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Dual use of tobacco merchandise is a health concern because it may result in higher exposure to toxins and worse respiratory outcomes than using both product alone (6–9). In 2021, most e-cigarette customers aged 18–24 had never smoked cigarettes (11). Despite this, the percentage of adults aged 18–24 who have been twin users of e-cigarettes and cigarettes was just like the share among adults aged 25–44 (1.8% in contrast with 2.0%). Adults aged 45 and over had the bottom ranges of e-cigarette only use (1.1%) and dual use of e-cigarettes and cigarettes (0.8%).
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