A2.3-1

Appendix 2.3

Other Supporting Literature

Prevalence Estimates A2.3-2

Youth A2.3-2

Young Adults A2.3-3

Trends in Prevalence A2.3-3

Youth A2.3-3

Young Adults A2.3-3

E-Cigarette Use and Use of Other Tobacco Products A2.3-4

Youth A2.3-4

Young Adults A2.3-5

References A2.3-38

List of Tables

Table A2.3-1 Summary of studies presenting data on patterns of e-cigarette use among youth A2.3-6

Table A2.3-2 Summary of published studies presenting data on susceptibility and intentions to use e-cigarettes among 

youth and young adults A2.3-20

Table A2.3-3 Summary of studies presenting data on patterns of e-cigarette use among young adults A2.3-23
A Report of the Surgeon General

A2.3-2 Appendix 2.3

Prevalence Estimates

Youth

Table A2.3-1 summarizes additional studies included 

in this chapter on patterns of e-cigarette use among 

youth, including ever and past-30-day use. Data from the 

2013–2014 wave of the Population Assessment of Tobacco 

and Health (PATH) Study, representing 13,651 youth aged 

12–17 years, revealed that 10.7% of respondents reported 

ever using e-cigarettes, with 3.1% using in the past 30 days 

(Ambrose et al. 2015). Data from this wave of PATH also 

showed that 27% of youth were susceptible to e-cigarettes, 

equivalent to the percentage who were susceptible to conventional cigarettes (Trinidad et al. 2016). The estimates 

of past-30-day use are lower than the 2015 data from the 

National Youth Tobacco Survey (NYTS) (16% among high 

school students and 5.3% among middle school students) 

(Tables 2.2a and 2.2b in Chapter 2). National estimates of 

e-cigarette use are even higher, given data from the 2015 

Youth Risk Behavior Surveillance System, a national surveillance study of youth in 9th–12th grades. This study 

showed 44.9% of students had ever used e-cigarettes, while 

24.1% had used them in the past 30 days (CDC 2016). The 

disparity in these three different estimates may be due to 

differences in the way the question was asked on the surveys (see Tables 2.2a and 2.2b in Chapter 2) or to the range 

in ages of respondents (Table A2.3-1). Other reasons for 

these differences may include the way in which the data 

were collected (e.g., school-based surveys vs. householdbased surveys) and the content of the survey (e.g., whether 

the survey was solely about tobacco use or included other 

risky behaviors, such as drug use, sexual activity, etc.).

Data from state-level and local studies echo patterns seen at the national level. In 2013, among students in southeast Connecticut, 25.2% of high school 

students and 3.5%  of middle school students were ever 

users of e-cigarettes. In the same survey, older students, 

males, and non-Hispanic Whites were the most likely 

in their respective categories to have tried e-cigarettes 

(Krishnan-Sarin et al. 2015). Similarly, a 2013 survey in 

Oahu, Hawaii, revealed that among students in 9th  and 

10th grades, 29%  had ever used e-cigarettes, compared 

to 15%  who had ever used conventional cigarettes. 

Specifically, 9% had used e-cigarettes only once or twice 

in their lifetimes; 11% had used them three to four times; 

2%, yearly; 3%, monthly; 2%, weekly; and 2% had used 

them daily. In addition, 18% of all 9th and 10th graders 

had used e-cigarettes in the past month (Wills et al. 2015). 

A number of studies using 1 or 2 years of the NYTS data 

have reinforced the conclusion that past-30-day use of 

e-cigarettes is higher among older youth and males than 

their counterparts (Amrock et al. 2015).

Use of e-cigarettes is also common in other countries. In Switzerland, in 2014, a study found that 43% of 

students in eighth grade had ever tried e-cigarettes. In that 

study, 24% of eighth graders self-identified as “regular” 

e-cigarette users. However, the definition of “regular” use 

was left open to the respondent, and thus the actual patterns of e-cigarette use underlying this definition are not 

clear (Suris et al. 2015). A study of Irish 16–17-year-olds 

in 2014 found that 20.7% had ever used e-cigarettes and 

3.2% had used them in the past 30 days (Babineau et al. 

2015). In South Korea, an estimated 5%  of middle and 

high school students had used e-cigarettes in the past 

30  days, according to a large study conducted there in 

2011 (Lee et al. 2014). 

Table A2.3-2 summarizes other studies related to 

susceptibility to use e-cigarettes. In a nationally representative sample of individuals 15 years of age or older in 

Italy, of those who had heard of e-cigarettes but had never 

tried one, 10.1% had an intention to try one in the future 

(Gallus et al. 2014). In the United States, several studies 

have explored interest or intention to try e-cigarettes in 

smaller or regional samples. In a small sample of U.S. 

adolescent males, willingness to try e-cigarettes was associated with being a smoker of conventional cigarettes 

(Pepper et al. 2013). Also in that study, among adolescent 

male nonsmokers, having fewer negative beliefs about 

the typical smoker was associated with willingness to try 

e-cigarettes (Pepper et al. 2013). In Connecticut, a 2013 

study of middle and high school students examined susceptibility to e-cigarette use by asking students if they 

would smoke an e-cigarette offered to them by one of their 

best friends, and if they thought they would experiment 

with e-cigarettes in the future. Among never smokers, 

25.5% of middle school students and 29.6% of high school 

students were susceptible to e-cigarettes, with “susceptible” students defined as those who answered anything 

other than “definitely not” on that survey. In this study, 

White males who had ever tried cigarettes or were current 

smokers were more susceptible to e-cigarettes than were 

their counterparts (Krishnan-Sarin et al. 2015). Finally, 

in a 2011 survey of a small sample of freshman and sophomore college students in the United States, smoking 

status, use of alternative tobacco products, and acceptability of the public use of e-cigarettes were significant 

predictors of intention to use or try e-cigarettes within the 

next 6 months (Trumbo and Harper 2013).
Other Supporting Literature A2.3-3

E-Cigarette Use Among Youth and Young Adults

Young Adults

Table A2.3-3 summarizes additional studies of patterns of e-cigarette use behaviors, including ever and 

current use, among young adults. Some of these surveys 

suffered from methodologic issues that limited their comparability and yielded diverse estimates of ever use. For 

example, the age range that defines “young adult” populations varied; in some studies, these were adults up to 

24 years of age, while in others, the upper boundary was 

34 years. Additional information on susceptibility and 

intentions to use e-cigarettes among young adults can be 

found in Table A2.3-2.

Data from the nationally representative 2014 

National Health Interview Survey (NHIS) indicated that 

21.6% of adults aged 18–24 years had ever used e-cigarettes, 

and 5.6% were current users, defined as using e-cigarettes 

every day or some days (Delnevo et al. 2015; Schoenborn 

and Gindi 2015). The 2014 NHIS also found that 3.2% of 

adults who had never smoked cigarettes had tried an 

e-cigarette. Ever having used an e-cigarette was highest 

among adult never smokers, 18–24 years of age (9.7%) and 

declined with age (Schoenborn and Gindi 2015).

Another national survey reported that 25.3% of 

young adults (18–34 years of age) had ever used e-cigarettes 

in 2014, and 7.9% of the population of interest had used 

these products in the past 30 days (Sanders-Jackson et al. 

2015). Similarly, the 2014 Tobacco Products and Risk 

Perceptions Survey, which uses a probability sample of 

U.S. adults, found that 19.9% of young adults (18–24 years 

of age) had ever used e-cigarettes, and 5.2% of the 18−24 

group had used them in the past 30 days (Weaver et al. 

2016). Estimates of e-cigarette use by young adults from 

these studies are lower than what was reported above using 

2013–2014 NATS data (35.8% for ever use and 13.6% for 

past-30-day use, respectively). As with youth, possible reasons for these discrepancies could include differences in 

the age range of the participants and differences in how 

questions were worded.

Several studies with regional and local samples also 

assessed past-30-day use of e-cigarettes in young adults. 

In a 2009 study of North Carolina college students, the 

prevalence of such use was 1.5% (Sutfin et al. 2013), while 

in a population-based, prospective cohort study of persons 20−28 years of age in the Midwest, the estimate was 

1.2% for 2010–2011 (Choi and Forster 2013). In contrast, 

in 2013, 28% of college students in Oahu, Hawaii, were 

found to be past-30-day users (Pokhrel et al. 2015), but in 

the same year, in a study of college students 18–23 years of 

age in upstate New York, the estimate was about half that 

at 14.9% (Saddleson et al. 2015). In that study, past-30-day 

use was less common among those 20–23 years of age than 

those 18 years of age, females compared with males, nonHispanic non-Whites versus non-Hispanic Whites, and 

those reporting better-than-average school performance 

(Saddleson et al. 2015).

Trends in Prevalence

Youth

Few published studies are available on trends in the 

prevalence of e-cigarette use among youth over time. Ever 

use of e-cigarettes has increased abroad as well as in the 

United States (Table A2.3-1). Among middle and high school 

students in Korea, the prevalence of ever use increased 

from 0.5% in 2008 (Cho et al. 2011) to 9.4% in 2011 (Lee 

et al. 2014). In a national school-based survey of Polish adolescents 15–19 years of age, ever use rose from 16.8% in 

2010–2011 to 62.1% in 2013–2014 (Goniewicz et al. 2014). 

A survey of high school students in Connecticut and New 

York showed an increase in past-30-day use from February 

2010 (0.9%) to June 2011 (2.3%) (Camenga et al. 2014a). 

In addition, repeated cross-sectional studies of adolescents 

from Poland found that the prevalence of past-30-day use 

of e-cigarettes among high school students increased from 

8.9% in 2010–2011 (Goniewicz and Zielinska-Danch 2012) 

to 29.9% in 2013–2014 (Goniewicz et al. 2014).

Young Adults

In general, other surveys suggest increasing 

trends among young adults in ever using e-cigarettes 

(Table  A2.3-3). One national study, which relied on the 

2011–2012 GfK KnowledgePanel, showed a doubling of 

ever use (5.0% to 10.3%) from 2011 to 2012 among young 

adults 18–34 years of age (Richardson et al. 2014), but 

most of this use was among dual or poly-tobacco users. In 

another national survey (the 2014 Tobacco Products and 

Risk Perception Survey), never use increased from 2.5% in 

2010 to 21.0% in 2013 among young adults (18–24 years). 

In that survey, past-30-day use of e-cigarettes in this age 

group was negligible (0%) in both 2010 and 2011, but it 

then rose to 3.4% in 2012 and all the way to 14.2% in 2013 

(McMillen et al. 2015).
A Report of the Surgeon General

A2.3-4 Appendix 2.3

E-Cigarette Use and Use of Other Tobacco Products

Youth

Other cross-sectional studies related to covariation in the use of e-cigarettes and other tobacco products 

are presented in Table A2.3-1. In a study from southeast 

Connecticut conducted in 2013, among students who 

had never tried conventional cigarettes, 2.1% of middle 

school and 13.2% of high school students were found to 

have tried e-cigarettes (Krishnan-Sarin et al. 2015). This 

study estimated that 12% of the high school students were 

current e-cigarette users in 2013 and that 22.9% of high 

school students who were ever smokers were past-30-day 

e-cigarette users. The study also found that, among middle 

school students, e-cigarettes were the first product they 

reported trying and, among middle and high school students, ever and past-30-day cigarette smokers were more 

likely to have ever tried e-cigarettes in their lifetimes than 

were never smokers. Among students who had tried cigarettes in the past but had not smoked in the past 30 days, 

59.8% reported having tried e-cigarettes.

