The proportion of Americans who smoke cigarettes continues to fall. At the same time, an increasing number have switched to using e-cigarettes instead, whilst the overall use of nicotine products has changed only marginally. This is shown by a new study in the journal Nicotine & Tobacco Research, in which researchers analysed trends in smoking and vaping over a ten-year period in the US.
The researchers based their analysis on the National Health Interview Survey (NHIS), which provides quarterly data from 2014 to 2024.
New method provides a clearer picture
According to the researchers, much of the ongoing monitoring of tobacco and nicotine use is based on analysing each product separately – for example, how many people smoke cigarettes or use e-cigarettes. This makes it difficult to track how people actually switch between different products.
In the new study, participants were therefore divided into nine different groups, depending on whether they smoked, used vejp or used both products, and whether their use was daily or more sporadic.
– ‘This type of classification makes it possible to track changes in usage patterns over time, rather than simply measuring the prevalence of individual products,’ the researchers write.
More vejpar – fewer smokers
The results show that overall use of cigarettes or e-cigarettes fell only slightly during the period – from 18 per cent of the population at the start of 2014 to 16 per cent at the end of 2024.
At the same time, the composition of users changed significantly.
Among people who used any of the products, the proportion who smoked only fell from 80 to 50 per cent. During the same period, the proportion who used only e-cigarettes rose from 5 to 40 per cent.
So-called ‘dual use’ – people who both smoke and use vejp – also changed over time. The researchers describe the trend as U-shaped: initially, dual use declined, only to rise again in recent years.
The biggest change is among younger people
The most marked trend was seen among younger adults.
In the 18–29 age group, the proportion of exclusive smokers fell from 73 per cent to 7 per cent among those who used cigarettes or e-cigarettes.
There was also a significant change among people aged between 30 and 44, with the proportion of exclusive smokers falling from 78 to 47 per cent. For the 45–59 age group, the corresponding proportion fell from 84 to 72 per cent.
Among people over the age of 60, however, the trend was different. In this group, cigarette smoking continued to dominate clearly throughout the study period, with only minor changes.
”May represent a reduced risk”
The researchers believe that the results show a clear shift in how nicotine is used in the US.
”A clear shift from smoking cigarettes exclusively to using vejp exclusively took place between 2014 and 2024. This transition may represent a reduction in harm at population level as users switch to non-combustible products, particularly among younger adults, whilst the change has been limited among older adults.”
At the same time, the researchers emphasise that it remains important to strike a balance between providing adult smokers with access to lower-risk alternatives and preventing people who do not use nicotine from taking up these products.
The researchers also point out that the persistently high proportion of smokers among older adults shows that this group requires specific measures.
Confirms previous trends
The findings are in line with several US studies previously reported on by Vejpkollen. In recent years, US authorities, amongst others, have shown that e-cigarettes have become the most common aid for quitting smoking among adult smokers. Other studies have linked the faster decline in smoking to increased use of e-cigarettes, whilst several analyses have suggested that restrictions on flavoured e-cigarettes have, in some cases, been followed by an increase in cigarette sales or a rise in the number of young smokers.
