Beyond Cigarettes: The Risks of Non-Cigarette Nicotine Products and Implications for Tobacco Control

While much is known about the effects of tobacco use, the current state of knowledge regarding non-cigarette nicotine products that do not contain tobacco — such as e-cigarettes and other vaping devices, water pipes and hookah, smokeless tobacco, cigars, and cigarillos — is not robust enough to yield a definitive consensus regarding their relative risks and benefits.

Key Takeaways

The landscape of nicotine product use is changing. Fewer people in the U.S. are smoking cigarettes while more people, particularly youth, are using non-cigarette nicotine products. Key findings include the following:

• An estimated 16 percent of adults and 15 percent of middle and high school students reported current use of at least one non-cigarette nicotine product.
• The most commonly used nicotine products among adults were cigarettes (18 percent), cigars (7 percent) and e-cigarettes (7 percent). Among middle and high school students, they were e-cigarettes (9 percent) followed by water pipe/hookah (6 percent) and cigarettes (6 percent).
• More than one-third (38 percent) of adults and half (50 percent) of middle and high school students who reported current use of cigarettes or non-cigarette nicotine products indicated that they used more than one product.
• An estimated 5 percent of adults who reported using only non-cigarette nicotine products (and not cigarettes) in the past 30 days met criteria for nicotine addiction.
• More than half of adults and half of middle and high school students who only used non-cigarette nicotine products reported at least one symptom of nicotine addiction.

Recommendations

For parents:

• Establish healthy patterns of communication with children
• Be involved in children’s friendships and activities
• Set and enforce rules regarding substance use and other risky behaviors.

 

For government policy:

• Ban all characterizing flavors, including menthol, from all nicotine and tobacco products.
• Restrict the advertising and marketing of all nicotine products in the same way cigarette and smokeless tobacco products are restricted.
• Restrict the advertising and marketing of all nicotine products in ways that appeal to youth, such as on television and other media, and through brand name sponsorship of sporting and cultural events.
• Increase the minimum legal sale age for all nicotine products to 21.

 

For health care professionals:

• Be knowledgeable about the risks of each type of nicotine product and about how to advise patients accordingly.
• Screen all patients for all nicotine product use, and provide brief interventions and cessation services to those who screen positive.

Research Methods

In this report, we review and summarize the available research on all non-nicotine products, describe the risk factors and consequences of use and the current regulatory landscape, discuss barriers to reducing use, and offer concrete recommendations for overcoming these barriers. To explore the prevalence and patterns of use of non-cigarette nicotine products, we present findings from an analysis of nationally representative data from the U.S. Centers for Disease Control and Prevention (CDC) on nicotine product use among middle and high school students (from 2014) and among adults, aged 18 and older (from 2013-2014).