In a sample of youth from four high schools in 

New York and Connecticut in 2010 and 2011, past-30-day 

e-cigarette users reported use of a greater number of 

alternative tobacco products (cigars, blunts, hookahs, 

or smokeless tobacco) (mean = 1.75, SD = 1.32) than 

past-30-day cigarette smokers who did not use e-cigarettes 

(mean = 1.15, SD = 1.03) or never smokers (mean = 0.06, 

SD = 0.3, p <.0001) (Camenga et al. 2014b). A  higher 

proportion of current e-cigarette users (n = 76) reported 

occasional cigarette use (44.7%) than daily cigarette use 

(30.3%). Among those who were not current e-cigarette 

users, 66.1% reported occasional cigarette use compared 

to 33.9% who smoked cigarettes daily. Another survey of 

high school students, this one sampling grades 9–12 in 

Connecticut and New York (n = 1,345), found an increase 

in dual use of conventional cigarettes and e-cigarettes from 

February 2010 (0.8%) to June 2011 (1.9%). The majority of 

e-cigarette users were dual users (87.5% in wave 1, 82.8% 

in wave 2, and 83.9% in wave 3) (Camenga et al. 2014a).

Data from a 2013 survey of 9th and 10th graders 

(both public and private students) in Oahu, Hawaii 

(n = 1,941), indicated that 12% had ever used both 

e-cigarettes and conventional cigarettes (Wills et al. 2015). 

Elsewhere, data from a longitudinal cohort study of children with alcoholic parents (n = 136 families) found that, 

among adolescents (middle and late adolescence) who had 

ever used e-cigarettes, 68.9% had ever used conventional 

cigarettes also; and among those who had smoked regular cigarettes, e-cigarette use was associated with more 

frequent use of conventional cigarettes during the previous 30 days (Lessard et al. 2014). The study by Wills and 

colleagues (2015) found that e-cigarette use was associated with willingness to smoke other tobacco products, 

such as cigarettes, in the future.

A study using data from the 2011 NYTS found 

that the odds of ever e-cigarette use were 58 times as 

high among current cigarette smokers as they were 

among nonsmokers after controlling for age, gender, 

race/ethnicity, disposable income, living with a smoker, 

and having a friend who smokes (Lippert 2015). The study 

also found that over 41% of adolescents who had ever used 

e-cigarettes were past-30-day smokers and 49.3% had ever 

tried a cigarette. That study also found that 90.7% of ever 

e-cigarette users had smoked combustible cigarettes in 

their lifetimes (Lippert 2015).

In 2012, according to data from the NYTS, 42.2% of 

past-30-day smokers and 60.2% of past-30-day smokers 

who had smoked at least 100 cigarettes in their lifetime 

had ever used e-cigarettes. Of smokers who had not used 

conventional cigarettes in the past 30 days, 13.6% had 

used e-cigarettes, compared with 0.9% of never smokers 

(Ambrose et al. 2014; Cardenas et al. 2015). Data from the 

2012 NYTS also indicated that poly-tobacco use was positively correlated, after adjustment for multiple covariates, 

with male gender, race/ethnicity (White, non-Hispanic), 

use of flavored products, nicotine dependence, receptivity 

to tobacco marketing, and perceived prevalence of tobacco 

use in adolescents after adjustment for multiple covariates (Lee et al. 2015). In this adjusted model, poly-tobacco 

use was negatively correlated with living with someone 

who used tobacco and with agreeing that breathing smoke 

from tobacco products causes harm.

Bunnell and colleagues (2015) conducted similar 

analyses on 6th–12th-grade students who participated in 

the 2011, 2012, and 2013 NYTS, with their study focused 

on 43,873 students who had never tried a conventional 

cigarette. The authors found that 20.2% of ever smokers 

of regular cigarettes had tried an e-cigarette, compared 

with 0.9% of never cigarette smokers; and only 0.3% of 

never cigarette smokers had used an e-cigarette in the 

previous 30 days (i.e., 99.7% of school students who had 

never smoked a conventional cigarette had not used an 

e-cigarette in the previous 30 days). However, from 2011 

to 2013, the weighted estimate of never smokers who had 

used an e-cigarette increased over 300%, from 79,000 to 

over 263,000 (Bunnell et al. 2015). In multivariate analyses of never smokers of conventional cigarettes, this 

study found that those who had tried e-cigarettes were 
Other Supporting Literature A2.3-5

E-Cigarette Use Among Youth and Young Adults

more open to trying a conventional cigarette in the future 

(43.9%, compared with 21.5% of those who had never 

tried an e-cigarette), as were those who had tried another 

combustible or noncombustible tobacco product. The 

study noted that, although e-cigarette use had increased 

by the latest year of the study (2013), the overall percentage indicating intentions to smoke conventional cigarettes decreased significantly (from 22.8% in 2011 to 

17.9% in 2013), and the proportion of all students who 

smoked regular cigarettes decreased each year.

In the published literature on co-use of e-cigarettes 

and other tobacco products (Table A2.3-1) outside of the 

United States, one study from Wales found that among 10- 

to 11-year-old children, 47.6% of those who reported having 

smoked tobacco (1.4% of the sample) also reported having 

used e-cigarettes, compared to 5.3% of never smokers 

(98.1% of the sample) (Moore et  al. 2016). Elsewhere, 

among eighth-grade students in Switzerland, nearly half 

of regular e-cigarette users and nearly one-quarter of 

ever e-cigarette users were current smokers (Suris et al. 

2015). An analysis of data from the 2011 Korean Youth 

Risk Behavior Web-Based Survey found that 3.6% of students 13–18 years of age were past-30-day dual users of 

e-cigarettes and conventional cigarettes; past-30-day cigarette smokers were significantly more likely than never 

or former cigarette smokers to use e-cigarettes; and those 

who had smoked daily for the past 30 days had the highest 

rate of past-30-day e-cigarette use (50.8% vs. 0.6% for nonsmokers) (Lee et al. 2014). Finally, a national school-based 

survey of youth 15–19 years of age in Poland found that 

dual use of e-cigarettes and cigarettes increased from 3.6% 

in 2010–2011 to 21.8% in 2013–2014 (Goniewicz et  al. 

2014). The same study found that nearly 73% of past-30-day 

e-cigarette users also smoked conventional cigarettes in 

2013–2014, compared with 65.3% in 2010–2011.

Young Adults

Estimates of the co-use of e-cigarettes and other 

tobacco products among young adults have varied widely in 

other studies because of their different definitions of “current” tobacco use and varying definitions of young adulthood. These studies are also presented in Tables 2.7a and 

2.7b. In a national sample of U.S. adults (PATH), only 3.2% of 

those 18–24 years of age who had never used conventional 

cigarettes had ever tried e-cigarettes (Ambrose et al. 2014; 

Cardenas et  al. 2015). In contrast, the 2014 NHIS estimated this figure was 9.7% (Schoenborn and Gindi 2015). 

Correspondingly, studies of ever e-cigarette use among 

young adults in subnational and regional studies have indicated that e-cigarette use is closely associated with tobacco 

use, especially cigarette smoking. For example, among a 

sample of North Carolina college students in 2009, current daily smokers, current nondaily smokers, and former 

smokers all had higher odds of ever using e-cigarettes in 

comparison with nonsmokers (Sutfin et al. 2013). A study 

in the Midwest found that among young adults 20–28 years 

of age, 9.7% of former cigarette smokers and 28.5% of current smokers were ever e-cigarette users in 2010–2011 

(Choi and Forster 2013). In another study, this one using 

a sample of students at two universities in the Southeast, 

20.0% of current smokers were ever e-cigarette users in 

2013 (Berg et al. 2015). In a convenience sample of college students from Oahu, Hawaii, studied in 2013, 18.4% of 

never cigarette smokers, 47.7% of former cigarette 

smokers, and 68.2% of current cigarette smokers were ever 

e-cigarette users (Pokhrel et al. 2015).

Other studies using U.S. regional samples have 

reported consistent findings related to co-use of 

e-cigarettes and other tobacco products. In 2013, in an 

upstate New York sample of young adults (18–23 years of 

age) in colleges and universities (n = 1,437), past-30-day 

cigarette smokers had six times the odds of currently 

using e-cigarettes as those who had not smoked in the 

past 30 days; among those who had used tobacco that 

was not part of a cigarette in the past 30 days, 55.3% had 

ever used e-cigarettes (Saddleson et al. 2015). Moreover, 

this study found that users of e-cigarettes had most commonly used another nicotine product first (86.9%), compared with just 7.2% who started with e-cigarettes. In 

contrast, only 2.5% of ever smokers of conventional cigarettes had used e-cigarettes before smoking (although 

many probably started smoking before e-cigarettes had 

become widely available). In the 2013 sample of students 

from the Southeast (n = 2,002) discussed above, among 

past-30-day e-cigarette users, 71.6% also used cigarettes; 

46.6%, cigars; 17.0%; smokeless tobacco; and 54.5%, hookahs (Berg et al. 2015). Finally, in a regional sample of 

past-30-day cigarette smokers from universities in North 

Carolina and Virginia, 43.5% had tried e-cigarettes by the 

beginning of their junior year (Sutfin et al. 2015).
A Report of the Surgeon General

A2.3-6 Appendix 2.3

Table A2.3-1 Summary of studies on patterns of e-cigarette use among youth

Study Design/population Measures Outcomes/findings

Cho et al. (2011) • Cross-sectional

• 2008

• School-based survey of 4,341 Korean 

middle and high school students

• Cluster probability sampling 

• Ever use: asked if ever used an e-cigarette, even one 

or two puffs 

• Past-30-day use: n/a 

• Cigarette smoking: asked if ever used a cigarette, 

even one or two puffs 

• Dual use with cigarette: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 0.5%

• Past-30-day use: not reported

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Goniewicz and 

Zielinska-Danch 

et al. (2012)

• Cross-sectional

• 2010–2011 

• School-based survey of Polish students:

– 11,893 high school students (youth), 

15–19 years of age

– 1,894 university students (young adults), 

20–24 years of age

• Three-stage stratified cluster sampling

• Ever use: asked if ever used an e-cigarette

• Past-30-day use: asked if used an e-cigarette at least 

once in the past 30 days

• Cigarette smoking: (1) experimenters (those who 

had smoked a single cigarette in their lifetime); 

(2) ever smokers (those who had smoked at least 

100 cigarettes in their lifetime); (3) current 

smokers (those who had smoked more than 

100 cigarettes in their lifetime and who had smoked 

at least once in the past 30 days) 

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use:

– Overall: 20.9% (CI, 20.1–21.6%)

– High school: 23.5% (CI, 22.7–24.3%)

– University: 19.0% (CI, 17.1–20.8%)

• Past-30-day use:

– Overall: 6.9% (CI, 6.4– 7.4%)

– High school: 8.2% (CI, 7.6–8.7%)

– University: 5.9% (CI, 4.8–7.0%)

• Dual use with cigarettes: 10.0% 

(CI, 9.2–10.9%)

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Centers for 

Disease Control 

and Prevention 

(2013a)

• Cross-sectional

• NYTS

• 2011, 2012

• School-based survey of 24,658 U.S. middle 

and high school students in grades 6–12

• Three-stage cluster sampling 

• Ever use: defined as ever trying electronic cigarettes 

or e-cigarettes, such as Ruyan or NJOY, even just 

once 

• Past-30-day use: defined as using electronic 

cigarettes ≥ 1 or more days in the past 30 days

• Cigarette smoking: defined as using cigarettes 

≥1 or more days in the past 30 days

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use:

– Overall: 3.3% in 2011; 6.8% in 2012

– Middle school: 1.4% in 2011; 2.7% in 

2012

• Past-30-day use:

– Overall: 1.1% in 2011; 2.1% in 2012

– Middle school: 2011, 0.6% (CI, 0.4–0.9%); 

2012, 1.1% (CI, 0.9–1.5%)

– High school: 2011, 1.5% (CI, 1.2–2.0%); 

2012, 2.8% (CI, 2.3–3.5%) 

• Dual use with cigarettes: overall current 

use: 0.8% in 2011; 1.6% in 2012

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-7

Study Design/population Measures Outcomes/findings

Centers for 

Disease Control 

and Prevention 

(2013b)

• Cross-sectional

• NYTS

• 2011–2012

• School-based survey of 24,658 U.S. middle 

and high school students in grades 6–12

• Three-stage cluster sampling 

• Ever use: n/a

• Past-30-day use: asked if during the past 30 days 

had used electronic cigarettes on at least 1 day

• Cigarette smoking: current smokers (those who had 

smoked on at least 1 day in the past 30 days)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: n/a

• Past-30-day use:

– Middle school: 0.6% (2011); 1.1% (2012)

– High school: 1.5% (2011); 2.8% (2012)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Ambrose et al. 

