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E-Cigarette Use
E-Cigarette Use in United States
United States

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United States Value:

7.7%

Percentage of adults who reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days

E-Cigarette Use in depth:

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General Population

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E-Cigarette Use by State

Percentage of adults who reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days




E-Cigarette Use Trends

Percentage of adults who reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days

Trend: E-Cigarette Use in United States, 2023 Annual Report

Percentage of adults who reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days

United States
Source:

 CDC, Behavioral Risk Factor Surveillance System

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About E-Cigarette Use

US Value: 7.7%

Top State(s): Maryland: 4.5%

Bottom State(s): Oklahoma: 11.0%

Definition: Percentage of adults who reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days

Data Source and Years: CDC, Behavioral Risk Factor Surveillance System, 2022

Suggested Citation: America's Health Rankings analysis of CDC, Behavioral Risk Factor Surveillance System, United Health Foundation, AmericasHealthRankings.org, accessed 2023.

Electronic cigarettes, also called e-cigarettes or vape pens, are electronic devices that use heat to make an aerosol that is inhaled by the user. In recent years, there has been an increase in the popularity of e-cigarettes, especially among youth. The aerosol made by e-cigarettes contains toxic substances that can cause cancer and serious lung disease. Use of e-cigarettes is associated with increased odds of developing respiratory symptoms or wheezing and respiratory disease. A 2017 study also found e-cigarette use in adolescence to be a strong predictor of regular cigarette use in adulthood. 

E-cigarettes are typically used to deliver the highly addictive compound nicotine or tetrahydrocannabinol (THC), the active component of cannabis, and may contain flavorings and other additives. Nicotine is harmful to pregnant women and their developing fetuses and has also been found to negatively affect brain development in children and adolescents. Additives in e-cigarettes include other harmful substances such as cancer-causing chemicals and flavoring chemicals that are linked to serious lung disease and lung injury.

According to America’s Health Rankings data, populations with a higher rate of e-cigarette use include:

  • Men compared with women. 
  • Adults ages 18-44 compared with older adults.
  • Hawaiian/Pacific Islander and multiracial adults compared with Black adults. 
  • Adults with a high school diploma or GED degree compared with college graduates.
  • Adults with annual household incomes less than $75,000 compared with adults with higher income levels. 
  • Adults living in non-metropolitan areas compared with those in metropolitan areas.

Regulations and policies to prevent e-cigarette-related harms include

  • Restricting flavors, including menthol, on all e-cigarette products.
  • Restricting the concentration of nicotine products.
  • Regulating e-cigarette companies directly by increasing taxes on and limiting density for e-cigarette distributors.
  • Restricting e-cigarette advertisements online and on social media platforms such as YouTube, Twitter and Instagram, particularly ads targeting youth.
  • Reporting on and assessing lung injuries caused by e-cigarette use.

The types of e-cigarette products available to consumers have evolved dramatically and regulations have been slow to respond. An expansion of existing tobacco policies and regulations to include e-cigarette products is needed to protect young people from e-cigarette addiction and related lung injury.

Studies have shown mixed results on whether e-cigarettes are effective in cigarette smoking cessation, more research in this area is needed. Currently the FDA has not approved e-cigarettes as an aid for smoking cessation, however it has approved the use of other types of smoking cessation medications.

Reducing current e-cigarette use among adolescents is a Healthy People 2030 goal.

Bhatta, Dharma N., and Stanton A. Glantz. “Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis.” American Journal of Preventive Medicine 58, no. 2 (February 1, 2020): 182–90. https://doi.org/10.1016/j.amepre.2019.07.028.

Dasgupta, Nabarun, and Alfredo Morabia. “Experimental Forum 2: Two Years After the 2020 Food and Drug Administration Guidance on E-Cigarette Flavors.” American Journal of Public Health 112, no. 7 (July 2022): 995–98. https://doi.org/10.2105/AJPH.2022.306921.

England, Lucinda J., Rebecca E. Bunnell, Terry F. Pechacek, Van T. Tong, and Tim A. McAfee. “Nicotine and the Developing Human.” American Journal of Preventive Medicine 49, no. 2 (August 16, 2015): 286–93. https://doi.org/10.1016/j.amepre.2015.01.015.

Mravec, Boris, Miroslav Tibensky, Lubica Horvathova, and Pavel Babal. “E-Cigarettes and Cancer Risk.” Cancer Prevention Research 13, no. 2 (February 1, 2020): 137–44. https://doi.org/10.1158/1940-6207.CAPR-19-0346.

Soneji, Samir, Jessica L. Barrington-Trimis, Thomas A. Wills, Adam M. Leventhal, Jennifer B. Unger, Laura A. Gibson, JaeWon Yang, et al. “Association Between Initial Use of E-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-Analysis.” JAMA Pediatrics 171, no. 8 (August 1, 2017): 788–97. https://doi.org/10.1001/jamapediatrics.2017.1488.

Wickstrom, Ronny. “Effects of Nicotine During Pregnancy: Human and Experimental Evidence.” Current Neuropharmacology 5, no. 3 (September 1, 2007): 213–22. https://doi.org/10.2174/157015907781695955.

Xie, Wubin, Alayna P. Tackett, Jonathan B. Berlowitz, Alyssa F. Harlow, Hasmeena Kathuria, Panagis Galiatsatos, Jessica L. Fetterman, et al. “Association of Electronic Cigarette Use with Respiratory Symptom Development among U.S. Young Adults.” American Journal of Respiratory and Critical Care Medicine 205, no. 11 (June 2022): 1320–29. https://doi.org/10.1164/rccm.202107-1718OC.

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