- Exclusive cigarette smoking fell sharply among US adults who used cigarettes or vapes between 2014 and 2024.
- Exclusive vaping rose from 5.5% to 39.9% of cigarette and/or vape use over the same period.
- The shift was strongest among adults aged 18 to 29, where exclusive smoking fell from 72.8% to 7.1%.
- Adults aged 60 and over saw little change, with exclusive smoking still accounting for 85.4% of cigarette and/or vape use in late 2024.
US adults who use nicotine are moving away from cigarettes and towards vaping, according to a new analysis of national health survey data covering more than a decade.
The study, published in Nicotine & Tobacco Research, examined quarterly data from the US National Health Interview Survey between 2014 and 2024.
Researchers found that overall use of cigarettes and/or vapes changed only modestly, falling from 17.9 per cent of US adults in the first quarter of 2014 to 16.1 per cent in the final quarter of 2024.
But beneath that headline figure, the type of product being used changed dramatically.
Among adults who used cigarettes and/or vapes, exclusive cigarette smoking fell from 79.7 per cent in early 2014 to 49.7 per cent by the end of 2024. Over the same period, exclusive vaping rose from 5.5 per cent to 39.9 per cent.
The authors said the pattern showed a marked shift away from exclusive smoking and towards exclusive vaping, particularly among younger adults.
Younger adults show the biggest shift
The change was most pronounced among adults aged 18 to 29. In this group, among those who used cigarettes and/or vapes, exclusive smoking fell by more than 90 per cent, from 72.8 per cent in the first quarter of 2014 to 7.1 per cent in the final quarter of 2024.
Exclusive vaping moved in the opposite direction, rising from 8.8 per cent to 83.0 per cent.
By late 2024, the most common pattern among 18 to 29-year-olds who used either product was exclusive daily vaping, which accounted for 47.3 per cent of all cigarette and/or vape use behaviours in that age group.
The shift was also seen among adults aged 30 to 44 and 45 to 59, though it was less dramatic.
Among adults aged 30 to 44 who used cigarettes and/or vapes, exclusive smoking fell from 77.7 per cent to 47.2 per cent. Among those aged 45 to 59, it fell from 84.2 per cent to 71.9 per cent.
Despite those declines, exclusive daily smoking remained the most common pattern in both groups by the end of the study period.
Older smokers remain largely unchanged
The pattern was very different among adults aged 60 and over. In this group, exclusive smoking remained largely unchanged, falling only slightly from 85.9 per cent of cigarette and/or vape use in early 2014 to 85.4 per cent in late 2024.
Exclusive vaping rose modestly, from 3.8 per cent to 9.0 per cent, while dual use fell from 10.4 per cent to 5.7 per cent.
Daily exclusive smoking accounted for 69.0 per cent of cigarette and/or vape use among adults aged 60 and over in late 2024, followed by non-daily exclusive smoking at 16.4 per cent.
The authors said this older group remained a priority because it carries a high burden of smoking-related illness and death, but had seen little movement away from cigarettes.
They suggested risk misperceptions may be one possible factor, noting that older adults are more likely than younger adults to believe vapes are at least as harmful as cigarettes.
Dual use rose again after 2019
The study also looked at dual use, where adults use both cigarettes and vapes.
Dual use followed a U-shaped pattern over the decade. It fell at first, then began rising again from around 2019.
Even so, dual use remained a smaller part of the overall picture, accounting for about 10 per cent to 15 per cent of adults who used cigarettes and/or vapes during the study period.
The most common dual-use pattern was daily smoking combined with non-daily vaping.
The study could not show whether individual adults were using vaping as a temporary step towards quitting smoking, cutting down, or simply adding vaping to continued cigarette use. That’s because the analysis was based on repeated cross-sectional survey data, rather than following the same people over time.
However, the authors noted that the share of dual users who smoked non-daily increased over time, which they said could suggest some movement away from daily smoking among part of this group.
What the study measured
The analysis used data from 338,405 US adults who took part in the National Health Interview Survey between 2014 and 2024, with an average of around 30,000 participants each year.
The researchers grouped adults into nine categories based on whether they smoked every day, smoked some days or did not smoke, and whether they vaped every day, vaped some days or did not vape.
That allowed them to look beyond simple smoking or vaping prevalence and examine how the two behaviours overlapped.
They also analysed results by age group: 18 to 29, 30 to 44, 45 to 59, and 60 and over.
The authors said this more detailed approach was important because measuring smoking and vaping separately can miss product substitution. In other words, it can fail to show whether people are moving from one product to another.
Harm reduction implications
The study’s central finding is that exclusive smoking has fallen substantially among US adults who use cigarettes or vapes, while exclusive vaping has risen.
The authors said this could represent population-level harm reduction if adults are replacing combustible cigarettes with non-combustible nicotine products.
They also argued that the overall level of cigarette and/or vape use did not expand over the study period. Instead, the mix of products changed.
That point is key because much of the vaping policy debate focuses on whether vaping adds new nicotine use to the population or displaces smoking. This study points to displacement among adults, especially younger adults.
The paper doesn’t argue that vapes are harmless. It says the balance between adult access to lower-risk alternatives and preventing uptake among non-users remains critical.
Study limits and disclosures
The authors said the results should be considered exploratory because the analysis was not pre-registered.
The study was also based on self-reported smoking and vaping behaviour, which can be subject to bias. Some less common behaviour patterns involved small numbers of participants, particularly when split by age group.
The analysis did not include other nicotine and tobacco products, such as nicotine pouches, because of low prevalence in the survey data.
The study reported no specific funding for the work.
Two of the authors are full-time employees of Pinney Associates, which has consulted for Juul Labs on nicotine vapour products and has also consulted for Philip Morris International on US regulatory pathways for non-combustible, non-tobacco nicotine products.
The paper states that none of the funders of the authors’ other work had any role in, or oversight of, this study.
