Nearly 11 million U.S. adults are considered as current users of electronic cigarettes, representing about 4.5 percent of the adult population, according to a report released recently by the Annals of Internal Medicine.

About 15 percent of those users, or 1.62 million, began smoking e-cigs without first consuming traditional cigarettes — which has been a concern of anti-tobacco advocates.

In 2016, the National Institutes of Health reported there were 7.75 million adult vapers, of which 51.7 percent were current smokers, 34.8 percent were former smokers and 13.5 percent were people who had never smoked.

The report represents another attempt at trying to measure the prevalence of e-cig usage, particularly among adults ages 18 to 24. About 9.2 percent of young adults, or about 2.8 million, were determined to have used an e-cig product.

By contrast, the U.S. adult traditional cigarette smoking rate fell to a historic low of 13.9 percent in 2017, reversing a one-year uptick, the Centers for Disease Control and Prevention reported June 19.

The rate was 15.8 percent in 2016 and 15.1 percent in 2015.

The Annals of Internal Medicine report determined 51 percent of e-cig consumers are younger than age 35. Usage was more common among men than women, as well as by LGBT individuals and individuals with chronic health conditions.

“These contemporary estimates may inform researchers, health care policymakers and tobacco regulators about demographic and geographic distributions of e-cigarette use,” the report authors said in their conclusion.

Some studies, including one by the Royal College of Physicians, have claimed e-cigs and vaporizers are up to 95 percent less harmful than traditional cigarettes. The Royal College’s study on traditional cigarettes played a key role in the landmark 1964 surgeon general’s determination that traditional cigarettes were the primary cause of lung cancer.

Meanwhile, then-U.S. surgeon general Dr. Vivek Murthy sounded an alarm in December 2016 about e-cigs, saying there is no safe use for people younger than 25.

The FDA has been walking a regulatory and marketing tightrope since announcing plans in July 2017 for a sweeping regulatory “road map” on tobacco and nicotine products that included limiting or eliminating flavorings, such as menthol in traditional cigarettes and candy and fruits in e-cigs and vaporizers, that the agency says appeal to youths.

However, the FDA also supports extending the application deadline for regulatory review for new products, such as e-cigs and vaporizers, from late 2018 to as far out as August 2022. That allows those products to remain available at retail and online.

On March 27, seven public health groups sued the FDA over its decision to allow flavored e-cigs to stay on the market without being reviewed by the agency.

The FDA could provide an update on its regulatory guidance any day since a public comment period concluded this summer.

The federal government’s 2016 National Youth Tobacco survey determined that e-cig and vaporizer usage among teens fell from a high of 16 percent in 2015 to 11.3 percent for 2016. That represented a reversal of a five-year trend of increased youth e-cig use.

Anti-tobacco advocates say part of the urgency in their advocacy related to top-selling Juul is fears of the trend reversing in both e-cigs and traditional cigarettes.

On Feb. 20, the American Cancer Society recommended — with caution — to health care clinicians that they add e-cigs and vaporizers as a smoking-cessation option. The nonprofit group stressed the policy statement is directed strictly at adults, including strongly recommending against e-cig use by the young.

The Annals of Internal Medicine report represents another example of why “there is a huge need for dispassionate analysis of what is happening in the market, and how best to turn it to a public health advantage,” said David Sweanor, an adjunct law professor at the University of Ottawa and author of several e-cig and health studies.

“We know that there are now millions of vapers and millions fewer smokers, but ideology and a lack of curiosity has impeded our ability to connect dots.

“That, in turn, limits our ability to more effectively facilitate smokers moving to massively less hazardous alternatives,” Sweanor said.

Scott Ballin, past president of anti-smoking alliance Coalition of Science or Health, said that since the 2017 announcement, “the FDA has done little to nothing in the area of regulating based on the continuum of risk ... denying consumers valuable information that could lead them to use significantly lower-risk forms of tobacco and nicotine products.”

Get today’s top stories right in your inbox. Sign up for our daily morning newsletter.

rcraver@wsjournal.com 336-727-7376 @rcraverWSJ

Load comments