(2014)

• Cross-sectional

• NYTS

• 2012

• School-based survey of 24,658 U.S. middle 

and high school students in grades 6–12

• Three-stage cluster sampling 

• Ever use: asked if ever tried electronic or 

e-cigarettes, such as Ruyan or NJOY

• Past-30-day use: asked if on at least 1 of the past 

30 days used e-cigarettes

• Cigarette smoking: (1) never-established smokers 

(responded “no” to ever trying a cigarette, even 

one or two puffs); (2) former smokers (those who 

reported trying cigarettes but had not smoked in 

the past 30 days); and (3) current smokers (those 

who had smoked on at least 1 of the past 30 days)

• Dual use with cigarettes: any reported past-30-day 

use of e-cigarettes among current cigarette smokers

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 6.8% 

• Past-30-day use: n/a 

• Dual use with cigarettes: 1.6% 

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Camenga et al. 

(2014a)

• Cross-sectional

• 2010–2011

• School-based survey of U.S. high school 

students in Connecticut and New York 

(3 waves) as part of intervention study:

– 1,719 (Feb. 2010)

– 1,702 (Oct. 2010)

– 1,345 (June 2011)

• Ever use: n/a 

• Past-30-day use: asked if had used e-cigarettes 

(an electronic cigarette that is filled with liquid 

nicotine) in the past 30 days

• Cigarette smoking: current use defined as use in the 

past 30 days

• Dual use with cigarettes: concurrent use of 

e-cigarettes and cigarettes in the past 30 days

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: n/a

• Past-30-day use: 0.9% (Feb. 2010); 

1.7% (Oct. 2010); 2.3% (June 2011)

• Dual use with cigarettes: 0.8% (Feb. 2010); 

1.4% (Oct. 2010); 1.9% (June 2011) 

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
A Report of the Surgeon General

A2.3-8 Appendix 2.3

Study Design/population Measures Outcomes/findings

Camenga et al. 

(2014b)

• Cross-sectional

• 2010–2011

• School-based survey of U.S. high school 

students (3 waves) in four suburban high 

schools in Connecticut and New York as 

part of intervention study:

– Full sample: 3,102

– Subsample: 1,556

• Ever use: n/a

• Past-30-day use: asked if had used e-cigarettes (an 

electronic cigarette that is filled with liquid nicotine 

and emits “smoke” vapor) in the past 30 days 

• Cigarette smoking: current use defined as using 

cigarettes ≥1 day in the past 30 days

• Dual use with cigarette: not defined

• Poly use with other tobacco products: not defined

• Co-occurrence with other substances: not defined

• Ever use: n/a

• Past-30-day use: 2.5%

• Dual use with cigarettes: 

75% (44.7% current occasional smokers 

and 30.3% current daily smokers) (among 

current e-cigarette users, n = 76)

• Poly use with other tobacco products: 

Among current e-cigarette users (n = 76), 

40.8% used cigars; 67.1% used blunts; 

42.1% used hookah; 25.0% used smokeless 

tobacco

• Co-occurrence with other substances: 

Among current e-cigarette users 

(n = 52), 94.2% had ever used alcohol; 

86.5% currently used alcohol; 

67.3% currently binge drank; 78.8% had 

ever used marijuana; 71.2% currently used 

marijuana

Centers for 

Disease Control 

and Prevention 

(2014b)

• Cross-sectional

• NYTS

• 2013

• School-based survey of 18,406 U.S. middle 

and high school students in grades 6–12

• Three-stage cluster sampling

• Ever use: asked if ever tried at least once.

• Past-30-day use: asked if on at least 1 of the past 

30 days used e-cigarettes

• Cigarette smoking: (1) ever use (tried at least once); 

(2) current use (used at least once in the past 

30 days)

• Dual use with cigarettes: use of only combustible 

tobacco products and e-cigarettes

• Poly use with other tobacco products: use of only 

noncombustible tobacco products and e-cigarettes 

or use of combustible, noncombustible, and 

electronic cigarettes

• Co-occurrence with other substances: n/a

• Ever use: 

– Middle school: 3.0% (CI, 2.5–3.0%) 

– High school: 11.9% (CI, 10.5–13.5%)

• Past-30-day use:

– Middle school: 1.1% (CI, 0.8–1.5%); 

0.4% (exclusive use)

– High school: 4.5% (CI, 3.8–5.3%); 

0.6% (exclusive use)

• Dual use with combustible products 

(cigarettes, cigars, pipes, bidis, kreteks, 

hookah):

– Middle school: 0.4%

– High school: 2.7% 

• Poly use with other tobacco products 

(combustible, noncombustible, electronic 

cigarettes): 

– Middle school: 0.2% 

– High school: 1.1% 

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-9

Study Design/population Measures Outcomes/findings

Czoli et al. 

(2014)

• Cross-sectional

survey

• 2012

• 1,188 Canadian youth (16–19 years of age) 

and young adults (20–30 years of age)

• Recruitment through an online panel of a 

commercial market research company

• Ever use: defined as those who had tried an 

e-cigarette but had not smoked one in the last 

30 days

• Past-30-day use: defined as those who had tried an 

e-cigarette and had smoked one in the last 30 days

• Cigarette smoking: (1) current smokers (those who 

had smoked 100 cigarettes in their lifetime and had 

smoked in the last 30 days); (2) former smokers 

(those who had smoked 100 cigarettes in their 

lifetime but had not smoked in the last 30 days); 

(3) nonsmokers (those who had smoked less than 

100 cigarettes in their lifetime)

• Dual use with cigarette: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 16.1%

• Past-30-day use: 5.7%

• Dual use with cigarette: 15.0%

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Dutra and 

Glantz (2014)

• Cross-sectional

• NYTS

• 2011–2012

• School-based survey of U.S. middle and 

high school students:

• 17,353 in 2011

22,529 in 2012

• Three-stage cluster sampling 

• Ever use: defined as those who had tried electronic 

cigarettes or e-cigarettes, such as Ruyan or NJOY, 

even just one time

• Past-30-day use: defined as those who had used 

e-cigarettes on at least 1 day in the past 30 days

• Cigarette smoking: (1) experimenters (those who 

had tried cigarette smoking, even one or two 

puffs); (2) ever smokers (those who smoked 100 or 

more cigarettes/five or more packs in lifetime); 

(3) current smokers (those who smoked at least 

100 cigarettes and smoked in the past 30 days)

• Dual use with cigarette: defined as those who are 

currently using e-cigarettes and conventional 

cigarettes

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 3.1% (2011), 6.5% (2012)

• Past-30-day use: 1.1% (2011), 2.0% (2012)

• Dual use with cigarettes: 0.5% (2011), 

1.0% (2012) 

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
A Report of the Surgeon General

A2.3-10 Appendix 2.3

Study Design/population Measures Outcomes/findings

Goniewicz et al. 

(2014)

• Cross-sectional

• 2010–2011, 2013–2014 

• School-based survey of 3,730 Polish 

students, 15–19 years of age

• Three-stage stratified cluster sampling

• Ever use: asked if ever puffed on e-cigarette, even a 

single puff

• Past-30-day use: asked if puffed on e-cigarette in the 

past 30 days

• Cigarette smoking: (1) ever smokers (those who 

had ever smoked tobacco cigarettes); (2) current 

smokers (those who had smoked tobacco cigarettes 

within the past 30 days)

• Dual use with cigarettes: current use of e-cigarettes 

and tobacco cigarettes

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

• Ever use: 2010–2011, 16.8% 

(CI, 14.7– 19.2%); 2013−2014, 

62.1% (CI 60.1–64.0%)

• Past-30-day use: 2010−2011, 

5.5% (CI, 3.8–7.8%); 2013−2014, 

29.9% (CI, 28.2–31.7%)

• Dual use with cigarettes: 2010−2011, 

3.6% (CI, 2.2–5.8%); 2013−2014, 

21.8% (CI, 20.3–23.5)

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Lee et al. (2014) • Cross-sectional

• 2011

• Web-based survey of 75,643 Korean 

students, 13–18 years of age

• Stratified multistage cluster sampling

• Ever use: asked if they had ever used e-cigarettes

• Past-30-day use: asked if they had used e-cigarettes 

in the past 30 days

• Cigarette smoking: (1) ever smokers (not defined); 

(2) former smokers (those who had ever smoked 

one puff but had not smoked in the past 30 days; 

(3) current smokers (those who had smoked in the 

past 30 days)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 9.4% (1.4% of the students only 

ever used e-cigs)

• Past-30-day use: 4.7%

• Dual use with cigarettes: 3.6% 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Lessard et al. 

(2014)

• Cross-sectional survey

• 136 adolescents from ongoing longitudinal 

case-control study who were recruited at 

12 months of age

• Recruited from ongoing longitudinal study 

• Ever use: asked if ever used an e-cigarette.

• Past-30-day use: n/a

• Cigarette smoking: (1) current smoker (those who 

answered yes when asked if they currently smoke)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: participants 

were asked if they had ever used marijuana, ever 

had more than a few sips of alcohol

• Ever use: 36.9%

• Past-30-day use: n/a

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: 

• Ever marijuana and e-cigarette use: 84.4%

• Ever alcohol and e-cigarette use: 97.8% 

Table A2.3-1 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-11

Study Design/population Measures Outcomes/findings

Wang et al. 

(2014)

• Cross-sectional

• 2012

• NYTS

• School-based survey of 24,658 U.S. middle 

and high school students in grades 6–12

• Three-stage cluster sampling

• Ever use: asked if they had ever used electronic 

cigarettes or e-cigarettes, such as Ruyan or NJOY, 

even just one time

• Past-30-day use: asked if they used electronic 

cigarettes or e-cigarettes, such as Ruyan or NJOY, 

on at least 1 day during the past 30 days

• Cigarette smoking: (1) ever smoker (those who 

reported ever trying cigarette smoking, even one 

or two puffs); (2) current smoker (those who had 

smoked cigarettes on at least 1 of the past 30 days)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

• Ever use: 6.8% (CI, 5.9–7.8%)

• Past-30-day use: 2.1% (CI, 1.8–2.5%)

• Dual use with conventional tobacco: 

12.9% (CI, 11.0–15.0%) 

• Poly use with other tobacco products:

– Current e-cigarette and other 

nonconventional tobacco product use: 

19.1% (CI, 16.2–22.2%)

• Co-occurrence with other substances: n/a

Ambrose et al. 

(2015)

• Cross-sectional

• Wave 1 of PATH study

• Household-based, nationally representative 

survey of 13,651 youth 12–17 years of age

• Ever use: asked if ever used an e-cigarette, even one 

or two times

• Past-30-day use: asked how many days in the last 

30 used an e-cigarette

• Cigarette smoking: asked if ever used a cigarette, 

even one or two puffs, in the past 30 days

• Dual use with cigarette: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 10.7% 

• Past-30-day use: 3.1% 

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Amrock et al. 

(2015)

• Cross-sectional

• NYTS

• 2012

• School-based survey of 24,658 U.S. middle 

and high school students in grades 6–12

• Three-stage cluster sampling

• Ever use: asked if ever tried electronic or 

e-cigarettes, such as Ruyan or NJOY

• Past-30-day use: asked if on at least 1 of the past 

30 days used e-cigarettes

• Ever use: 6.8%

• Past-30-day use: 2.1% 

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Bostean et al. 

