The number of cigarette smokers in the US hit the lowest levels public health officials have ever seen, the Centers for Disease Control and Prevention announced today. But even though e-cigarette companies tout vapes as alternatives to cigarettes, this dramatic drop in smoking isn’t necessarily because of a rise in vaping.

Only about 14 percent of Americans over the age of 18 smoked cigarettes last year, down from more than 40 percent in 1965, the CDC reports. The record low number of cigarette smokers is good news: smoking kills nearly half a million Americans every year, making it the leading cause of preventable death and disability in the US. The bad news is that there are still populations where smoking is worryingly common — including among people experiencing psychological distress, and those on Medicaid or without health insurance, according to results published in today’s Morbidity and Mortality Weekly Report.

The big question is why we’re seeing the number of smokers in the US decline. While e-cigarette companies are careful not to say their vapes help people quit nicotine altogether, they do market the devices as cigarette alternatives. Back in July, a spokesperson for Juul told The Verge that “Juul is intended for adult smokers only who want to switch from combustible cigarettes.” So it’s tempting to jump to the conclusion that the drop in smoking corresponds with the rise in vaping. But that’s not necessarily the case.

True, some adults do use vapes to kick their cigarette habit. But there still isn’t enough rigorous, long-term research to say if e-cigarettes work for quitting at a population level, according to Brian King, who works at the CDC’s Office on Smoking and Health and is the senior author on today’s study. “The jury’s still out on the effectiveness of e-cigarettes for helping people quit,” he says. “Although anecdotally we know that there are many people who are quitting using e-cigarettes, the plural of anecdote is not data.”

King points out that if smokers were switching en masse from conventional cigarettes to the electronic kind, you’d expect to see the number of e-cigarette users climb as the number of smokers drop. But his team saw the opposite: in 2017, about 2.8 percent of adults used e-cigarettes, down from 3.4 percent in 2015. “We’re basically seeing a gradual decline in overall e-cigarette use among adults, which is starkly different from what we’re seeing in youth,” King says.

However, Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital, cautions that’s not the only way to interpret the data: “That’s assuming that people are switching to e-cigarettes and staying with e-cigarettes, rather than using them for a short time and then quitting nicotine altogether,” she says. “But certainly I agree you can’t ascribe this to e-cigarettes.” Adam Leventhal, professor of preventive medicine at the University of Southern California, agrees. ”I wouldn’t necessarily say that the results indicate one way or the other that vaping is influencing prevalence of smoking,” he says.

The other reason to be skeptical that vapes are behind this drop in smoking is that the majority of e-cigarette users also smoke conventional cigarettes, King says. “That’s a public health concern because if there’s going to be any individual benefits from e-cigarettes for a smoker, they have to quit completely,” he says. It’s possible that people who use both electronic and regular cigarettes are on their way to completely quitting smoking, but current long-term studies suggest that might be overly optimistic. “They continue to engage in dual use or they just relapse to cigarette smoking altogether,” King says.

The CDC says there are tried-and-true methods that do help cut down on the number of people who smoke: taxing tobacco products, banning smoking in public places like bars, and access to cessation aids like nicotine gum and patches, King says: “Continued implementation of these strategies is really going to be critical to continue to see declines in all forms of tobacco use — but particularly cigarettes.”



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