Background: Combustible cigarette smoking is the leading cause of preventable death in the United States (1). E-cigarettes remain the most controversial smoking cessation intervention, and public health authorities are concerned that e-cigarette uptake among tobacco-naive people might outstrip the potential utility of e-cigarettes as quit devices (2). Indeed, the newest generations of e-cigarettes (including JUUL) are designed and marketed to appeal to non–combustible cigarette smokers (3). Therefore, a description of sole e-cigarette users (defined as users who never smoked combustible cigarettes) is vital to understand determinants of e-cigarette use and for devising effective interventions and policies.

Objective: We used the Behavioral Risk Factor Surveillance System (BRFSS) 2016 to examine age distribution, state-level prevalence, health perceptions, and behaviors of US adults who were sole e-cigarette users.

Methods: Details on the analytic approach are published elsewhere (4). All analyses applied BRFSS weights to account for the complex survey design, noncoverage, and nonresponse using STATA, version 13.1 (4). We included 261# 541 never-smokers (< 100 cigarettes/lifetime) in our analysis of the prevalence of current (including daily and occasional) sole e-cigarette use. To report the absolute projected number of sole e-cigarette users, we used US census projections of the number of adults in 2016 (4). We used behavioral variables available in BRFSS 2016 to compare health perceptions, behaviors, and health care access of sole e-cigarette users versus nonusers.(Survey questions are available in the Appendix Table.) All frequencies of health behaviors, perceptions, and prevalence estimates are age standardized and presented as percentages (95% CIs).