Prevalence of Electronic Cigarette Use Among Adult Workers — United States, 2017–2018

Electronic cigarettes (e-cigarettes) heat a liquid to produce an aerosol that usually contains nicotine, flavors, and other chemicals and that is inhaled by the user (1). E-cigarette aerosols generally have a lower number and level of harmful toxicants than conventional cigarettes; however, e-cigarette aerosols can contain harmful ingredients, including ultrafine particles, volatile organic compounds, and heavy metals (1,2). The U.S. Surgeon General has determined that evidence is inadequate to conclude that use of e-cigarettes, in general, increases smoking cessation (3). During 2014–2016, an estimated 5.2 million U.S. workers were current e-cigarette users, and prevalence of e-cigarette use was higher among workers in certain industries and occupations (4). To estimate recent national prevalence of e-cigarette use among U.S. workers, CDC analyzed 2017–2018 National Health Interview Survey (NHIS) data for adults aged ≥18 years who were employed during the week before the interview. Among an estimated 156 million U.S. workers, 5.3 million (3.4%) were current e-cigarette users (i.e., “every day” or “some days” use), approximately one half of whom also currently used combustible tobacco products. Current e-cigarette use was highest among males, non-Hispanic Whites, those aged 18–24 years, those with no health insurance, those reporting poor or fair physical health, and those who currently used other tobacco products. Prevalence of e-cigarette use was highest among workers in the accommodation and food services industry and in food preparation and serving-related occupations. Continued surveillance of e-cigarette use in the United States, including among workers, is important to inform the development and implementation of evidence-based strategies to minimize population risks of use of e-cigarettes while continuing to explore their potential usefulness for cessation among adult cigarette smokers (2,3). To maximize the health of workers, employers can integrate comprehensive and effective tobacco cessation programs into workplace health promotion programs (4,5).

NHIS is an annual, nationally representative, in-person survey of the noninstitutionalized U.S. civilian population.* The NHIS adult questionnaire is administered to one adult aged ≥18 years randomly selected from each family within the sampled household.^† Sample sizes (response rates) for NHIS were 26,742 (53.0%) in 2017 and 25,417 (53.1%) in 2018.^§

Data analysis included responses from 30,447 adults aged ≥18 years who were “working at a job or business,” “with a job or business but not at work,” or “working, but not for pay, at a family-owned job or business” during the week before the interview. A standardized coding system was used to classify industry of employment and occupation information.^† Current e-cigarette users were defined as adults who reported ever using an e-cigarette, even one time, and who reported using e-cigarettes “every day” (daily) or “some days” at the time of the survey. Current e-cigarette use was also assessed by cigarette smoking status (current, former, or never),^¶ current use of other noncigarette combustible tobacco products (yes or no),** current use of any combustible tobacco products (yes or no),^†† and current use of any smokeless tobacco products (yes or no).^§§

Sample weights were adjusted for pooled data to provide nationally representative estimates. Prevalence estimates and 95% confidence intervals were calculated. E-cigarette use was assessed overall for working adults and by sociodemographic characteristics, industry, and occupation. Estimates with a relative standard error ≥30% are not reported. Two-sided t-tests were used to determine statistically significant (p<0.05) differences between point estimates.

During 2017–2018, the prevalence of current e-cigarette use among U.S. workers (3.4%) was significantly higher than that among nonworkers (2.3%). Prevalence was highest among workers who were male (4.1%), non-Hispanic White (4.0%), and aged 18–24 years (7.3%) and among those with a high school education or less (4.7%), with family income <$35,000 (4.9%), with no health insurance (5.0%), and with self-reported poor or fair physical health (5.0%) (Table 1). The prevalence of e-cigarette use was 10.9% among current cigarette smokers, 6.8% among former smokers, 10.4% among users of other combustible tobacco, and 7.3% among smokeless tobacco users. Among the estimated 5.3 million workers who were current e-cigarettes users, 2.3 million (43.1%) were daily e-cigarette users, and 2.6 million (49.5%) also currently smoked combustible tobacco products. Among the estimated 2 million former cigarette smokers, 1.3 million (65.8%) were daily e-cigarette users.

Among the industries assessed, the prevalence of current e-cigarette use ranged from 6.9% among accommodation and food services workers (36.9% were daily users; 49.0% were current combustible tobacco product users) to 1.4% among education services workers (40.0% were daily users; 38.8% were current combustible tobacco product users). Among the occupations assessed, current e-cigarette use prevalence ranged from 7.3% among food preparation and serving-related workers (31.0% were daily users; 47.5% were current combustible tobacco product users) to 1.4% among education, training, and library workers (44.2% were daily users; 29.1% were current combustible tobacco product users). Daily e-cigarette use was highest among workers in the wholesale trade industry and production occupations. Among e-cigarette users, the prevalence of current combustible tobacco product use was highest among workers in the other services industry (including repair and maintenance, private household, and laundry services^¶¶) and transportation and material moving occupations (Table 2).

Acknowledgments

Teresa W. Wang, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; Maria Villarroel, Division of Health Interview Statistics, National Center for Health Statistics, CDC.