(2015)

• California Health Kids Survey

• 2012–2013

• School-based survey of 482,179 middle 

and high school students in grades 6–12 in 

California

• Ever use: asked if ever used e-cigarettes at least 

once in their lifetime

• Past-30-day use: asked if used e-cigarettes on 1 or 

more days in the past 30 days

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

• Ever use: 24.4%

• Past-30-day use: 12.9%

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
A Report of the Surgeon General

A2.3-12 Appendix 2.3

Study Design/population Measures Outcomes/findings

Bunnell et al. 

(2015)

• Cross-sectional

• NYTS

• 2011, 2012, 2013 (pooled data from all 

3 years)

• School-based survey of 43,873 U.S. middle 

and high school students in grades 6–12

• Three-stage cluster sampling 

• Ever use: asked if ever tried, even just one time [...] 

electronic cigarettes or e-cigarettes, such as Ruyan 

or NJOY

• Past-30-day use: asked if in the past 30 days had 

used e-cigarettes on at least 1 day

• Cigarette smoking: (1) ever use (those who had 

tried, even just one time); (2) never use (those who 

had not tried, even just one time)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

• Ever use: 6.1%

• Past-30-day use: no overall prevalence 

available

• Current e-cigarette use: 6.9% among ever 

cigarette users; 0.3% among never cigarette 

users

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Cardenas et al. 

(2015)

• Cross-sectional NYTS

• 2012

• School-based survey of U.S. middle and 

high school students

• Full sample size not reported; subsample of 

14,861 children who never tried smoking 

cigarettes

• Three-stage cluster sampling 

• Ever use: defined as ever trying electronic cigarettes 

or e-cigarettes, such as Ruyan or NJOY, even just 

once

• Past-30-day use: asked if had used electronic 

cigarettes or e-cigarettes, such as Ruyan or NJOY, 

on at least 1 day in the past 30 days

• Cigarette smoking: (1) ever use (those who had 

tried, even just once); (2) current use (those who 

used on at least 1 day in the past 30 days)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: weighted prevalence: 1.5% 

(11–12 years of age); 6.3% (13–16 years of 

age); 12.8% (17–18 years of age)

• Past-30-day use: not reported

• Dual use with cigarettes: 60.2%

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Hamilton et al. 

(2015)

• Cross-sectional

• 2013

• Biennial provincewide survey of 

2,892 Canadian high school students

• Two-stage stratified cluster sampling

• Ever use: asked if ever smoked at least one puff 

from an electronic cigarette (responses of “smoked 

an e-cigarette with nicotine” and “smoked an 

e-cigarette without nicotine” grouped as ever 

smokers)

• Past-30-day use: n/a

• Cigarette smoking: (1) ever smokers (those who 

smoked at least a puff of a cigarette in their 

lifetime); (2) 12-month smokers (those who 

reported any smoking within the last 12 months)

• Dual use with cigarettes: those who reported ever 

use of both e-cigarettes and tobacco cigarettes

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 14.6% (CI, 12.3–17.3%) (5% of 

this group had never used other tobacco 

products)

• Past-30-day use: n/a

• Dual use with cigarettes: 

9.6% (CI, 8.0–11.5%)

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-13

Study Design/population Measures Outcomes/findings

Hughes et al. 

(2015)

• Cross-sectional

• 2013

• School-based survey of 16,193 students in 

North West England, 14–17 years of age

• Ever use: asked if ever bought or tried e-cigarettes

• Past-30-day use: n/a

• Cigarette smoking: ranged from never smoker to 

tried but didn’t like it to ex-smoker, to only smoke 

when drinking, to regular light smoker (<5/day), to 

regular heavy smoker (>5/day)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: frequency 

of alcohol consumption evaluated and students 

categorized into five drinker types from nondrinker 

at the lowest to regular drinkers that binge at the 

highest

• 19.2% reported having accessed 

e-cigarettes (bought or ever tried)

• E-cigarette access was 4.9% among never 

smokers, 50.7% among ex-smokers, 

67.2% among light regular smokers, and 

75.8% among heavy regular smokers, 

p <0.001

• Participants who drank regularly and binge 

drank were significantly more likely to have 

accessed e-cigarettes

Hummel et al. 

(2015)

• Cohort study

• 2008, 2010, 2013, 2014

• 6,602 Dutch smokers, 15 years of age or 

older:

– 1,520 in 2008

– 1,802 in 2010

– 1,530 in 2013

– 1,550 in 2014

• Recruitment through probability-based web 

database 

• Ever use: defined as those who reported using an 

e-cigarette but less than monthly

• Past-30-day use: defined as those who reported 

using an e-cigarette at least monthly

• Cigarette smoking: smokers (those who smoked 

at least 100 cigarettes in their lifetime and were 

currently smoking at least monthly)

• Dual use with cigarettes: not defined 

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

• Ever use: no point estimate available; 

OR for every trial of e-cigarettes of 1.52 

(CI, 1.09–2.11) among 15- to 24-year-olds 

compared with those 55+ years of age 

(2014)

• Past-30-day use: no point estimate 

available; OR for current use of 

e-cigarettes of 0.48 (CI, 0.28–0.85) among 

15–24-year-olds compared with those 

55+ years of age (2014)

• Dual use with cigarettes: not reported. 

explicitly for young adults

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
A Report of the Surgeon General

A2.3-14 Appendix 2.3

Study Design/population Measures Outcomes/findings

Kinnunen et al. 

(2015)

• Cross-sectional

• 2013

• Biennial, mail-based survey of 

3,535 Finnish adolescents, 12–18 years of 

age

• Nationally representative sample

• Ever use: those who reported trying once or 

twice, trying 20 times or less, or trying more than 

20 times

• Past-30-day use: n/a

• Cigarette smoking: (1) never smokers (those 

who never tried conventional cigarettes); 

(2) experimenters (those who tried but did not 

smoke daily); (3) current smokers (those who 

reported daily smoking and smoked >50 cigarettes 

in their lifetime)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 17.4%

• Past-30-day use: n/a

• Dual use with cigarettes: 32.9% ever use 

among experimenters with conventional 

cigarettes; 81.1% ever use among daily 

smokers 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Kong et al. 

(2015)

• Cross-sectional

• 2012–2013

• Middle and high school students (youth) in 

New Haven County, Connecticut:

– Focus groups = 18 (n = 127)

– Schoolwide survey = 4,780

• College students (young adults) in 

New Haven County, Connecticut:

– Focus groups = 127

– Schoolwide survey = 625

• Recruitment by flyers and active 

recruitment sessions 

• Ever use: those who indicated they had ever tried 

e-cigarettes

• Past-30-day use: n/a 

• Cigarette smoking: (1) never smokers (those who 

indicated never smoking); (2) cigarette smokers 

(those who indicated smoking occasionally or 

every day)

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use for focus group: 33.9%

• Past-30-day use: n/a

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-15

Study Design/population Measures Outcomes/findings

Krishnan-Sarin 

et al. (2015)

• Cross-sectional

• 2013

• School-based survey of middle (1,166) and 

high school (3,614) students in Connecticut

• Recruitment by selected district reference 

groups

• Ever use: defined as those who had tried an 

e-cigarette

• Past-30-day use: defined as those who indicated use 

in the past 30 days

• Cigarette smoking: (1) never smoker (those who 

had never smoked a cigarette); (2) current smokers 

(those who smoked cigarettes on 1 or more days 

during the past 30 days); (3) ever smokers (those 

who had tried cigarettes but reported not smoking 

cigarettes during the past 30 days)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 

– Middle school: 3.5%

– High school: 25.2% 

• Past-30-day use: 

– Middle school: 1.5% 

– High school: 12%

• Dual use with cigarettes: 

– Middle school: 38.5% 

– High school: 64.1% 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Lee et al. (2015) • Cross-sectional

• NYTS

• 2012

• School-based survey of 24,658 U.S. middle 

and high school students in grades 6–12

• Three-stage cluster sampling 

• Ever use: n/a 

• Past-30-day use: defined as use of e-cigarettes on at 

least 1 of the past 30 days

• Cigarette smoking: current smoker (those who had 

smoked a cigarette on at least 1 of the past 30 days)

• Dual use with cigarettes: defined as current 

cigarette smokers who reported using one other 

tobacco product

• Poly use with other tobacco products: defined as 

current cigarette smokers who reported using 

two or more other tobacco products

• Co-occurrence with other substances: n/a

• Ever use: n/a

• Past-30-day use: 0.9% (CI, 0.7–1.3%) were 

users of e-cigarettes exclusively

• Dual use with cigarettes: 

0.4% (CI, 0.3–0.5%)

• Poly use with other tobacco products: poly 

use with e-cigarettes not explicitly reported

• Co-occurrence with other substances: n/a

Leventhal et al. 

(2015)

• Longitudinal repeated assessment

• 2013 (baseline); 2014 (6-month follow-up); 

2014 (12-month follow-up)

• School-based cohort of 2,530 middle and 

high school students who reported never 

using combustible tobacco at baseline, in 

grades 6–10 from 10 public high schools in 

Los Angeles, California

• Convenience sampling

• Ever use: asked if they had ever used an e-cigarette 

in lifetime

• Past-30-day use: n/a

• Cigarette smoking: use of combustible cigarettes in 

the past month

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 8.8% at baseline

• Past-30-day use: n/a

• Dual use with cigarettes: not explicitly 

reported; only past 6- and 12-month 

tobacco use against ever use of e-cigarettes 

were reported

• Poly use with other tobacco products: not 

reported

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
A Report of the Surgeon General

A2.3-16 Appendix 2.3

Study Design/population Measures Outcomes/findings

Li et al. (2015) • Cross-sectional

• 2014

• Nationwide, in-home survey in 

New Zealand

• Multistage, stratified, clustered, and 

random probability sampling method 

(oversampling of Maori and Pacific peoples)

• Participants 15 years of age and older, 

n = 2,594

• Youth: 15–17 years of age, 3.8% of sample

• Young adults: 18–24 years of age, 13.4% of 

sample

• Ever use: asked if ever used an e-cigarette

• Current use: defined as at least once a day, at least 

once a week, at least once a month, less than once a 

month, and do not use one now

• Cigarette smoking: n/a

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Among 15- to 17-year-olds, 20.7% had ever 

used an e-cigarette, and 0.0% were current 

users

• Among 18- to 24-year olds, 25.8% had ever 

used an e-cigarette, and 0.2% were current 

users

Lippert (2015) • Cross-sectional

• NYTS

• 2011

• School-based survey of 15,264 U.S. middle 

and high school students in grades 6–12

• Probability sampling

• Ever use: asked if ever tried e-cigarettes (short list 

of e-cigarette brands provided as examples)

• Past-30-day use: n/a

• Cigarette smoking: (1) never smoker (those who 

reported never smoking); (2) former smoker (those 

who had tried a cigarette but had not smoked at 

least once a day for 20 or more days in the past 

month); (3) current smoker (those who had smoked 

at least once a day for 20 or more days in the past 

month)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 3.2%

• Past-30-day use: n/a

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Moore et al. 

(2015)

• Cross-sectional

• Combination of two datasets:

– CHETS Wales: School-based survey 

of Welsh year 6 school children, 

10–11 years of age, n = 1,601

– HBSC Wales: School-based survey 

of Welsh secondary school students 

11–16 years of age, n = 9055

• Ever use: asked if they had ever used an e-cigarette

• Current use: HBSC Wales participants asked if they 

used e-cigarettes on “a few occasions (1–5 times),” 

or “regularly (at least once a month)”

• Cigarette smoking: both surveys asked if ever 

smoked tobacco; HBSC Wales respondents were 

asked on how many days they smoked cigarettes

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 5.8% of 10- to 11-year-olds, 

12.3% of 11- to 16-year-olds

• Current use: 1.5% of HBSC Wales 

respondents reported “regular use”

• Dual use with cigarettes: the majority of 

children who had ever used an e-cigarette 

reported that they had never smoked 

tobacco

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-17

Study Design/population Measures Outcomes/findings

Pentz et al. 

