Trends in E-Cigarette, Cigarette, Cigar, and Smokeless Tobacco Use Among US Adolescent Cohorts, 2014–2018

Rebecca Evans-Polce, PhD; Phil Veliz, PhD; Carol J. Boyd, PhD, MSN; Vita V. McCabe, MD, MHSA; Sean Esteban McCabe, PhD, MSW


Am J Public Health. 2020;110(2):163-165. 

In This Article

Abstract and Introduction


Objectives: To examine changes in age of initiation of e-cigarette, cigarette, cigar, and smokeless tobacco use among adolescents in the United States.

Methods: We used data from 5 cohorts of the National Youth Tobacco Survey (2014–2018; n = 26 662).

Results: In 2014, 8.8% of lifetime e-cigarette users initiated use at 14 years or younger, as compared with 28.6% of lifetime e-cigarette users in 2018. There was no such change in initiation ages for cigarettes, cigars, and smokeless tobacco among lifetime users of each of these products.

Conclusions: US adolescents are initiating e-cigarette use at younger ages in recent years. This is concerning given the association of e-cigarette use with subsequent cigarette use. Continued surveillance of these trends and additional prospective research are needed. Tobacco prevention programs, policies, and regulations that make it more difficult for youths to obtain e-cigarettes are warranted.


E-cigarette use has increased among adolescents in the United States over the past decade, with more than 1 in every 10 US high school students reporting past-month use.[1,2] Data from 2014 demonstrate e-cigarette initiation beginning as early as 7 years, with a mean age of 17.5 years.[3] Despite this concerning increase in e-cigarette use since the introduction of e-cigarettes to the US market in the mid-2000s,[4] there remains a gap in knowledge regarding whether age at initiation of e-cigarette use is changing.

The literature demonstrates the risks associated with early initiation of cigarettes, including later dependence, difficulty quitting, risk for other substance use,[5–7] and physical health risks including lung damage.[8] Less research to date has focused on age at initiation of e-cigarette use. One study showed that early use was associated with an increased risk of subsequent cigarette use.[9]

Although the increasing prevalence of e-cigarette use is well documented, no studies to our knowledge have examined whether age at initiation of e-cigarette use has changed across time and how changes in initiation of e-cigarettes compares with changes in initiation of other tobacco products. The purpose of this study was to examine trends in age of initiation of e-cigarettes across 5 cohorts and how these trends compare with those observed for other tobacco products in a large, nationally representative sample of young people in the United States.