E-Cigarette Use Increased Significantly Among Younger U.S. Adults Between 2019 and 2021

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Almost 750,000 more adults in the United States, aged 18 to 29 years, may have used e-cigarettes during the period that spanned the e-cigarette or vaping-product use–associated lung injury outbreak and COVID-19 pandemic from 2019 to 2021, according to a new study published by Bandi et al in the American Journal of Preventive Medicine. The findings demonstrated that the year-on-year increase may have been primarily among adults who never smoked cigarettes.

"Unfortunately, these numbers show we're moving in the wrong direction concerning e-cigarette use in this vulnerable population,” stressed lead study author Priti Bandi, PhD, Scientific Director of Cancer Risk Factors & Screening Surveillance Research at the American Cancer Society. “Our research findings [are] concerning, as [they] may point to an increase in nicotine addiction risk for young adults—potentially contributing to progression to combustible tobacco products and … increasing exposure to unknown toxicants, carcinogens, and the risk of respiratory diseases,” she added.


  • Between 2019 and 2021, e-cigarette use prevalence rose from 8.8% to 10.2% among individuals aged 18 to 29 years.
  • In this group, e-cigarette use increased from 4.9% to 6.4% among those who didn’t have a smoking history between 2019 and 2021.
  • This group also comprised 53% of individuals aged 18 to 29 years who used e-cigarettes in 2021.

Study Methods and Results

In the new study, investigators pooled data from the National Health Interview Survey from 2019, 2020, and 2021 to estimate individuals’ current e-cigarette use prevalence, adjusted prevalence difference between survey years, and population counts by age group and cigarette smoking status. They discovered that from 2019 and 2021, e-cigarette–use prevalence increased from 8.8% to 10.2% among U.S. adults aged 18 to 29 years (adjusted prevalence difference = 1.7%, 95% confidence interval = 0.1%–3.3%; P = .04).

Further, among these younger adults who never smoked cigarettes before, e-cigarette use jumped from 4.9% in 2019, to 5.2% in 2020, and 6.4% in 2021. This group of younger adults constituted 53% (n = 2.68 million) of younger adults who used e-cigarettes in 2021, increasing by 710,000 individuals from 2019. The investigators also found that among middle-aged and older U.S. adults, e-cigarette use prevalence was similar in 2019 and 2021 irrespective of combustible cigarette smoking status. Individuals who formerly smoked cigarettes constituted 51.1% (n = 3.1 million) of those who used e-cigarettes among adults aged 30 years or older in 2021.


“E-cigarette use is not harmless at any age. It may have serious health risks—including negative short-term effects on airways and blood vessels—and we do not know the long-term effects of their use,” Dr. Bandi underscored. “We must address the rise in e-cigarette use among younger adults who never smoked cigarettes and, at the same time, help those who may have switched from cigarettes to e-cigarettes to stop using these devices completely,” she suggested.

"It’s clear [that] Big Tobacco’s strategy is to addict future generations to its products with e-cigarettes, putting the health of the country at risk,” proclaimed Lisa Lacasse, MBA, President of the American Cancer Society Cancer Action Network. “Policymakers at the local, state, and federal levels must take action now to protect the public—especially youth—from this predatory industry. E-cigarettes must be regulated like all other tobacco products, and we urge the [U.S. Food and Drug Administration] to complete and enforce the premarket review process for all new tobacco products, including e-cigarettes,” she concluded.

Disclosure: For full disclosures of the study authors, visit

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