E-cigarettes may be a healthier alternative for adult smokers than traditional cigarettes, but they have also attracted some otherwise tobacco-naïve young adults, according to a report published in the Annals of Internal Medicine.1

Researchers examined demographic, geographic, behavioral, and perception-based data from the Behavioral Risk Factor Surveillance System 2016 to understand patterns among adults in the United States who reportedly used e-cigarettes as their only tobacco source vs nonusers who had not smoked combustible cigarettes.1

The researchers found a rate of sole e-cigarette use of 1.4% (95% CI, 1.3%-1.5%) in 2016, for an estimated 1.9 million people smoking exclusively e-cigarettes, with 17.7% (95% CI, 15.1%-20.6%) of them reporting daily use. People ages 18 to 24 years formed the age group with the greatest incidence of sole users.1

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Some behaviors that were more common among sole e-cigarette users compared with nonusers included heavy drinking (7.4% vs 3.9%) and binge drinking (26.3% vs 13.1%). Within the 30 days prior to the survey, drinking and driving (6.3% vs 3.3%) and marijuana use (24.9% vs 4.2%) were also more common among sole e-cigarette users than nonusers.1

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Mental distress was more prevalent among sole e-cigarette users, occurring on 21 to 30 of the prior 30 days for 10.3% of sole e-cigarette users vs 4.6% of nonusers.1

An editorial accompanying the report noted that while overall e-cigarette use is becoming less common among US adults (declining from 3.7% in 2014 to 3.2% in 2016), among never-smokers, use increased during the same period (0.4% to 0.7%).2

Prevalence of e-cigarette use was low in 2016, but a younger demographic of tobacco-naïve adults may be turning to e-cigarette use.1


1. Mirbolouk M, Charkhchi P, Orimoloye OA, et al. E-cigarette use without a history of combustible cigarette smoking among U.S. adults: Behavioral Risk Factor Surveillance System, 2016 [published online October 9, 2018]. Ann Intern Med. doi: 10.7326/M18-1826

2. Thorndike AN. E-cigarette use by young adult nonsmokers: next-generation nicotine dependence? [published online October 9, 2018]. Ann Intern Med. doi: 10.7326/M18-2581