Prevalence and correlates of e-cigarette use among older adults aged 60 years and over

Purpose: E-cigarette use has increased substantially in the general population, yet evidence on use among older adults remains limited. Older adults bear a disproportionate burden of smoking-related morbidity and, in some populations, have shown persistently high smoking prevalence relative to younger age groups. Understanding the prevalence and correlates of e-cigarette use in this population is essential to inform targeted tobacco control and harm reduction strategies. Methods: We conducted a pooled cross-sectional analysis of 13,297 adults aged 60 years and over (mean age 71.4 years; 54.3% female) from seven waves (2017-2024, excluding 2020) of the Scottish Health Survey (SHeS), a nationally representative household survey. Current e-cigarette use was the primary outcome. Survey-weighted logistic regression was used to estimate crude and adjusted odds ratios for the association between current e-cigarette use and sociodemographic, behavioural, and health-related covariates, accounting for the complex survey design. Results: The weighted prevalence of current e-cigarette use among older adults was 4.5% (95% CI: 4.1-4.9). Prevalence remained broadly stable across survey years, ranging from 2.16% (95% CI: 1.43-3.25) in 2021 to 5.55% (95% CI: 4.43-6.93) in 2023. E-cigarette use was overwhelmingly concentrated among those with a smoking history: current smokers (adjusted OR 18.78, 95% CI: 11.79-29.92, p < 0.001) and ex-smokers (adjusted OR 20.17, 95% CI: 13.10-31.06, p < 0.001) had markedly elevated odds compared with never smokers. E-cigarette use declined sharply with advancing age: compared with the 60-64 reference group, adjusted odds were lower at ages 65-69 (OR 0.61, 95% CI: 0.47-0.79, p < 0.001), 70-74 (OR 0.44, 95% CI: 0.33-0.58, p < 0.001), 75-79 (OR 0.19, 95% CI: 0.13-0.29, p < 0.001), and 80 and over (OR 0.11, 95% CI: 0.06-0.19, p < 0.001). Residence in less deprived areas was associated with lower odds of use compared with the most deprived quintile: fourth quintile (OR 0.49, 95% CI: 0.34-0.70, p < 0.001) and least deprived (OR 0.41, 95% CI: 0.27-0.61, p < 0.001). Respondents reporting fair (OR 1.32, 95% CI: 1.03-1.70, p = 0.028) or bad/very bad self-rated health (OR 1.73, 95% CI: 1.31-2.27, p < 0.001) had higher odds than those in very good or good health. Being divorced was independently associated with current use (OR 1.65, 95% CI: 1.22-2.23, p = 0.001). Sex and alcohol consumption were not significant correlates. Conclusions: E-cigarette use among Scottish older adults was low but non-trivial and was strongly patterned by smoking history. The concentration of use among current and former smokers suggests that e-cigarette use in this age group occurs mainly among people with prior exposure to combustible tobacco, although the cross-sectional design cannot determine whether use reflects cessation, substitution, experimentation, or persistent dual use. The steep age gradient, deprivation patterning, and association with poorer self-rated health highlight the need for age-sensitive clinical counselling and balanced risk communication in older adults.