Noncombustible Nicotine Products Replacing Cigarettes Among Young Adults

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## National Health Data Tracks E-Cigarette Rise
To understand how tobacco use patterns are evolving, researchers analyzed data from the National Health Interview Survey covering 2015 through 2023. Michael Cummings, Ph.D., the year 2015 served as the baseline because electronic cigarettes began gaining widespread popularity then. The study distinguished between combustible products (cigarettes, cigars, pipes, and hookahs) and noncombustible products (e-cigarettes, smokeless tobacco, and nicotine pouches). Investigators from Rutgers University, Georgetown University, the University of Michigan, and the University of British Columbia collaborated with Hollings researchers Avery Roberson and Tracy Smith, Ph.D., on the analysis. Data revealed that exclusive combustible tobacco use dropped across nearly every age group. The sharpest declines occurred among young adults aged 18 to 34. Meanwhile, exclusive use of noncombustible products climbed, driven primarily by electronic cigarettes.

## The Generational Divide in Nicotine Consumption
While younger demographics are moving away from smoked tobacco, older adults lag behind in switching to alternatives. Adults aged 55 and older continue to smoke cigarettes at higher rates with low uptake of noncombustible products.

“The red light, or take-home message, for me is that we’re failing older people who smoke cigarettes,” Cummings stated regarding the findings. He noted that this older demographic has decades of smoking behind them and stands to gain the most immediate health benefits from eliminating smoked tobacco.

Interestingly, dual use—using both cigarettes and e-cigarettes simultaneously—remained uncommon and remarkably stable, reported by only 2% to 3% of adults throughout the study period. Cummings noted that researchers initially expected dual use to rise as cigarette smoking declined, but instead, consumers shifted directly to exclusive e-cigarette use.

## Measuring Harm Reduction at the Population Level
To gauge whether tobacco use is becoming less harmful overall, investigators developed a population harm-reduction index. This metric compares the prevalence of exclusive noncombustible tobacco use against any combustible tobacco use.

The strongest evidence of product substitution appeared among adults aged 18 to 24. In this age group, exclusive noncombustible tobacco use surpassed the use of any combustible tobacco.

Prior research by Cummings and Hollings colleagues demonstrated that smokers who switch entirely to electronic cigarettes face exposure to far fewer cancer-causing chemicals and achieve higher quit rates than those who keep smoking cigarettes. However, researchers emphasize that no nicotine product is completely safe, and the healthiest choice remains never starting or quitting entirely.

## Frequently Asked Questions

### What caused the decline in cigarette smoking among young adults?
Data from the National Health Interview Survey shows that younger adults are increasingly replacing conventional cigarettes with exclusive use of noncombustible alternatives, primarily electronic cigarettes.

### Is dual use of cigarettes and e-cigarettes increasing?
No. According to the study published in JNCI Cancer Spectrum, dual use remained stable at 2% to 3% among U.S. adults between 2015 and 2023.

### Which age group has been slowest to adopt noncombustible tobacco products?
Adults aged 55 and older continue to smoke traditional cigarettes at higher rates, showing lower uptake of alternative noncombustible products compared to younger adults.

### Are e-cigarettes completely safe?
No tobacco or nicotine product is completely safe. Researchers stress that the healthiest option is never to begin using nicotine or to stop using these products altogether.