(2015)

• Cross-sectional

• 2013

• School-based survey of 410 seventh-grade 

students from two public middle schools in 

Southern California

• Recruited from cross-sectional pilot study 

of a large randomized controlled trial

• Ever use: defined as those who did not indicate 

“none” when asked how many cartridges or 

disposable e-cigarettes they had used in their entire 

life

• Past-30-day use: n/a 

• Cigarette smoking: lifetime use (those who did 

not indicate “no use” when asked if they had ever 

smoked a cigarette in their whole life)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

• Ever use: 11% 

• Past-30-day use: n/a

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Primack et al. 

(2015)

• Longitudinal cohort:

– Wave 2: 2012–2013

– Wave 3: 2013–2014

• 694 youth (16–17 years of age) and young 

adults (18–26 years of age)

• Participants had to be never smokers and 

nonsusceptible to smoking at baseline

• Random-digit dialing

• National sample from Dartmouth Media, 

Advertising, and Health Study

• Ever use: asked if ever used an e-cigarette

• Past-30-day use: n/a

• Cigarette smoking: defined as someone who had 

smoked at least one puff of a cigarette in her or his 

lifetime

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 2.3% at baseline

• Past-30-day use: not reported

• Dual use with cigarettes: not explicitly 

reported

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Wills et al. 

(2015)

• Cross-sectional

• 2013

• School-based survey of 1,941 private or 

public high school students in Oahu, 

Hawaii

• Recruitment through five schools 

representative of the Hawaii educational 

system

• Ever use: defined as those who reported any use of 

e-cigarettes

• Past-30-day use: defined as those who indicated 

using e-cigarettes once, twice, or ≥3 times in the 

past month

• Cigarette smoking: not defined

• Dual use with cigarettes: defined as ever use of 

e-cigarettes and ever use of cigarettes

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 29%

• Past-30-day use: 18%

• Dual use with cigarettes: 12% 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
A Report of the Surgeon General

A2.3-18 Appendix 2.3

Study Design/population Measures Outcomes/findings

CDC (2016) • Cross-sectional

• 2014–2015 school year

• School-based, self-administered 

questionnaire

• 15,624 middle and high school students

• Ever use: defined as those who had ever tried 

e-cigarettes

• Past-30-day use: defined as those who indicated 

using e-cigarettes on at least 1 day during the 

30 days before the survey

• Cigarette smoking: status on scale from never to 

every day, number of smoking days within the past 

30 days

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 44.9%

• Past-30-day use: 24.1%

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Gilreath et al. 

(2016)

• Cross-sectional

• Southern California Children’s Health 

Study

• 2014

• 2,091 students in grades 11 and 12

• Ever use: defined as those who provided an age 

of first use of e-cigarettes but no use in the past 

30 days

• Current use: defined as those who indicated using 

e-cigarettes in the past month 

• Cigarette smoking: same definitions as ever use and 

current use for e-cigarettes

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 14.4%

• Current use: 9.6%

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Jiang et al. 

(2016)

• Cross-sectional

• School-based Survey on Smoking Among 

Students

• 2012–2013

• 45,857 secondary school 

students (grades 7–12) in Hong Kong

• Ever use: n/a

• Past 30-day use: defined as those who indicated 

using e-cigarettes in the past 30 days 

• Cigarette smoking: status on scale from never to 

every day, number of smoking days within the past 

30 days

• Dual use with cigarettes: use of both products 

within the past 30 days

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: n/a

• Past-30-day use: 1.1%

• Dual use with cigarettes: Among former 

or current smokers, 9.6% were current 

e-cigarette users

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Table A2.3-1 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-19

Study Design/population Measures Outcomes/findings

Moore et al. 

(2016)

• Cross-sectional

• 2014

• School-based survey of Welsh year 6 school 

children, 10–11 years of age:

– Students = 1,578

– Items on e-cigarette use 

completed = 1,495

• Probability sampling

• Ever use: asked if they had ever used an e-cigarette

• Past-30-day use: n/a

• Cigarette smoking: (1) ever smoker (those who 

reported ever smoking at least one cigarette)

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 5.3% among never smokers

• Past-30-day use: n/a

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products 

(among children that used tobacco): 

(n = 21); 47.6% had used an e-cigarette 

• Co-occurrence with other substances: n/a

Morean et al. 

(2016)

• Cross-sectional

• 2013

• 2,241 adolescents in grades 9–12 at four 

high schools in Southeastern Connecticut

• Ever use: n/a

• Current use: defined as using e-cigarettes on at 

least 1 day in the past 30 days

• Cigarette smoking: defined as use on at least 1 day 

in the past 30 days

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: alcohol use, 

defined as use on at least 1 day in past 30 days

• Ever use: n/a

• Current use: 11.6%

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: 

e-cigarettes and alcohol, 4.60%

Thrasher et al. 

(2016)

• Cross-sectional

• 2015

• Stratified random sampling in Mexico’s 

three largest cities (Mexico City, 

Guadalajara, and Monterrey)

• 10,146 middle school students

• Ever use: defined as those who had ever tried 

e-cigarettes

• Current use: n/a

• Cigarette smoking: n/a

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 10%

• Current use: n/a

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a 

• Co-occurrence with other substances: n/a

Wills et al. 

(2016)

• Longitudinal

• 2013 and 2014 

• School-based survey of 2,338 private and 

public high school students in Oahu, 

Hawaii

• Recruitment through five schools 

representative of the Hawaii educational 

system

• Ever use: defined as those who reported any use of 

e-cigarettes

• Past-30-day use: n/a 

• Cigarette smoking: defined as those who had ever 

smoked a cigarette

• Dual use with cigarettes: defined as ever use of both 

products

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 31% at baseline (2013), 

38% (2014)

• Current use: n/a

• Dual use with cigarettes: Among never 

smokers at baseline (in 2013), those who 

had used e-cigarettes at baseline were more 

likely to have smoked cigarettes in 2014 

(AOR = 2.87, p <0.0001)

Note: AOR = adjusted odds ratio; CI = confidence interval; PATH = Population Assessment of Tobacco and Health Study; NYTS = National Youth Tobacco Survey; 

OR = odds ratio.

Table A2.3-1 Continued
A Report of the Surgeon General

A2.3-20 Appendix 2.3

Table A2.3-2 Summary of studies on susceptibility and intentions to use e-cigarettes among youth and young adults

Study Design/population Measures Outcomes/findings

Faletau et al. 

(2013)

• Qualitative exploratory

• Structured focus groups and individual 

interviews

• Recruited from two low-socioeconomic 

primary schools in East and South 

Auckland, New Zealand

• Year sample drawn: 2011 

• Youth: Maori, Tongan, Samoan, Cook 

Island, and Niuean, 6–10 years of age; 

N = 20 

• Young adults: n/a

• Viewed tobacco cigarette and e-cigarette 

videos

• Children thought the e-cigarette was “cool ... cause you 

can charge it like a phone and it lasts longer”

Li et al. (2013) • Cross-sectional

• Telephone-based survey

• Random-digit-dial sampling

• Years sample drawn: 2011–2012

• Youth: n/a

• Young adults: current smokers and recent 

quitters, ≥18 years of age, in New Zealand; 

N = 840

• Indicate your level of agreement:

1. I would switch to e-cigarettes 

completely if they were cheaper than 

tobacco cigarettes (n = 360)

2. If I wanted to stop smoking tobacco, 

I would give e-cigarettes a go to help 

me quit smoking (n = 360)

• OR = 1.14 (CI, 0.47–2.76) among participants 

18–24 years of age for willingness to switch to 

e-cigarettes if they are cheaper compared with 

participants ≥45 years of age

• OR = 3.37 (CI, 1.17–9.69) among participants 

18–24 years of age for willingness to use e-cigarettes 

to support a quit attempt compared with participants 

≥45 years of age

Pepper et al. 

(2013)

• Cross-sectional

• Web-based survey

• Recruited through parents who were 

members of an online panel assembled by 

random-digit dialing and address-based 

sampling

• Year sample drawn: 2011

• Youth: U.S. males, 11–17 years of age; 

N = 228

• Young adults: n/a 

• If one of your best friends were to offer 

you an e-cigarette, would you try it?

• If one of your best friends were to offer 

you a flavored e-cigarette (chocolate, 

mint, apple, etc.), would you try it?

• 18% were willing to try an e-cigarette if offered by a best 

friend:

– 13% were willing to try a plain e-cigarette

– 5% were willing to try flavored e-cigarettes or both 

kinds

• Willingness to try e-cigarettes by age:

– 11–13: 11%

– 14–16: 15%

– 17–19: 29%

• OR = 3.26 (CI, 1.27– 8.35) among those 17–19 years of 

age for willingness to try an e-cigarette, compared with 

those 11–13 years of age

• Willingness to try e-cigarettes by smoking status:

– Nonsmoker: 13%

– Smoker: 74%

• OR = 18.67 (CI, 6.22–55.98) among smokers for 

willingness to try an e-cigarette, compared with 

nonsmokers
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-21

Study Design/population Measures Outcomes/findings

Trumbo and 

Harper (2013)

• Cross-sectional

• Web-based survey

• Recruitment by offer of extra credit to 

students in a 100-level course

• Year sample drawn: 2011

• Youth: n/a

• Young adults: freshmen and sophomores 

in a 100-level mass media in society 

course; n = 244 

• How likely do you think it is that 

you would use an e-cigarette in the 

not-too-distant future, say in the next 

6 months?

• Indicate your level of agreement with the 

following attitudes (5-point scale):

1. Use of e-cigarettes should be legal for 

adults

2. E-cigarettes are a big step forward

3. E-cigarettes are a more modern way of 

using tobacco

• Most students had little intention of using an e-cigarette 

within the next 6 months

• Mean score (SD) of attitude items: 11.5 (2.3)

Czoli et al. 

(2014)

• Cross-sectional

• Survey

• Recruitment through online panel of 

commercial market research company

• Year sample drawn: 2012

• Youth: Canadian youth recruited 

from online panel, 16–30 years of age 

(n = 1,188)

• Young adults: Canadian young adults 

recruited from online panel noted above

• Would you be interested in trying this 

product?

• Mean score for interest in trying e-cigarettes:

– Among cigarette nonsmokers: 1.9 (e-cigarette 

nonuser) vs. 4.2 (e-cigarette ever user)

– Among former smokers: 3.2 (e-cigarette nonuser) vs. 

4.1 (e-cigarette ever user)

– Among current smokers: 3.1 (e-cigarette nonuser) vs. 

7.1 (e-cigarette ever user)

• Reasons for trying e-cigarettes among current cigarette 

smokers:

– To help cut back on the amount they smoked (77.7%)

– As a long-term replacement for cigarettes (77.8%)

– For the times when they don’t want to smoke around 

others (78.8%)

– To help them while they are trying to quit smoking 

(80.4%)

– As a cheaper alternative to cigarettes (80.7%)

– In places where they can’t smoke cigarettes (80.9%)

Gallus et al. 

(2014)

• Cross-sectional

• In-person survey

• Representative multistage sampling

• Year sample drawn: 2013 

• Youth: n/a

• Young adults: Italians ≥15 years of age; 

N = 3,000

• Have you heard about e-cigarettes, have 

you ever tried them, or do you have the 

intention to try them?

• 10.1% of participants aware of electronic cigarettes were 

intent on trying electronic cigarettes

Table A2.3-2 Continued
A Report of the Surgeon General

A2.3-22 Appendix 2.3

Study Design/population Measures Outcomes/findings

KrishnanSarin et al. 

(2015)

• Cross-sectional

• School-based survey

• Recruitment by selected district reference 

groups

• Year sample drawn: 2013

• Youth: Connecticut middle (n = 1,166) 

and high school (n = 3,614) students

• Young adults: n/a

• Given a choice, would you rather smoke 

an e-cigarette, a regular cigarette, or 

neither?

