Noncombustible Nicotine Replaces Cigarettes in Young US Adults

Researchers at the MUSC Hollings Cancer Center have confirmed that the steady decline in US cigarette smoking is driven by young adults transitioning to noncombustible nicotine products. This shift, detailed in a study published in JNCI Cancer Spectrum, indicates a structural change in tobacco consumption that could lower future cancer rates.

Because combustible tobacco products—mainly cigarettes—cause the vast majority of tobacco-related cancer deaths, tracking what types of products people use is vital for predicting the future burden of cancer. The study analyzed how these patterns are changing on a national scale.

Analyzing the Shift in US Tobacco Use

The research team, led by tobacco control researcher K. Michael Cummings, Ph.D., analyzed data from the National Health Interview Survey spanning the years 2015 through 2023. The year 2015 was selected as the baseline because it marks the period when electronic cigarettes began gaining widespread popularity in the United States.

National surveys show that cigarette smoking among youth has dropped below 2% and continues to decline among adults. To understand what products are replacing cigarettes, the researchers categorized tobacco use into three distinct groups:

Combustible Products: Cigarettes, cigars, pipes, and hookahs.
Noncombustible Products: Electronic cigarettes, smokeless tobacco, and nicotine pouches.
Dual Use: The concurrent use of both combustible and noncombustible products.

Product Category	Examples Included	Public Health Impact & Trends
Combustible Tobacco	Cigarettes, cigars, pipes, hookahs	Responsible for 90% of lung cancer deaths; use is declining rapidly among young adults.
Noncombustible Nicotine	E-cigarettes, smokeless tobacco, pouches	Exposes users to far fewer cancer-causing chemicals; increasingly preferred by adults under 35.
Dual Use	Using both cigarettes and e-cigarettes	Remained highly stable at 2% to 3% of the population from 2015 to 2023.

Key Findings: The Generational Divide

The analysis revealed that exclusive combustible tobacco use decreased across nearly every age group, with the sharpest drops observed in young adults aged 18 to 34. Over the same period, exclusive use of noncombustible products rose, driven almost entirely by e-cigarettes.

A surprising finding was the stability of dual use. Public health experts previously feared that the rise of e-cigarettes would lead to more people using both products. Instead, dual use remained flat, while exclusive e-cigarette use grew.

However, the data also highlighted a clear divide by age. While younger demographics are moving away from smoked tobacco, adults aged 55 and older continue to smoke cigarettes and rarely adopt noncombustible alternatives. Cummings noted that public health efforts are failing older smokers, who have decades of smoking history and would experience the most immediate health benefits from switching to lower-risk products.

Measuring Population-Level Harm Reduction

To evaluate whether these changing habits make tobacco consumption less dangerous overall, the researchers developed a “population harm-reduction index.” This index compares the prevalence of exclusive noncombustible tobacco use with the prevalence of any combustible tobacco use.

A higher ratio on this index indicates that more people are replacing highly toxic burned tobacco with alternatives that expose them to substantially fewer cancer-causing chemicals. The strongest evidence of this shift was seen among adults aged 18 to 24, for whom exclusive noncombustible use now exc

Source: Medical University of South Carolina

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Matthew Ma

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With over a decade of experience in the e-cigarette industry, Matthew Ma is a seasoned expert in both the manufacturing and usage aspects of vaping products. His extensive background has provided him with a deep understanding of the intricacies and evolving dynamics of e-cigarettes.