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AHA News: Millions Who Never Smoked Cigarettes Are Using Other Tobacco Products

MONDAY, Nov. 18, 2019 (American Heart Association News) — Adults who have never smoked traditional cigarettes are being lured into tobacco use by a host of other products, including e-cigarettes, new research shows.

The study found 1 in 5 adults in the U.S. who had never smoked reported trying non-cigarette tobacco products – with young adults 18 to 39 reporting the highest prevalence of use.

“In general, cigarette use has decreased,” said Dr. Javier Valero-Elizondo, who led the study. He is a research associate in the Heart Research Center at Houston Methodist Research Institute. “But we are now seeing that use of e-cigarettes, cigars, cigarillos, hookahs and other products are on the rise.

“This study was about shining a light on a potential problem we didn’t previously know the size of.”

Valero-Elizondo presented the preliminary findings Monday at the American Heart Association’s Scientific Sessions in Philadelphia. He conducted the research as a postdoctoral associate at Yale University in New Haven, Connecticut.

Valero-Elizondo and his colleagues analyzed data collected on 77,623 never-smokers who were 18 and older taking part in the National Health Interview Survey from 2014 to 2018.

Among those surveyed, 22% reported using at least one non-cigarette tobacco product, suggesting 32.7 million U.S. adults have tried these products.

In addition, 4.8% of the adults surveyed reported currently using non-cigarette tobacco products. This translates into 7.3 million U.S. adults annually.

These findings “raise concerns regarding the high prevalence of tobacco use among never-cigarette-smokers,” said Mary Rezk-Hanna, an assistant professor in the School of Nursing at the University of California, Los Angeles, who was not involved with the research.

Rezk-Hanna said she would like to see research that follows the users of non-cigarette tobacco products over time to determine whether they eventually take up traditional cigarette smoking.

Tobacco use remains a leading cause of preventable death in the United States and globally. Experts estimate it accounted for 7.1 million deaths worldwide in 2016.

Smoking is a major cause of cardiovascular disease, which is the leading cause of death in the U.S., killing more than 800,000 people a year. About 1 in 4 of those deaths are from smoking, according to a 2014 surgeon general’s report.

E-cigarettes, most of which contain nicotine that comes from tobacco, heat a liquid into an aerosol that can be inhaled. In addition to nicotine, the liquid usually has other harmful ingredients such as flavorants and heavy metals.

In August, the Centers for Disease Control and Prevention reported the first death from a vaping-related lung injury. Since then, at least 39 deaths from a vaping-related lung injury have occurred. There also have been at least 2,051 cases of e-cigarette or vaping-related lung injuries reported to the CDC.

The CDC is working with the Food and Drug Administration, public health officials, scientists and others to determine the cause of the lung injuries linked to e-cigarettes.

“There are many aspects of this study that are timely with respect to current health concerns about these products,” said Rezk-Hanna.

The findings from the new study can help researchers develop effective non-cigarette tobacco prevention and cessation programs.

“Our study helps us pinpoint population subgroups where more targeted public heath efforts could be focused,” said Valero-Elizondo. “By us describing who is at higher risk for using these products and pairing that with national mortality data and other epidemiology studies on smoking use, we can put together a plan to start a conversation to tackle the problem, help those who are using these products quit, and keep those haven’t started from using them at all.”

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email

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