E-Cigarette Use Among Adults

What to know

Everyone deserves a fair and just opportunity to attain their highest level of health. Different factors influence some groups to use e-cigarettes and other tobacco products more than others. Understanding what these influences are is important to addressing commercial tobacco use.

E-cigarette use among U.S. adults

E-cigarette use among adults has been increasing. It rose from 3.7% in 2020 to 4.5% in 2021.1

  • In 2021, about 3 in 10 (29.4%) adults who vaped also smoked cigarettes.2 This is called dual use.
    • Dual use is not an effective way to protect health. It may result in greater exposure to toxins and worse respiratory outcomes than using either product alone.345
    • Smoking even a few cigarettes a day can be dangerous. It is important for people to quit smoking completely to protect their health.345
    • Dual use was more common among older adults. Among adults aged 45 years and older, 42.7% reported both vaping and smoking cigarettes.2
  • Many adults who use e-cigarettes have never smoked cigarettes. In 2021, about 3 in 10 (30.3%) adults who vaped had never smoked cigarettes.2
    • This is particularly true for young adults. Among adults 18-24 years of age, 61.4% reported they vaped and had never smoked cigarettes.2

Some adults use e-cigarettes to try to quit smoking cigarettes. There is currently no e-cigarette approved by the FDA to help people quit smoking. E-cigarettes may have the potential to benefit adults who smoke and are not pregnant if they are used as a complete substitute for all smoked tobacco products.

Most adults who vape want to quit. In a 2016–2018 study, 60.1% of adults who currently used e-cigarettes reported having future plans to quit e-cigarettes.6 In the same study, 15% reported trying to quit in the last year. In another study, about 26% of adults who vaped had tried to quit in the last year.7

There are many factors associated with adult tobacco product use, including vaping. These factors can help explain why some groups use tobacco products more than other groups. Some examples include:

  • The tobacco industry uses tailored marketing and advertising to target some groups and communities.8910
  • Tobacco companies use flavors to entice specific groups of people to try tobacco products.91112
  • The pressures of discrimination, poverty, and other social conditions can increase commercial tobacco use and make health problems worse.1314151617
  • Some groups of people encounter barriers to health care and treatment for tobacco use and dependence.1819202122

Some groups of adults use e-cigarettes at a higher percentage than others. For example:123

  • More men than women report current e-cigarette use.
  • A higher percentage of 18–24 year-olds use e-cigarettes than adults in other age groups. As age increases, use of e-cigarettes decreases.
  • E-cigarette use is higher among adults who have less education or lower incomes, or who do not have health insurance.
  • E-cigarette use is higher among adults who identify as lesbian, gay, or bisexual than adults who identify as heterosexual.
  • E-cigarette use is higher among adults who report serious psychological distress than those who do not.
  1. Cornelius ME, Loretan CG, Jamal A, et al. Tobacco product use among adultsUnited States, 2021. MMWR Morb Mortal Wkly Rep. 2023;72:475–483.
  2. Centers for Disease Control and Prevention.QuickStats: Percentage distribution of cigarette smoking status among current adult e-cigarette users, by age group—National Health Interview Survey, United States, 2021. MMWR Morb Mortal Wkly Rep. 2023;72:270.
  3. Goniewicz ML, Smith DM, Edwards KC, et al. Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes. JAMA Netw Open. 2018;1(8):e185937.
  4. Reddy KP, Schwamm E, Kalkhoran S, et al. Respiratory symptom incidence among people using electronic cigarettes, combustible tobacco, or both. Am J Respir Crit Care Med. 2021;204(2):231–234.
  5. Smith DM, Christensen C, van Bemmel D, et al. Exposure to nicotine and toxicants among dual users of tobacco cigarettes and e-cigarettes: Population Assessment of Tobacco and Health (PATH) Study, 2013-2014. Nicotine Tob Res. 2021;23(5):790–797.
  6. Palmer AM, Smith TT, Nahhas GJ, et al. Interest in quitting e-cigarettes among adult e-cigarette users with and without cigarette smoking history. JAMA Netw Open. 2021;4(4):e214146.
  7. Rosen RL, Steinberg ML. Interest in quitting e-cigarettes among adults in the United States. Nicotine Tob Res. 2020;22(5):857–858.
  8. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Centers for Disease Control and Prevention; 2012. Accessed Feb 14, 2024.
  9. U.S. National Cancer Institute. A Socioecological Approach to Addressing Tobacco Related Health Disparities. National Cancer Institute Tobacco Control Monograph 22. National Institutes of Health; 2017. NIH Publication No. 17-CA-8035A. Accessed March 28, 2024.
  10. U.S. National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control. National Cancer Institute Tobacco Control Monograph 19. National Institutes of Health; 2008. NIH Pub. No. 07-6242. Accessed March 28, 2024.
  11. U.S. Department of Health and Human Services. E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Centers for Disease Control and Prevention; 2016. Accessed Feb 14, 2024.
  12. Gardiner PS. The African Americanization of menthol cigarette use in the United States. Nicotine Tob Res. 2004;6(Suppl 1):S55–S65.
  13. Purnell JQ, Peppone LJ, Alcaraz K, et al. Perceived discrimination, psychological distress, and current smoking status: Results from the Behavioral Risk Factor Surveillance System Reactions to Race module, 2004–2008. Am J Public Health. 2012;102(5):844–851.
  14. Slopen N, Kontos EZ, Ryff CD, et al. Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9-10 years: a prospective study of middle-aged adults in the United States. Cancer Causes Control. 2013;24(10):1849–1863.
  15. Slopen N, Dutra LM, Williams DR, et al. Psychosocial stressors and cigarette smoking among African American adults in midlife. Nicotine Tob Res. 2012;14(10):1161–1169.
  16. Chae DH, Takeuchi DT, Barbeau EM, et al. Unfair treatment, racial/ethnic discrimination, ethnic identification, and smoking among Asian Americans in the National Latino and Asian American Study. Am J Public Health. 2008;98(3):485–492.
  17. Shires DA, Jaffee KD. Structural discrimination is associated with smoking status among a national sample of transgender individuals.Nic Tob Res. 2016;18(6):1502–08.
  18. Babb S, Malarcher A, Schauer G, et al. Quitting smoking among adults—United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 2017;65(52):1457–1464.
  19. Babb S, Malarcher A, Asman K, et al. Disparities in cessation behaviors between Hispanic and non-Hispanic white adult cigarette smokers in the United States, 2000–2015. Prev Chronic Dis. 2020;17:190279.
  20. Zhang L, Babb S, Schauer G, et al. Cessation behaviors and treatment use among U.S. smokers by insurance status, 2000-2015. Am J Prev Med. 2019;57(4):478–486.
  21. Cox LS, Okuyemi K, Choi WS, Ahluwalia JS. A review of tobacco use treatments in U.S. ethnic minority populations. Am J Health Promot. 2011;25(5):S30.
  22. Hooper MW, Payne M, Parkinson KA. Tobacco cessation pharmacotherapy use among racial/ethnic minorities in the United States: considerations for primary care. Fam Med Community Health. 2017;5(3):193–203.
  23. Kramarow EA, Elgaddal N. Current electronic cigarette use among adults aged 18 and over: United States, 2021. NCHS Data Brief, no 475. National Center for Health Statistics; 2023.