Electronic Cigarette Use Among Working Adults — United States, 2014

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver a heated aerosol, which typically contains nicotine, flavorings, and other additives, to the user. The e-cigarette marketplace is rapidly evolving, but the long-term health effects of these products are not known. Carcinogens and toxins such as diacetyl, acetaldehyde, and other harmful chemicals have been documented in the aerosol from some e-cigarettes (1–3). On May 5, 2016, the Food and Drug Administration (FDA) finalized a rule extending its authority to all tobacco products, including e-cigarettes.* The prevalence of e-cigarette use among U.S. adults has increased in recent years, particularly among current and former conventional cigarette smokers (4); in 2014, 3.7% of all U.S. adults, including 15.9% of current cigarette smokers, and 22.0% of former cigarette smokers, used e-cigarettes every day or some days (5). The extent of current e-cigarette use among U.S. working adults has not been assessed. Therefore, CDC analyzed 2014 National Health Interview Survey (NHIS) data for adults aged ≥18 years who were working during the week before the interview, to provide national estimates of current e-cigarette use among U.S. working adults by industry and occupation. Among the estimated 146 million working adults, 3.8% (5.5 million) were current (every day or some days) e-cigarette users; the highest prevalences were among males, non-Hispanic whites, persons aged 18–24 years, persons with annual household income <$35,000, persons with no health insurance, cigarette smokers, other combustible tobacco users, and smokeless tobacco users. By industry and occupation, workers in the accommodation and food services industry and in the food preparation and serving-related occupations had the highest prevalence of current e-cigarette use. Higher prevalences of e-cigarette use among specific groups and the effect of e-cigarette use on patterns of conventional tobacco use underscore the importance of continued surveillance of e-cigarette use among U.S. working adults to inform public health policy, planning, and practice.

NHIS data are collected annually from a nationally representative sample of the noninstitutionalized U.S. civilian population through a personal household interview. The NHIS adult core questionnaire is administered to a randomly selected adult aged ≥18 years in each sampled household. In 2014, the NHIS adult sample included 36,697 respondents and the response rate was 58.9% (6). The NHIS collected information on e-cigarette use for the first time in 2014.

Survey participants were considered to be currently working if they reported “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. Information on participants’ industry of employment and occupation was classified by the National Center for Health Statistics using a standardized coding system (6). Current e-cigarette users were adults who answered “yes” to the question about having ever used an e-cigarette, even one time in the past, and who then reported that they currently used e-cigarettes every day or some days at the time of the survey (5). Current e-cigarette use was also assessed within subgroups defined by current cigarette smoking, use of other combustible tobacco products (cigars/little cigars/cigarillos, bidis, pipes, or water pipes/hookahs), and current use of smokeless tobacco products (chewing tobacco/snuff/dip, snus, or dissolvable tobacco). Current cigarette smokers were respondents who reported smoking ≥100 cigarettes during their lifetime, and who reported smoking every day or some days at the time of the survey. Former smokers were respondents who reported smoking ≥100 cigarettes during their lifetime, and reported not smoking at the time of the survey. Never smokers were respondents who reported not having smoked 100 cigarettes during their lifetime. Current other combustible tobacco smokers were respondents who reported ever smoking other tobacco products (including cigars/little cigars/cigarillos, bidis, pipes, or water pipes/hookahs), even one time, and who reported smoking other tobacco products every day, some days, or rarely at the time of the survey. Current smokeless tobacco users were respondents who reported ever using smokeless tobacco products that are placed in the mouth or nose (including chewing tobacco, snuff, dip, snus, or dissolvable tobacco, snuff or chewed tobacco), even one time, and who reported use every day, some days, or rarely at the time of the survey.

Data were adjusted for nonresponse and weighted to provide nationally representative estimates. Prevalence estimates and corresponding 95% confidence intervals were calculated. E-cigarette use was assessed overall, and by age, sex, race/ethnicity, education, annual household income, health insurance status, U.S. census region, perceived health status, current cigarette smoking, other combustible tobacco use, and smokeless tobacco use. 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.

