Understanding the Prevalence and Trends of E-cigarette Use

The awareness and use of e-cigarettes is increasing. E-cigarettes are advertised in magazines, convenience stores, internet web sites and social media networks.12 E-cigarette advertisement rose from $6.4 million in 2011 to $115 million in 2014.70

Their high-tech design, wide variety of flavors and easy availability are sold via mall kiosks, convenience stores, online websites and retail outlets making e-cigarettes desirable to youth and young adults.13,20 A typical starter kit, which contains the e-cigarette device, a battery and several cartridges, can cost anywhere from $30 to $100, depending on the manufacturer, model and style. And then there's the cost of the cartridges. The cost of a year's worth of replacement cartridges for sustaining the equivalent of a pack-a-day habit will cost about $600.9 E-cigarettes have also been endorsed by celebrity spokespeople such as Jenny McCarthy and Stephen Dorff. E-cigarettes are being seen more frequently in public by actors, including Leonardo DiCaprio, Katy Perry, Bruno Mars and many more.14-16

According to the Philadelphia Department of Public Health, in 2010, 40% of adults were aware of e-cigarettes and 10% of tobacco smokers had used an e-cigarette recently. In 2011, this number rose to 60% of adults aware of e-cigarettes with 21% of smokers having used an e-cigarette recently. While e-cigarette usage increased for all groups that were studied, including young adults, the sharpest increases were seen among non-Hispanic Caucasians aged 45–54 years, in both current and former smokers.17

The National Center of Biotechnological Information (NCBI) published information gained from two surveys that were conducted in 2010: a national online study (n = 2649) and the Legacy Longitudinal Smoker Cohort (n = 3658). Multivariable models were used to examine e-cigarette awareness, use, and harm perceptions.18

The results of the two studies found that 40.2% of participants had heard of e-cigarettes, with the highest awareness being among current tobacco smokers. Utilization of e-cigarettes was higher among current tobacco smokers (11.4%) than in the total population (3.4%). In addition, 2.0% of former tobacco smokers were now using e-cigarettes and 0.8% of those who had never used tobacco were now using e-cigarettes. In both surveys, non-Hispanic Caucasians, current smokers, young adults, and those with at least a high-school diploma were most likely to perceive e-cigarettes as less harmful than regular cigarettes. The article recommended product regulation and careful surveillance to monitor public health impact and emerging utilization patterns.

Etter and Bullen studied the profile, utilization, satisfaction and perceived efficacy of e-cigarettes. They determined the awareness of the product is high in the adult population and the most common reasons for using e-cigarettes (as stated by consumers) is to help with cravings, to use less toxic alternatives to regular cigarettes, to avoid relapse, and to attempt to cut down or quit smoking.19

Bullen, et al, evaluated the use of e-cigarettes for tobacco cessation and concluded that among smokers wanting to quit, nicotine e-cigarettes might be as effective as patches for achieving cessation at 6 months. Additionally, they identified no difference in adverse events with e-cigarettes as compared to the patches.36

Possibly of greater concern is the use of e-cigarettes in adolescents. A study by Jamal A, Gentzke A, Hu S, analyzed data from the 2011–2016 National Youth Tobacco Surveys (NYTS) The survey examined middle and high school students in the United States from 2011-2016.

Among all high school students, current use of any tobacco product did not change significantly from 2011 (24.2%) to 2016 (20.2%); however, a nonlinear decrease occurred in current use of any combustible tobacco product (21.8% to 13.8%), tobacco products (12.0% to 9.6%), cigarettes (15.8% to 8.0%), cigars (11.6% to 7.7%), and smokeless tobacco (7.9% to 5.8%), and a nonlinear decrease occurred in current use of pipe tobacco (4.0% to 1.4%) and bidis (2.0% to 0.5%) A nonlinear increases occurred for current use of e-cigarettes (1.5% to 11.3%) and hookahs (4.1% to 4.8%).

During 2011–2016, among middle school students, a linear decrease occurred in current use of any combustible tobacco products (6.4% to 4.3%), cigarettes (4.3% to 2.2%), cigars (3.5% to 2.2%), and pipe tobacco (2.2% to 0.7%).

However, during 2015–2016, among high school students, decreases occurred in the use of any tobacco product (25.3% to 20.2%), any combustible tobacco product (17.2% to 13.8%), ≥2 tobacco products (13.0% to 9.6%), e-cigarettes (16.0% to 11.3%), and hookahs (7.2% to 4.8%).

August 8, 2016, the FDA finalized its rule, giving them jurisdiction over the regulation, manufacturing, distribution and marketing of tobacco products, including e-cigarettes, cigars, pipe tobacco, and hookah tobacco. Implementation of comprehensive tobacco control and prevention strategies at CDC-recommended funding levels Tobacco prevention and control strategies at the national, state, and local levels likely have contributed to the reduction in use of certain tobacco products, including e-cigarettes, among youths in recent years.77

The Food and Drug Administration (FDA) warned of health risks posed by e-cigarette use.13 Reported concerns included:

  • More than 3 million middle and high school students were current users of e-cigarettes in 2015, up from an estimated 2.46 million in 2014.73,74
  • Sixteen percent of high school and 5.3 percent of middle school students were current users of e-cigarettes in 2015, making e-cigarettes the most commonly used tobacco product among youth for the second consecutive year.73
  • During 2011-2015, e-cigarette use rose from 1.5 percent to 16.0 percent among high school students and from 0.6 percent to 5.3 percent among middle school students.73
  • In 2013-2014, 81% of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use.77
  • In 2014, 12.6% of U.S. adults had ever tried an e-cigarette, and about 3.7% of adults used e-cigarettes daily or some days.78

Figure 4. Estimated percentage of high school students who currently use any tobacco products, any combustible tobacco products, ≥2 tobacco products, and selected tobacco products — National Youth Tobacco Survey, United States, 2011–2016.

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Figure 5. Estimated percentage of middle school students who currently use any tobacco products, any combustible tobacco product, ≥2 tobacco products, and selected tobacco products — National Youth Tobacco Survey, 2011–2016.

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