• Do you think that in the future you might 

experiment with e-cigarettes?

• Susceptibility to future e-cigarette use was significantly 

higher in ever smokers and current smokers, compared 

with never smokers

• Susceptible to future use, middle school:

– 26.4% (overall)

– 25.5% (never smokers)

– 100.0% (ever smokers)

– 83.3% (current smokers)

• Susceptible to future use, high school:

– 31.7% (overall)

– 29.6% (never smokers)

– 57.0% (ever smokers)

– 73.3% (current smokers)

Pokhrel et al. 

(2015)

• Cross-sectional

• Web-based survey

• Recruitment by flyers across three college 

campuses

• Year sample drawn: 2013

• Youth: n/a

• Young adults: U.S. students from a 4-year 

university and two 2-year community 

colleges in Oahu, Hawaii; n = 307

• Of the ads or commercials you see, how 

much do you like the ads?

• When you see e-cigarette ads or 

commercials, do you think they are 

funny?

• When you see e-cigarette ads or 

commercials, do you think they are sexy?

• When you see e-cigarette ads or 

commercials, do you wish you were like 

people in the ads or commercials?

• 41.2% reported liking e-cigarette ads the least compared 

with 4.0% who liked e-cigarette ads the most

• 45.9% reported never finding e-cigarette ads funny 

compared with 4.3% who always found e-cigarette ads 

funny

• 65.9% reported never finding e-cigarette ads sexy 

compared with 1.0% who always found e-cigarette ads 

sexy

• 78.0% reported never wishing to be like the people in 

the ads compared with 0.7% who always wished to be 

like the people in the ads

Notes: CI = confidence interval; OR = odds ratio; SD = standard deviation.

Table A2.3-2 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-23

Table A2.3-3 Summary of studies on patterns of e-cigarette use among young adults

Study Design/population Measures Outcomes/findings

Goniewicz and 

Zielinska-Danch 

(2012)

• Cross-sectional

• 2010–2011

• School-based survey of Polish students

– 11,893 high school students, 15–19 years 

of age

– 1,894 university students, 20–24 years 

of age

• Three-stage stratified cluster sampling

• Ever use: asked if ever used an e-cigarette

• Past-30-day use: asked if used an e-cigarette at least 

once in the past 30 days

• Cigarette smoking: (1) experimenters (those 

who had smoked a single cigarette in their life); 

(2) ever smokers (those who had smoked at least 

100 cigarettes in their life); (3) current smokers 

(those who had smoked more than 100 cigarettes in 

their lifetime and who had smoked at least once in 

the past 30 days)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: overall, 20.9% (CI, 20.1–21.6%); 

high school, 23.5% (CI, 22.7–24.3%); 

university, 19.0% (CI, 17.1–20.8%)

• Past-30-day use: overall, 

6.9% (CI, 6.4–7.4%); high school, 

8.2% (CI, 7.6–8.7%); university, 

5.9% (CI, 4.8–7.0%)

• Dual use with cigarettes: 

10.0% (CI, 9.2–10.9%)

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

McMillen et al. 

(2012)

• Cross-sectional

• 2010

• Mixed-mode, mixed-frame survey of 

3,240 U.S. adults, 18 years of age or older:

– 1,504 in mode 1

– 1,736 in mode 2

• Probability-based sampling

• Ever use: asked if ever tried electronic cigarettes or 

e-cigarettes, such as Ruyan or NJOY, even just one 

time

• Past-30-day use: asked if used an electronic cigarette 

or e-cigarette, such as Ruyan or NJOY, in the past 

30 days

• Cigarette smoking: (1) current smokers (those who 

had smoked at least 100 cigarettes in their entire life 

and now smoke every day or some days); (2) never 

smokers (those who had not smoked at least 

100 cigarettes); (3) former smokers (those who had 

smoked at least 100 cigarettes but no longer smoke)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever e-cigarette use: overall, 

1.8% (p < .001)

• Never smokers, 0.3%

• Former smokers, 1.5%

• Nondaily smokers, 8.2%

• Daily smokers, 6.2%
A Report of the Surgeon General

A2.3-24 Appendix 2.3

Study Design/population Measures Outcomes/findings

Pearson et al. 

(2012)

• Cross-sectional

• Survey 1:

– 2010

– Web-based

– 2,649 U.S. adults

– Recruited primarily through addressbased sampling

– Some random-digit-dial sampling

• Survey 2:

– 2008–2010

– Phone-based

– 3,658 U.S. adults

• List-assisted random-digit-dial sampling 

• Ever use: asked if they had ever tried or used an 

electronic cigarette or e-cigarette

• Past-30-day use: asked if they had used an electronic 

cigarette in the past 30 days (asked only in survey 1)

• Cigarette smoking: (1) never smokers (those who 

had smoked fewer than 100 cigarettes in their 

lives; (2) former smokers (those who had smoked 

100 cigarettes or more in their lives but do not 

currently smoke); (3) current smokers (those who 

had smoked more than 100 cigarettes in their lives 

and reported currently smoking every day or some 

days)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: not explicitly reported for young 

adults

• Past-30-day use: not explicitly reported for 

young adults

• Dual use with cigarettes: not explicitly 

reported for young adults

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Rath et al. 

(2012)

• Cross-sectional

• 2011

• Web-based survey of 4,201 U.S. adults, 

18–34 years of age

• Probability sampling

• Ever use: asked if they had ever used or tried 

e-cigarettes like blu or NJOY

• Past-30-day use: asked during the past 30 days, on 

how many days have you used e-cigarettes (like blu 

or NJOY)

• Cigarette smoking: now smoke cigarettes every day 

or some days

• Dual use with cigarettes: every-day or some-day use 

of both cigarettes and other tobacco products (not 

specific to e-cigarettes)

• Poly use with other tobacco products: not defined

• Co-occurrence with other substances: n/a

• Ever use: 6% (CI, 5–7%)

• Past-30-day use: 7% among those who used 

cigarettes or tobacco products every day or 

some days

• Dual use with cigarettes: 9%

• Poly use with other tobacco products: not 

reported

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-25

Study Design/population Measures Outcomes/findings

Choi and 

Forster (2013)

• Population-based

• Cross-sectional interview

• 2010–2011

• 2,624 U.S. adults, 20–28 years of age, in 

Minnesota

• Cluster random sampling

• Ever use: asked if ever used e-cigarettes, described 

in awareness item as “an e-cigarette or electronic 

cigarette, a cigarette-looking electronic device that 

delivers nicotine vapor when you puff it”

• Past-30-day use: the number of days they had used 

e-cigarettes in the past 30 days, dichotomized

• Cigarette smoking: (1) never established smokers 

(those who had not smoked 100 cigarettes); 

(2) former smokers (those who had smoked 

100 cigarettes but had not smoked in the past 

30 days); and (3) current smokers (those who had 

smoked at least 100 cigarettes and had smoked in 

the past 30 days)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 7% prevalence

• Past-30-day use: 1.2%

• Dual use with cigarettes: 28.5% of current 

smokers had ever used e-cigarettes; 9.7% of 

former smokers had ever used e-cigarettes; 

OR was 10.07 (CI, 6.38–15.89) among 

current smokers and 3.51 (CI, 1.97–6.27) 

among former smokers for ever e-cigarette 

use in comparison with never established 

smokers

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances : n/a

Dockrell et al. 

(2013)

• Population 

online-based surveys

• 2010, 2012

• British young adults, 18–24 years of age 

(full sample included adults older than 

25 years of age)

• Targeted quota sampling 

• Ever use: defined as those who have tried 

e-cigarettes but do not use them anymore

• Past-30-day use: defined as those who had tried 

e-cigarettes and still use them

• Cigarette smoking: (1) never smokers (those 

who reported having never smoked); (2) former 

smokers (those who reported having smoked, but 

not currently); (3) occasional smokers (those who 

currently smoked, but not every day); (4) daily 

smokers (those who reported smoking every day)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: not reported explicitly for young 

adults

• Past-30-day use: not reported explicitly for 

young adults

• Dual use with cigarette: not reported 

explicitly for young adults

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
A Report of the Surgeon General

A2.3-26 Appendix 2.3

Study Design/population Measures Outcomes/findings

King et al. 

(2013)

• Cross-sectional consumer panel

• HealthStyles

• 2010–2011

• Mail- and web-based survey of 10,739 U.S. 

adults, 18 years of age or older:

– 2010 mail = 4,184

– 2010 web = 2,505

– 2011 web = 4,050

• Stratified random sampling (2010 mailbased survey)

• Probability-based sampling (2010, 2011 

web-based surveys) 

• Ever use: asked if ever tried electronic cigarettes or 

e-cigarettes, even just one time

• Past-30-day use: n/a

• Cigarette smoking: current smokers (those who had 

smoked ≥100 cigarettes in their lifetime and now 

smoke every day or some days)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 2.1% (2010 mail); 

3.3% (2010 web); 6.2% (2011 web)

• Past-30-day use: n/a

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Regan et al. 

(2013)

• Cross-sectional

• ConsumerStyles

• 2009–2010

• Consumer-based mail-in survey of 

20,915 U.S. adults, 18 years of age or older:

– 10,587 in 2009

– 10,328 in 2010

• Stratified sampling

• Ever use: asked if they had ever tried electronic 

cigarettes or e-cigarettes, even just one time

• Past-30-day use: asked if in the past 30 days they had 

used an electronic cigarette or e-cigarette at least 

once (asked only in 2010 survey)

• Cigarette smoking: (1) current smokers (those who 

had smoked ≥100 cigarettes in their lifetime and 

currently smoke every day or some days); (2) former 

smokers (those who had smoked ≥100 cigarettes 

in their lifetime but currently do not smoke at 

all); (3) never smokers (those who had not smoked 

100 cigarettes in their lifetime)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: defined as 

current use of multiple tobacco products

• Co-occurrence with other substances: n/a

• Ever use: 10.1% (CI, 3.1–17.0%) among 

18–24- year-olds

• Past-30-day use: not reported due to 

unreliable estimate

• Dual use with cigarettes: not explicitly 

reported for young adults

• Poly use with other tobacco products: not 

explicitly reported for young adults

• Co-occurrence with other substances: n/a

Trumbo and 

Harper (2013)

• Cross-sectional

• 2011

• Web-based survey of 244 first- and secondyear college students who were taking 

a 100-level course titled “Mass Media in 

Society”

• Recruitment by offer of extra credit to 

students in a 100-level course

• Ever use: asked if they had ever used an e-cigarette

• Past-30-day use: asked if they used e-cigarettes every 

day or some days

• Cigarette smoking: not defined

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 13%

• Past-30-day use: not reported

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-27

Study Design/population Measures Outcomes/findings

Vickerman et al. 

(2013)

• Cross-sectional

• 2011–2012

• Telephone-based survey of 2,758 adults, 

18 years of age or older, who were enrolled 

in a one-call or multiple-call smoking 

cessation program

• Recruitment among states with evaluations 

with Alere Wellbeing, Inc.

• Ever use: those who had ever used e-cigarettes, 

electronic, or vapor cigarettes (current or past use)

• Past-30-day use: those who currently used 

e-cigarettes every day or some days

• Cigarette smoking: n/a

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: not explicitly reported for young 

adults

• Past-30-day use: not explicitly reported for 

young adults

• Dual use with cigarettes: n/a

Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Bartoli et al. 