In 2014, an estimated 146 million U.S. adults were working during the week before the NHIS interview. Among working adults, 3.8% (an estimated 5.5 million) were current e-cigarette users. The prevalences of current e-cigarette use were significantly (p<0.05) higher among males (4.5%) and non-Hispanic whites (4.5%), and among persons aged 18–24 years (5.1%), with annual family income <$35,000 (5.1%), with no health insurance (5.9%), residing in the Midwest region (4.5%), and with fair or poor health (5.7%) than among females (3.0%) and non-Hispanic blacks (1.9%), and persons aged 45–64 years (2.9%), with income >$75,000 (2.6%), with health insurance (3.4%), residing in the Northeast region (2.0%), and with excellent health (2.4%) (Table 1). E-cigarette use was also significantly (p<0.05) higher among current cigarette smokers (16.2%) and users of other combustible tobacco products (15.0%) or smokeless tobacco (9.7%) than among former (4.3%) and never (0.5%) cigarette smokers, and nonusers of combustible tobacco (2.9%) or smokeless tobacco (3.6%) (Table 2).

By industry, reported e-cigarette use was highest among workers in accommodation and food services (6.9%) and lowest among workers in education services (1.8%). By occupation, prevalences of e-cigarette use were highest among workers in food preparation and serving-related occupations (6.8%) and lowest among workers in business and financial operations occupations (2.3%) (Table 3).

Acknowledgments

Douglas O. Johns, Respiratory Health Division, National Institute for Occupational Safety and Health, CDC; Israel T. Agaku, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Corresponding author: Girija Syamlal, GSyamlal@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.

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TABLE 1. Current e-cigarette* use prevalence among currently working^† adults aged ≥18 years, by selected characteristics — National Health Interview Survey, United States, 2014

Abbreviations: CI = confidence interval; GED = General Educational Development certificate or diploma.
* Current users were adults who used e-cigarettes at least once in their lifetime and currently use every day or some days.
^† Adults who reported “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 estimates.
^¶ Estimated number of e-cigarette users among working adults.
** E-cigarette use was significantly associated (p<0.05) with age, gender, race, income, health insurance coverage, perceived health status, and region.
^†† Estimates suppressed because relative standard error for the estimate was >30%.
^§§ http://www.census.gov/econ/census/help/geography/regions_and_divisions.html.
^¶¶ 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?”

TABLE 2. Estimated prevalence of current e-cigarette* use, by current cigarette smoking status,^† current other combustible^§ tobacco use status, and current smokeless^¶ tobacco use status among working** adults aged ≥18 years — National Health Interview Survey, United States, 2014

Abbreviation: CI = confidence interval.
* Current users are adults who used e-cigarettes at least once in their lifetime and currently use every day or some days.
^† Current cigarette smokers smoked ≥100 cigarettes during their lifetime and currently smoke every day or somedays. Former cigarette smokers smoked ≥100 cigarettes during their lifetime and currently do not smoke. Never smokers are adults who reported not smoking 100 cigarettes in their lifetime.
^§ Used other non-cigarette combustible tobacco products (cigars/little cigars/cigarillos; bidis, pipes, or water pipes/hookahs) at least one time in the past, and currently smoke every day, some days, or rarely.
^¶ Used smokeless tobacco products (chewing tobacco/snuff/dip, snus, or dissolvable tobacco) at least one time in the past, and currently use them every day, some days, or rarely.
** Adults who reported “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 estimates for working adults.
^§§ Estimated number of e-cigarette users among working adults.
^¶¶ Estimates suppressed because relative standard error for the estimate was >30%.

Table 3. Current e-cigarette use* prevalence among currently working^† adults aged ≥18 years, by industry and occupation group — National Health Interview Survey, 2014

Abbreviation: CI = confidence interval.
* Current users are adults who used e-cigarettes at least once in their lifetime and currently use every day or some days.
^† Adults who reported “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 estimates using the survey sample weights for each participant.
^¶ Estimated number of e-cigarette users among working adults.
** Estimates suppressed because relative standard error for the estimate was >30%.
^†† Includes all industries with unreliable (relative standard error >30%) estimates combined: mining; transportation and warehousing; utilities; information; real estate, rental, and leasing; agriculture, forestry, fishing and hunting; management of companies and enterprises; and armed forces.
^§§ Includes all occupations with unreliable (relative standard error >30%) estimates combined: installation and maintenance and repair; protective services; farming, fishing and forestry, community and social services; arts design, entertainment sports and media; legal, life, physical and social science; education, training, and library; and military occupations.