public education campaigns, and regulatory policy around tobacco use, the authors conclude.

References

1. Rigotti N. Monitoring the rapidly changing landscape of e-cigarettes [published online August 28, 2018]. Ann Intern Med. doi: 10.7326/M18-2176.
2. 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 [published online August 28, 2018]. Ann Intern Med. doi: 10.7326/M17-3440.