(2014)

• Cross-sectional

• 2013

• 590 alcohol-consuming students in Italy, 

18–24 years of age

• Smartphone-based survey

• Ever use: n/a

• Past-30-day use: use of electronic cigarettes 

(e-cigarettes) in the last 30 days

• Cigarette smoking: use of cigarettes in the last 

30 days

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: not defined

• Ever use: n/a

• Past-30-day use: binge drinkers: 

6.7%; nonbinge drinkers: 2.5%

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: 

no point estimate available; OR of 

2.49 (CI, 1.01–6.18) among current 

e-cigarette users for a recent episode 

of binge drinking compared with never 

e-cigarette users

Centers for 

Disease Control 

and Prevention 

(2014a)

• Cross-sectional

• NATS

• 2012–2013

• Landline and cellular phone surveys of 

60,192 U.S. adults, 8 years of age or older

• National random-digit-dial sampling

• Ever use: usage threshold of ≥1 time

• Past-30-day use: asked if used e-cigarettes “every 

day” or “some days”

• Cigarette smoking: asked if used cigarettes “every 

day” or “some days”

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: not reported explicitly for young 

adults

• Past-30-day use: 2.4% (CI, 1.8–3.0%) for 

adults 18–24 years of age

• Dual use with cigarettes: n/a Poly use with 

other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
A Report of the Surgeon General

A2.3-28 Appendix 2.3

Study Design/population Measures Outcomes/findings

Choi and 

Forster (2014)

• Population-based

• 2011–2012

• Prospective cohort study survey

• 1,379 participants in the Minnesota 

Adolescent Community Cohort

• Average age = 24.1 years

• Cluster random sampling

• Ever use: asked if ever used an electronic cigarette

• Past-30-day use: n/a

• Cigarette smoking: (1) nonsmoker (never 

smoked ≥100 cigarettes in their lifetime and 

none in the past 30 days); (2) former smokers 

(smoked ≥100 cigarettes in their lifetime but none 

in the past 30 days); (3) current smokers (smoked 

≥100 cigarettes in their lifetime and at least 1 day in 

the past 30 days)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 7.4% (among those who had 

never used e-cigarettes at baseline, 

n = 102)

• Past-30-day use: n/a

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Czoli et al. 

(2014)

• Cross-sectional survey

• 2012

• 1,188 Canadian youth (16–19 years of age) 

and young adults (20–30 years of age)

• Recruitment through an online panel of a 

commercial market research company

• Ever use: defined as those who had tried an 

e-cigarette but had not smoked one in the last 

30 days

• Past-30-day use: defined as those who had tried an 

e-cigarette and had smoked one in the last 30 days

• Cigarette smoking: (1) current smokers (those who 

had smoked 100 cigarettes in their lifetime and had 

smoked in the last 30 days); (2) former smokers 

(those who had smoked 100 cigarettes in their 

lifetime but had not smoked in the last 30 days); 

(3) nonsmokers (those who had smoked fewer than 

100 cigarettes in their lifetime)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 16.1%

• Past-30-day use: 5.7%

• Dual use with cigarettes: 15.0%

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-29

Study Design/population Measures Outcomes/findings

Pokhrel et al. 

(2014)

• Cross-sectional

• 2013

• Web-based survey of 307 U.S. students 

from a 4-year university and two 2-year 

community colleges in Oahu, Hawaii

• Recruitment by flyers across three college 

campuses

• Ever use: asked if ever used an electronic cigarette

• Past-30-day use: asked how many times they had 

used e-cigarettes in the past 30 days

• Cigarette smoking: (1) current smokers (those who 

reported any use in the past 30 days and smoking 

100 or more cigarettes in their lifetime); (2) former 

smokers/experimenters (those who reported lifetime 

use but not use in the past 30 days)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: not reported

• Past-30-day use: not reported

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a 

Schmidt et al. 

(2014)

• Cross-sectional

• 2013

• Telephone-based survey of 

5,000 noninstitutionalized adults in 

Montana

• Random-digit-dial sampling

• Ever use: defined as those who had ever used an 

electronic cigarette, even just one time in their 

entire life

• Past-30-day use: defined as those who had ever used 

an electronic cigarette and currently use electronic 

cigarettes every day or some days

• Cigarette smoking: not defined

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 22.5% (CI, 16.4–28.6%) among 

18–34 year-olds

• Past-30-day use: not explicitly reported for 

young adults

• Dual use with cigarettes: not explicitly 

reported for young adults

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Delnevo et al. 

(2015)

• Cross-sectional

• National Health Interview Survey

• 2014

• Computer-assisted personal interviewing

• 36,697 adults 18 years of age or older

• 12.6% were 18–24 years of age

• Ever use: defined as those who had tried an 

e-cigarette, even one time

• Current use: defined as using “every day” or “some 

days” 

• Cigarette smoking: (1) current daily; (2) current 

some days; (3) recent quitter (i.e., quit 1 year ago or 

less); (4) former smoker who quit 2 to 3 years ago; 

(5) former smoker who quit 4 or more years ago; 

(6) never smoker

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Among adults 18–24 years of age, 

78.4% were never users, 16.5% were 

former smokers, 4.3% were some-day 

users, and 0.9% were daily users

Table A2.3-3 Continued
A Report of the Surgeon General

A2.3-30 Appendix 2.3

Study Design/population Measures Outcomes/findings

Berg et al. 

(2015)

• Cross-sectional

• 2013

• Online-based survey of 2,002 U.S. students 

from two southeastern universities

• Recruitment by random selection

• Ever use: asked if ever tried, even just one time, 

electronic cigarettes or e-cigarettes, such as Ruyan 

or NJOY

• Past-30-day use: number of days they had used 

e-cigarettes in the last 30 days

• Cigarette smoking: (1) ever users (those who had 

tried cigarettes, even just one time); (2) current 

users (those who used in the last 30 days)

• Dual use with cigarettes: concurrent use of 

e-cigarettes and cigarettes in the last 30 days

• Poly use with other tobacco products: concurrent 

use of e-cigarettes with cigar products, hookah, or 

smokeless tobacco in the last 30 days

• Co-occurrence with other substances: concurrent 

use of e-cigarettes with marijuana in the last 30 days

• Ever use: 13.2%

• Past-30-day use: 4.5%

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: 

among current e-cigarette users (n = 88), 

71.6% used cigarettes; 46.6% used cigar 

products; 54.5% used hookah; 17.0% used 

smokeless tobacco

• Co-occurrence with other substances: 

among current e-cigarette users (n = 88), 

53.4% used marijuana

Coleman et al. 

(2015)

• Cross-sectional

• NATS

• 2012–2013

• Landline and cellular phone surveys of 

4,310 U.S. young adults, 18–29 years 

of age, who never established cigarette 

smoking behavior

• National random-digit-dial sampling

• Ever use: asked if ever used an electronic cigarette, 

even just one time in entire life

• Past-30-day use: not defined

• Cigarette smoking: ever use defined as having tried 

cigarettes, even just one or two puffs

• Dual use with cigarettes: n/a

Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 7.9% (CI, 6.9–8.9%)

• Past-30-day use: among ever users 

(n = 328), 14.6% reported current use 

(CI, 9.8–19.3%)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Hummel et al. 

(2015)

• Cohort study

survey

• 2008, 2010, 2013, 2014

• 6,602 Dutch smokers, 15 years of age or 

older:

– 1,520 in 2008

– 1,802 in 2010

– 1,530 in 2013

– 1,550 in 2014

• Recruitment through probability-based 

web database 

• Ever use: defined as those who reported using an 

e-cigarette less than monthly

• Past-30-day use: defined as those who reported using 

an e-cigarette at least monthly

• Cigarette smoking: smokers (those who had smoked 

at least 100 cigarettes in their lifetime and were 

currently smoking at least monthly)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: no point estimate available; 

OR of 1.52 (CI, 1.09–2.11) among 15- to 

24-year-olds for ever trial of e-cigarettes 

compared with those 55+ years of age for 

2014

• Past-30-day use: no point estimate 

available; OR of 0.48 (CI, 0.28–0.85) among 

15- to 24-year-olds for current use of 

e-cigarettes compared with those 55+ years 

of age for 2014

• Dual use with cigarettes: not reported 

explicitly for young adults

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-31

Study Design/population Measures Outcomes/findings

King et al.

(2015)

• Cross-sectional

• HealthStyles

• 2010–2013

• Consumer panel

• Web-based survey of 14,758 U.S. adults, 

18 years of age and older:

– 2,505 in 2010

– 4,050 in 2011

– 4,170 in 2012

– 4,033 in 2013

• Probability-based sampling 

• Ever use: asked if ever tried electronic cigarettes or 

e-cigarettes, even just one time

• Past-30-day use: asked if used electronic cigarettes 

or e-cigarettes at least once in the past 30 days

• Cigarette smoking: (1) current smokers (those who 

had smoked ≥100 cigarettes in their lifetime and 

now smoke every day or some days); (2) former 

smokers (those who had smoked ≥100 cigarettes in 

their lifetime and reported smoking “not at all” at 

the time of survey); (3) never smokers (those who 

had not smoked ≥100 cigarettes in their lifetime)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 2010, 7.0% (CI, 3.0–10.9%); 

2011, 6.9% (CI, 3.2–10.6%); 2012, 4.1% 

(CI, 1.8–6.3%); 2013, 7.8% (CI, 4.2–11.4%)

• Past-30-day use: not reported for 

2010/2011 due to relative SE ≥40%; 

2012/2013, 0.9% (CI, 0.2–1.7%)

• Dual use with cigarettes: not reported 

explicitly for young adults

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Kong et al. 

(2015)

• Cross-sectional focus groups

• 2012–2013

• Middle and high school students (youth) in 

New Haven County, Connecticut:

– Focus groups = 18 (n = 127)

– Schoolwide survey = 4,780

• College students (young adults) in New 

Haven County, Connecticut:

– Focus groups = 127

– Schoolwide survey = 625

• Recruitment by flyers and active 

recruitment sessions 

• Ever use: those who indicated they had ever tried 

e-cigarettes

• Past-30-day use: n/a

• Cigarette smoking: (1) never smokers (those who 

indicated never smoking); (2) cigarette smokers 

(those who indicated smoking occasionally or every 

day)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use in focus group: 33.9%

• Past-30-day use: n/a

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Lee et al. (2015) • Cross-sectional

• 2012

• Phone-based survey of 3,507 U.S. civilian, 

noninstitutionalized adults, 18 years of age 

or older

• Probability sample

• Ever use: n/a

• Past-30-day use: defined as those who reported using 

electronic cigarettes every day, some days, or rarely

• Cigarette smoking: current smokers (those who 

smoke every day or some days and have smoked at 

least 100 cigarettes)

• Dual use with cigarettes: current use of cigarettes 

and electronic cigarettes

• Poly use with other tobacco products: current use of 

cigarettes and two or more other tobacco products

• Co-occurrence with other substances: n/a

• Ever use: n/a

• Past-30-day use: not explicitly reported for 

young adults

• Dual use with cigarettes: not explicitly 

reported for young adults

• Poly use with other tobacco products: poly 

use with e-cigarettes not explicitly reported

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
A Report of the Surgeon General

A2.3-32 Appendix 2.3

Study Design/population Measures Outcomes/findings

Li et al. (2015) • Cross-sectional

• 2014

• Nationwide, in-home survey in New 

Zealand

• Multistage, stratified, clustered, and 

random-probability sampling method 

(oversampling of Maori and Pacific peoples)

• Participants 15 years of age or older, 

n = 2,594

• Youth: 15–17 years of age, 3.8% of sample

• Young adults: 18–24 years of age, 13.4% of 

sample

• Ever use: asked if ever used an e-cigarette

• Current use: defined as at least once a day, at least 

once a week, at least once a month, less than once a 

month, and do not use one now

• Cigarette smoking: n/a

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Among 15- to 17-year-olds, 20.7% had ever 

used an e-cigarette, and 0.0% were current 

users

• Among 18- to 24-year-olds, 25.8% had ever 

used an e-cigarette, and 0.2% were current 

users

Majeed et al. 

(2015)

• Cross-sectional consumer panel

• HealthStyles

• 2012

• Web-based survey of 4,043 U.S. adults, 

18 years of age and older

• Probability-based sampling 

• Ever use: asked if ever tried electronic cigarettes or 

e-cigarettes, such as Ruyan or NJOY, even just one 

time

• Past-30-day use: n/a

• Cigarette smoking: (1) current smokers (those 

who had smoked 100 cigarettes or more in their 

lifetime and currently smoke every day or some 

days); (2) former smokers (those who had smoked 

100 cigarettes or more in their lifetime but do not 

currently smoke); (3) never smokers (those who had 

not smoked 100 cigarettes or more in their lifetime)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a 

• Ever use: not explicitly reported for young 

adults 

• Past-30-day use: n/a

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-33

Study Design/population Measures Outcomes/findings

McMillen et al. 

(2015)

• Cross-sectional

• 2010–2013

• Mixed-mode, mixed-frame survey of 

12,683 U.S. adults:

– 3,240 in 2010

– 3,097 in 2011

– 3,101 in 2012

– 3,245 in 2013

• Probability-based sampling

• Ever use: asked if ever tried electronic cigarettes or 

e-cigarettes, even just one time

• Past-30-day use: asked if used an electronic cigarette 

or e-cigarette every day or some days

• Cigarette smoking: (1) current smokers (those 

who had smoked at least 100 cigarettes in their 

entire life and now smoke every day or some days); 

(2) former smokers (those who had smoked at least 

100 cigarettes in their entire life but do not smoke 

now)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: Among 18–24 year olds:

– 2010: 2.5% (CI, 0.6–4.4%)

– 2011: 7.3% (CI, 4.5–10.1%)

– 2012: 15.0% (CI, 9.9–20.1%)

– 2013: 21.0% (CI, 16.6–25.4%)

• Past-30-day use:

– 2010: 0.0% (CI, 0.0–0.0%)

– 2011: 0.0% (CI, 0.0–0.0%)

– 2012: 3.4% (CI, 0.8–6.0%)

– 2013: 14.2% (CI, 10.4–18.0%)

• Dual use with cigarettes: not explicitly 

reported for young adults

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Pepper et al. 

(2015)

• Cross-sectional

• 2013

• Web-based survey of 6,607 U.S. adult 

smokers

• Random-digit-dial sampling 

• Ever use: asked if they had ever used an e-cigarette, 

even one puff

• Past-30-day use: defined as those who now use 

e-cigarettes some days or every day

• Cigarette smoking: n/a

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: not reported exclusively

• Past-30-day use: not reported exclusively

• Dual use with cigarettes: not explicitly 

reported for young adults

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Pokhrel et al. 

(2015)

• Cross-sectional

• 2013

• Web-based survey of 307 U.S. students 

from a 4-year university and two 2-year 

community colleges in Oahu, Hawaii

• Recruitment by flyers across three college 

campuses

• Ever use: asked if ever used an electronic cigarette

• Past-30-day use: asked how many times they had 

used e-cigarettes in the past 30 days

• Cigarette smoking: (1) current smokers (those who 

reported any use in the past 30 days and 100 or more 

cigarettes in their lifetime); (2) former smokers/

experimenters (those who reported lifetime use but 

did not report use in the past 30 days)

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 43%

• Past-30-day use: 28%

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a 

Table A2.3-3 Continued
A Report of the Surgeon General

A2.3-34 Appendix 2.3

Study Design/population Measures Outcomes/findings

Primack et al. 

(2015)

• Longitudinal cohort

– Wave 2: 2012–2013

– Wave 3: 2013–2014

• 694 youth (16–17 years of age) and young 

adults (18–26 years of age)

• Never smokers who were nonsusceptible to 

smoking at baseline

• Random-digit dialing

• National sample from Dartmouth Media, 

Advertising, and Health Study

• Ever use: asked if ever used an e-cigarette

• Past-30-day use: n/a

• Cigarette smoking: defined as someone who had 

smoked at least one puff of a cigarette in her or his 

lifetime

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 2.3% use at baseline

• Past-30-day use: not reported

• Dual use with cigarettes: not explicitly 

reported

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Ramo et al. 

(2015)

• Cross-sectional

• Web-based survey

• Study 1:

– 2009–2010

– 1,987 young adults, 18–25 years of age 

who had smoked at least one cigarette in 

the previous month

• Study 2:

– 2010–2011

– 570 young adults, 18–25 years of age who 

had smoked at least one cigarette in the 

previous month

• Study 3:

– 2013

– 79 young adults, 18–25 years of age who 

smoked 3 or more days each week and 

used Facebook 4 or more days per week

• Recruitment used three Internet-based 

methods:

– Advertisements on Craigslist.org

– Paid advertising on a variety of websites 

through Adbrite

– Purchase of completed surveys through 

Survey Sampling International 

• Ever use: n/a

• Past-30-day use: asked if they had used any tobacco 

products other than cigarettes in the past month

• Cigarette smoking: not defined

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: n/a

• Past-30-day use:

– Study 1: 6.2%

– Study 2: 18.8%

– Study 3: 41.0%

• Dual use with cigarettes: n/a

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-35

Study Design/population Measures Outcomes/findings

Rutten et al. 

(2015)

• Cross-sectional

• 2009–2010

• Web-based survey of 2,254 U.S. current 

smokers, 18 years of age or older

• Probability-based sampling 

• Ever use: n/a

• Past-30-day use: asked if they now use e-cigarettes 

(e.g., blu, NJOY, V2, Red Dragon)

• Cigarette smoking: current smokers (those who had 

smoked at least 100 cigarettes in their entire life and 

reported currently smoking some days or every day)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: n/a

• Past-30-day use: not explicitly reported

• Dual use with cigarettes: 19.6% (young 

adults, 18–29 years of age)

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Saddleson et al. 

(2015)

• Cross-sectional

• 2013

• Web-based survey of 1,437 U.S. college 

students, 18–23 years of age, in selected 

classes at four universities in the state of 

New York

• Recruitment by selected classes at four 

colleges in the state of New York

• Ever use: defined as those who ever tried or 

experimented with an e-cigarette, even one or 

two puffs

• Past-30-day use: defined as those who used 

e-cigarettes on one or more days in the previous 

30 days

• Cigarette smoking: (1) never smokers (those who 

reported never trying a tobacco cigarette); (2) former 

smokers (those who had smoked ≥100 cigarettes 

in their lifetime and had not smoked in the past 

30 days); (3) experimenters (those who had ever 

tried a cigarette, had smoked <100 cigarettes in their 

lifetime, and had not smoked in the past 30 days); 

(4) current smokers (those who had smoked on at 

least 1 day in the past 30 days)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 29.9%

• Past-30-day use: 14.9%

• Dual use with cigarettes: 6.4%

• Poly use with other tobacco products:

– Past-30-day other tobacco product 

use and current e-cigarette use: 

32.7% (AOR = 3.11, CI, 2.13–4.54)

• Co-occurrence with other substances:

– Past 12-month marijuana use and ever 

e-cigarette use: 54.2% (AOR = 2.37, 

CI, 1.69–3.31)

– Past 12-month marijuana use 

and current cigarette use: 

27.5% (AOR = 1.47, CI, 0.99–2.17)

– Past-30-day alcohol use and ever 

e-cigarette use: 23.9% (AOR = 0.98, 

CI, 0.58–1.68)

– Past-30-day alcohol use and current 

e-cigarette use: 10.7% (AOR = 1.15, 

CI, 0.58–2.30)

– Past-30-day binge drinking and ever 

e-cigarette use: 40.3% (AOR = 1.08, 

CI, 0.71–1.62)

– Past-30-day binge drinking and current 

e-cigarette use: 21.6% (AOR = 1.71, 

CI, 1.01–2.90)

Table A2.3-3 Continued
A Report of the Surgeon General

A2.3-36 Appendix 2.3

Study Design/population Measures Outcomes/findings

SandersJackson et al. 

(2015)

• Cross-sectional

• 2014

• Web-based survey of 1,247 U.S. young 

adults, 18–34 years of age

• Address-based and random-digit-dial 

sampling

• Ever use: defined as those who had ever used 

e-cigarettes but not within the past 30 days

• Past-30-day use: defined as any use in the past 

30 days

• Cigarette smoking: (1) nonsmoker (<100 cigarettes 

in their lifetime); (2) former smoker (those who 

had smoked at least 100 cigarettes in their lifetime 

but none in the past 30 days); (3) current smoker 

(nondaily or daily based on the number of days 

smoked in the past 30 days)

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: 25.3%

• Past-30-day use: 7.9%

• Dual use with cigarettes: 63.3%

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Vardavas et al. 

(2015)

• Cross-sectional

• 2012

• Phone-based survey of 26,566 youth and 

young adults, 15 years of age or older, from 

27 countries in the European Union

• Probability-based sampling

• Ever use: defined as those who responded 

“regularly,” “occasionally,” or “tried it once or 

twice” when asked if they had ever tried electronic 

cigarettes

• Past-30-day use: n/a

• Cigarette smoking: not defined

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: no point estimate available. OR of 

3.30 (CI, 2.50–4.55) for e-cigarette use 

among those 15–24 years of age for use of 

electronic cigarettes compared with those 

55 years of age and older

• Past-30-day use: n/a

• Dual use with cigarettes: no point estimate 

available. OR of 3.70 (CI, 2.70–5.00) among 

current smokers 15–24 years of age for 

use of electronic cigarettes compared with 

current smokers 55 years of age and older

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Table A2.3-3 Continued
E-Cigarette Use Among Youth and Young Adults

Other Supporting Literature A2.3-37

Study Design/population Measures Outcomes/findings

Gmel et al. 

(2016)

• Longitudinal

• Cohort Study on Substance Use Risk 

Factors (C-SURF)

• Baseline data collect between 2010 and 

2012; follow-up data collected between 

2012 and 2013

• Sample drawn from Army recruitment 

centers, from 21 Swiss cantons

• 5,128 Swiss men, 20 years of age 

• Ever use: n/a

• Current use: use of e-cigarettes within past year

• Cigarette smoking: use of cigarettes in past year

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Among baseline nonsmokers, e-cigarette 

users were more likely to start smoking at 

follow-up than non-e-cigarette users:

– OR = 6.02 (95% CI: 2.81–12.88) for 

becoming occasional smokers

– OR = 12.69 (95% CI: 4.00–40.28) for 

becoming daily smokers

• Among baseline occasional smokers, 

e-cigarette users were less likely to quit 

smoking (OR = 0.43; 95% CI: 0.19–0.96) 

or become daily smokers 

(OR = 0.42 [95% CI: 0.15–1.18)

Soneji et al. 

(2016)

• Cross-sectional

• 2012–2013

• Web-based survey of a national sample of 

1,596 youth and young adults, 16–26 years 

of age, who participated in longitudinal 

study.

• Random-digit-dial sampling

• Ever use: n/a

• Past-30-day use: defined as use of an electronic 

cigarette in the past 30 days

• Cigarette smoking: n/a

• Dual use with cigarettes: not defined

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Ever use: n/a

• Past-30-day use: 5%

• Dual use with cigarettes: 13%

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

Weaver et al. 

(2016)

• Cross-sectional

• 2014 Tobacco Products and Risk 

Perceptions Survey

• Probability sample drawn from 

GfK Knowledge Panel

• 5,717 adults, 18 years of age or older 

• Ever use: asked if they had ever used an e-cigarette, 

even just once

• Current use: those who had used the product at least 

once during the past 30 days

• Cigarette smoking: had smoked at least 

100 cigarettes in lifetime and used cigarettes “every 

day” or “some days”

• Dual use with cigarettes: n/a 

• Poly use with other tobacco products: n/a

• Co-occurrence with other substances: n/a

• Among adults 18–24 years of age (12.6% of 

the sample), 19.9% had ever used 

e-cigarettes, and 5.2% were current users

• 13.6% of adults 18–24 years of age were 

current cigarette users

Notes: AOR = adjusted odds ratio; CI = confidence interval; NATS = National Adult Tobacco Survey; OR = odds ratio.

Table A2.3-3 Continued
A Report of the Surgeon General

A2.3-38 Appendix 2.3

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