Use of electronic cigarettes appeared to have stabilized among U.S. adults in 2018, with cigarette smokers who had recently kicked the habit reporting the highest rates of ever- and current e-cigarette use, according to national survey data.

In 2018, 3.2% of surveyed adults (ages 18 and older) reported regular current e-cigarette use, which was the same percentage as in 2016, reported Maria Villarroel, PhD, of the CDC National Center for Health Statistics (NCHS), and colleagues.

And 14.9% of respondents in the 2018 survey reported having ever tried an e-cigarette in 2018 versus 13.9% in 2014 and 15.3% in 2016, they wrote in an NCHS Data Brief.

Adults who said they quit smoking traditional cigarettes within the past year were most likely to use e-cigarettes, with one in four (25.2%) recent smokers reporting that they were current e-cigarette users and more than half (57.35%) reporting ever use.

E-cigarette market leaders, such as JUUL Labs, have long promoted their products as alternatives to traditional cigarettes for adult smokers who want to quit, but the extent to which they are being used by smokers transitioning from combustible cigarettes remains unknown.

The latest data on e-cigarette use among adults from the National Health Interview Survey (NHIS) finds that while use of e-cigarettes is high among smokers who have recently quit, it is also high among current cigarette smokers.

Almost half of active cigarette smokers surveyed said they had tried e-cigarettes at least once, and 9.7% reported current dual use of traditional cigarettes and e-cigarettes. By way of comparison, just 1.1% of never smokers and 1.7% of former smokers who quit at least 5 years earlier reported current use of e-cigarettes in the 2018 survey.

Roughly 34 million adults in the U.S. were current cigarette smokers in 2018 and there were 55 million former smokers.

Villarroel told MedPage Today that it is not possible to infer from the survey findings if adult cigarette smokers are successfully using e-cigarettes to stop smoking.

“We don’t have data on when people started using e-cigarettes and when they started smoking cigarettes,” she said.

Chris Bostic, deputy director for policy for the anti-tobacco group Action of Smoking and Health (ASH), told MedPage Today that the role of e-cigarettes in smoking cessation remains highly controversial within the public health community, given their skyrocketing use among children, teens, and young adult non-smokers.

From 2018 to 2019 alone, e-cigarette use among middle-school and high-school students increased by 1.8 million, from 3.6 million to 5.4 million, according to the CDC.

“The ideal policy would be to find a way to give smokers ready access to these products with children having no access,” Bostic said. “But we’ve seen that this is hard. If e-cigarettes are on the market, kids are going to find them.”

The latest survey data found that men were almost twice as likely to report current e-cigarette use as women (4.3% vs. 2.3%), while young adults were far more likely to use e-cigarettes than older adults, with 7.6% of those ages 18 to 24 reporting current use versus 4.3% of those ages 25 to 44, 2.1% of those ages 45 to 64, and 0.8% of those ages 65 and older.

Villarroel’s group also reported that non-Hispanic whites were more likely to report current e-cigarette use (3.7%) than Hispanics (2.5%), non-Hispanic-blacks (1.6%) and non-Hispanic Asians (2.2%).

However, differences in use by income were not statistically significant with 3.9%, 3.5%, and 3.1% of respondents classified as “poor,” “near poor,” or “not poor,” respectively, reporting current use.

Among former smokers, the percentage of adults who had ever used an e-cigarette, or who were current users, declined with longer duration of quitting smoking.

The percentage of adults reporting ever using an e-cigarette or being current users was lowest among respondents who had never smoked traditional cigarettes, with just one in 100 (1.1%) reporting current e-cigarette use and 6.5% reporting ever use.