Cigarettes, Smokeless Tobacco, and E-Cigarettes: State-Specific Use Patterns Among U.S. Adults, 2017-2018.

INTRODUCTION: State-level monitoring of changes in tobacco product use can inform tobacco control policy and practice. This study examines the state-specific prevalence of current cigarette smoking, smokeless tobacco use, and E-cigarette use and related cigarette quitting behaviors among E-cigarette users during 2017-2018. METHODS: Data from the 2017 and 2018 Behavioral Risk Factor Surveillance System were used to assess state-specific current use of cigarettes, smokeless tobacco, and E-cigarettes among adults aged ≥18 years. Analyzed in 2021, state-specific tobacco product estimates and relative percentage changes between 2017 and 2018 were computed for U.S. states and the District of Columbia. Chi-square tests captured subgroup differences, and logistic regression assessed changes over time. RESULTS: Prevalence of adult current cigarette smoking and smokeless tobacco use varied across states and remained relatively stable during 2017-2018, whereas the prevalence of adult E-cigarette use significantly increased during 2017-2018 among 19 of 36 states that collected Behavioral Risk Factor Surveillance System E-cigarette data in 2018. In all states and the District of Columbia during 2017-2018 combined, the percentage of current cigarette smoking among current E-cigarette users was higher than that of never cigarette smoking; the percentage of attempting to quit cigarette smoking in the past year among dual users of cigarettes and E-cigarettes was >50%. CONCLUSIONS: During 2017-2018, the prevalence of adult current cigarette smoking and smokeless tobacco use varied across states and remained relatively stable, whereas adult E-cigarette use prevalence significantly increased. Comprehensive state-based tobacco prevention and control efforts are warranted to reduce the morbidity and mortality attributed to the use of all tobacco products, including E-cigarettes, among U.S. adults.