How Widespread Is the Use of E-Cigarettes Among Adults Who Have Never Smoked? A Tale of Three Studies

Background: Whilst e-cigarettes have been characterised as a less harmful means of consuming nicotine than combustible cigarettes, concerns have been expressed about the use of these devices by adults who have never smoked (ANS). It is important to quantify the prevalence of e-cigarette use and understand patterns of use among ANS to effectively guide public health policy and regulatory decisions. Methods The prevalence and patterns of e-cigarette use among ANS were estimated drawing upon data from three nationally representative surveys in the U.S. including the Population Assessment of Tobacco and Health (n = 29,780), the Tobacco Product Prevalence Study (n = 6,428), and the National Health Interview Survey (27,651). Results Between 9 million and 20 million ANS have ever tried e-cigarettes and most ever use is experimental meaning that use is limited to less than 100 times or has never been regular. We estimated that between 2.6 million and 5.2 million ANS are currently (in the past 30 days, ‘every day’ or ‘some days’) using e-cigarettes and current use is primarily infrequent (on less than 20 days of the past 30 days or on ‘some days’). Conclusions E-cigarettes are intended to be used by adults who are currently smoking and as such ANS are an unintended user population. It is important to implement real-time monitoring systems to track e-cigarette use among ANS, so the overall public health impact of these new tobacco and nicotine products can be adequately assessed.