Initiation of Electronic Cigarette Use by Age Among Youth in the U.S

Am J Prev Med. 2017 Sep;53(3):396-399. doi: 10.1016/j.amepre.2017.02.011. Epub 2017 Mar 31.


Introduction: The rapid increase in electronic cigarette (e-cigarette) smoking among U.S. youth requires data regarding the age pattern of initiation risk for effective tobacco use prevention.

Methods: Data from the 2014 National Youth Tobacco Survey (N=20,680, aged 11-19 years, 50.6% male) were analyzed using survival analysis in 2016 to quantify the likelihood of e-cigarette use initiation by age, overall and by gender and racial/ethnic groups.

Results: The estimated mean age of e-cigarette initiation was 17.50 (95% CI=17.47, 17.52) years. The estimated hazards of e-cigarette use initiation were 0 up to age 6 years, increased slowly from age 7 to 11 years, and continued with an accelerated increase up to age 17 years before it slowed down. There were significant gender (male > female) and racial/ethnicity (from high to low: multiracial, white, Hispanic, African, and Asian) differences in the age pattern.

Conclusions: E-cigarette smoking is initiated as young as age 7 years. Different from conventional cigarette smoking with peak initiation risk at age 14-15 years, the likelihood of initiating e-cigarette smoking continues to increase up to age 18 years. The unique age pattern and significant gender and racial/ethnic differences provide useful data to support further research to strengthen tobacco use prevention in the U.S.

MeSH terms

  • Adolescent
  • Adolescent Behavior / ethnology
  • Age Factors
  • Child
  • Continental Population Groups / statistics & numerical data
  • Electronic Nicotine Delivery Systems / statistics & numerical data*
  • Ethnic Groups / statistics & numerical data
  • Female
  • Humans
  • Male
  • Nutrition Surveys / statistics & numerical data*
  • Sex Factors
  • Smoking / epidemiology*
  • Smoking / trends
  • Tobacco Use / epidemiology
  • Tobacco Use / prevention & control*
  • Tobacco Use / trends
  • United States / epidemiology
  • Young Adult