Trends in Electronic Cigarette Use Among U.S. Adults: Use is Increasing in Both Smokers and Nonsmokers.
OBJECTIVE
We assessed trends in use of electronic cigarettes among U.S. adults, demographic predictors of use, and smoking status of current electronic cigarette users.


METHODS
Mixed-mode surveys were used to obtain representative, cross-sectional samples of U.S. adults in each of 4 years.


RESULTS
Sample sizes for 2010, 2011, 2012, and 2013 were 3,240, 3,097, 3,101, and 3,245, respectively. Ever use of electronic cigarettes increased from 1.8% (2010) to 13.0% (2013), while current use increased from 0.3% to 6.8%, p < .001. Prevalence of use increased significantly across all demographic groups. In 2013, current use among young adults 18-24 (14.2%) was higher than adults 25-44 (8.6%), 45-64 (5.5%), and 65+ (1.2%). Daily smokers (30.3%) and nondaily smokers (34.1%) were the most likely to currently use e-cigarettes, compared to former smokers (5.4%) and never-smokers (1.4%), p < .001. However, 32.5% of current electronic cigarette users are never- or former smokers.


CONCLUSIONS
There has been rapid growth in ever and current electronic cigarette use over the past 4 years. Use is highest among young adults and current cigarette smokers. Although smokers are most likely to use these products, almost a third of current users are nonsmokers, suggesting that e-cigarettes contribute to primary nicotine addiction and to renormalization of tobacco use. Regulatory action is needed at the federal, state, and local levels to ensure that these products do not contribute to preventable chronic disease.
Department of Psychology, Mississippi State University and American Academy of Pediatrics Julius B. Richmond Center of Excellence, Starkville, MS; rcm19@msstate.edu.
Robert C
RC
McMillen
Public Health Advocacy Institute at Northeastern University School of Law and American Academy of Pediatrics Julius B. Richmond Center of Excellence, Boston, MA;
Mark A
MA
Gottlieb
American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL;
Regina M Whitmore
RM
Shaefer
Department of General Pediatrics, MGH Center for Child and Adolescent Health Policy and American Academy of Pediatrics Julius B. Richmond Center of Excellence, Boston, MA.
Jonathan P
JP
Winickoff
American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL;
Jonathan D
JD
Klein
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult