Shifts away from exclusive cigarette smoking towards exclusive vaping in the US: Quarterly analysis of the National Health Interview Survey data, 2014-2024.

INTRODUCTION

Surveillance of nicotine/tobacco use typically examines binary use (vs. non-use) of each product in isolation, but this fails to capture product substitution and subtypes of multi-product use. The current analysis uses more temporally and behaviorally granular classifications to examine trends of electronic nicotine delivery systems (ENDS) and/or cigarette use.

METHODS

Quarterly trends in cigarette and ENDS use from the National Health Interview Survey (NHIS) 2014-2024 were examined. Smoking/vaping status was defined using self-reported frequency (every day, some days, not at all) for each product, yielding nine categories including non-use. Trends were analyzed overall and by age groups (18-29, 30-44, 45-59, ≥60).

RESULTS

Use of either product declined modestly (18% in 2014 Q1 to 16% in 2024 Q4). Exclusive smoking decreased substantially (80% to 50% of those using either product), which was largely offset by a pronounced increase in exclusive vaping (from 5% to 40%). Dual use exhibited a U-shaped pattern with an initial decline and subsequent increase. While use of either product remained stable for most age groups, age significantly moderated trends: adults aged 18-29 exhibited the steepest decline in exclusive smoking (73% to 7%), followed by adults aged 30-44 (78% to 47%) and 45-59 (84% to 72%). Conversely, exclusive smoking among adults aged ≥60 remained predominant and largely unchanged (86% to 85%).

CONCLUSION

A marked shift from exclusive smoking to exclusive vaping occurred from 2014-2024. This transition may represent population-level harm reduction by migration to noncombustible products, especially among younger adults, with limited change among older adults.

IMPLICATIONS: Population-level shifts from exclusive smoking to exclusive vaping - within an overall stable level of tobacco/nicotine product use - may indicate that noncombustible nicotine products have complemented traditional tobacco control efforts over this time period in reducing and/or preventing cigarette smoking. The balance between allowing access to lower-risk alternatives for adults who smoke and preventing uptake among non-users remains critical. The persistence of exclusive smoking among older adults highlights the need for targeted interventions for this priority population. Finally, the recent increase in dual use underscores the importance of continued surveillance, for which quarterly NHIS data can provide valuable insights.