Corresponding author: Girija Syamlal, gos2@cdc.gov, 304-285-5827.

¹Respiratory Health Division, National Institute for Occupational Safety and Health, CDC; ²Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

References

1. US Department of Health and Human Services. E-cigarette use among youth and young adults: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf
2. National Academies of Sciences, Engineering, and Medicine. Public health consequences of e-cigarettes. Washington, DC: The National Academies Press; 2018.
3. US Department of Health and Human Services. Smoking cessation: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf
4. Castellan RM, Chosewood LC, Trout D, et al. Current intelligence bulletin 67: promoting health and preventing disease and injury through workplace tobacco policies. Morgantown, WV: US Department of Health and Human Services, CDC, National Institute for Occupational Safety and Health; 2015. https://www.cdc.gov/niosh/docs/2015-113/pdfs/fy15_cib-67_2015-113_v3.pdf
5. Bauer JE, Hyland A, Li Q, Steger C, Cummings KM. A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use. Am J Public Health 2005;95:1024–9. https://doi.org/10.2105/AJPH.2004.048678 PMID:15914828
6. Syamlal G, King BA, Mazurek JM. Tobacco use among working adults—United States, 2014–2016. MMWR Morb Mortal Wkly Rep 2017;66:1130–5. https://doi.org/10.15585/mmwr.mm6642a2 PMID:29072865
7. Creamer MR, Wang TW, Babb S, et al. Tobacco product use and cessation indicators among adults—United States, 2018. MMWR Morb Mortal Wkly Rep 2019;68:1013–9. https://doi.org/10.15585/mmwr.mm6845a2 PMID:31725711
8. Caraballo RS, Shafer PR, Patel D, Davis KC, McAfee TA. Quit methods used by US adult cigarette smokers, 2014–2016. Prev Chronic Dis 2017;14:E32. https://doi.org/10.5888/pcd14.160600 PMID:28409740
9. Goniewicz ML, Smith DM, Edwards KC, et al. Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes. JAMA Netw Open 2018;1:e185937. https://doi.org/10.1001/jamanetworkopen.2018.5937 PMID:30646298
10. Syamlal G, King BA, Mazurek JM. Workplace smoke-free policies and cessation programs among U.S. working adults. Am J Prev Med 2019;56:548–62. https://doi.org/10.1016/j.amepre.2018.10.030 PMID:30772152

Abbreviations: CI = confidence interval; e-cigarettes = electronic cigarettes; GED = General Education Development certificate.
* Adults who were “working at a job or business,” “with a job or business but not at work,” or “working, but not for pay, at a family-owned job or business” during the week before the interview.
^† Weighted to provide national annual average population estimates for current employment.
^§ Used e-cigarettes at least once during their lifetime and used e-cigarettes “every day” or “some days” at the time of the survey.
^¶ Combustible tobacco users were defined as persons who used either “every day” or “some days” at least one combustible tobacco product: cigarettes, cigars, cigarillos, filtered little cigars, pipes, water pipes, or hookahs (for cigarettes, users were defined as persons who had smoked ≥100 cigarettes during their lifetime and smoked “every day” or “some days” at the time of the survey).
** Small sample sizes or prevalence estimates with a relative standard error ≥30% are not presented.
^†† Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
^§§ Cigarette smokers were defined as persons who reported smoking ≥100 cigarettes during their lifetime and who currently smoke every day or some days.
^¶¶ Cigars, cigarillos, or little filtered cigars, or smoked tobacco in a regular pipe, water pipe, or hookah at least once during their lifetime and now smoked at least one of these products “every day” or “some days.”
*** Using chewing tobacco, snuff, dip, snus, or dissolvable tobacco at least once during their lifetime and now used at least one of these products “every day” or “some days.”
^††† Perceived self-reported health categorized on the basis of the response to the question “Would you say your health in general is excellent, good, fair, or poor?”

Abbreviation: CI = confidence interval.
* Adults who were “working at a job or business”; “with a job or business but not at work”; or “working, but not for pay, at a family-owned job or business” during the week before the interview. Data are weighted to provide national estimates using the survey sample weights for each participant.
^† Current users are adults who used e-cigarettes at least once in their lifetime and currently use every day or some days.
^§ Combustible tobacco use was defined as use either “every day” or “some days” of at least one combustible tobacco product: cigarettes, cigars, cigarillos, filtered little cigars, pipes, water pipes, or hookahs (for cigarettes, users were defined as persons who had smoked ≥100 cigarette during their lifetime and reported currently smoking “every day” or “some days”).
^¶ Small sample size or prevalence estimates with a relative standard error ≥30% are not presented.
** Includes workers in the agriculture, forestry, fishing, and hunting industry, mining industry, utilities industry, Management of companies and enterprises industry and armed forces industry. Industries with small sample size or ≥30% relative standard error, were combined to improve reliability.
^†† Includes workers in the architecture and engineering occupation, life, physical, and social science occupation, community and social services occupation, legal occupation, farming, fishing, and forestry occupation, and military occupation. Occupations with small sample size or ≥30% relative standard error were combined to improve reliability.