Teen Vaping: A Deep Dive into Current Statistics

Teen vaping is a big concern in the U.S., but is it based on fact or fiction?

Current Teen Vaping Statistics in the U.S. 

Each year, the Food and Drug Administration (FDA) conducts a National Youth Tobacco Survey. The survey for 2022 found that more than 2.5 million high school and middle school students used e-cigarettes¹E. Park-Lee, “Tobacco Product Use Among Middle and High School Students — United States, 2022,” MMWR. Morbidity and Mortality Weekly Report, vol. 71, no. 45, 2022, doi: https://doi.org/10.15585/mmwr.mm7145a1. 

Of those 2.5 million:

• 3.3% (380,000) were middle school students
• 14.1% (2.14 million) were high school students 
• 1 in 4 (27.6%) used an e-cigarette product every day 

The study also identified the most popular type of device among the 2.5 million high school and middle school students. 

• 55.3% preferred disposables
• 25.2% preferred prefilled/refillable pods or cartridges

Is Teen Vaping On The Rise? 

If we compare the FDA’s Youth Tobacco Survey from 2021 and 2022, it is clear that teenage e-cigarette use is on the rise. According to the 2021 study, more than 2 million U.S. youths used e-cigarettes²“Morbidity and Mortality Weekly Report Tobacco Product Use and Associated Factors Among Middle and High School Students – National Youth Tobacco Survey, United States, 2021.” Available: https://www.cdc.gov/mmwr/volumes/71/ss/pdfs/ss7105a1-H.pdf. 

Of those 2 million: 

• 2.8% (320,000) were middle school students 
• 11.3% (1.34 million) were high school students
• 1 in 4 used an e-cigarette product every day 

Among the students who used e-cigarettes: 

• 53.7% preferred disposables 
• 28.7% preferred prefilled-refillable pods or cartridges

The number of youths who used e-cigarettes rose by over 500,000 from 2021 to 2022. The increase is mostly attributed to high school students, with around 800,000 more high schoolers taking up vaping in just one year. The increase in middle school students was far less dramatic, with only an additional 60,000 middle school students starting to vape within a year. 

It comes as no surprise that disposables are a steady favorite among young people. 

Popularity of Disposable Vapes

One of the biggest concerns around disposables is the bright colors, fun flavors, and low learning curve. Even before the Youth Tobacco Survey revealed that teenagers predominantly prefer disposable vapes over any other kind of vape, there were serious concerns about the existence of this accessible, beginner-friendly type of e-cigarette.  

Disposables are so popular that even the FDA’s ban has not stopped them from appearing on shelves. In January 2020, the FDA banned the sale of disposable vapes and introduced Premarket Tobacco Product Applications³Center for Tobacco Products, “Premarket Tobacco Product Applications,” U.S. Food and Drug Administration, 2019. https://www.fda.gov/tobacco-products/market-and-distribute-tobacco-product/premarket-tobacco-product-applications to monitor the e-cigarette products on the market. Despite having only authorized 23 tobacco-flavored e-cigarette products and devices⁴O. of the Commissioner, “FDA Denies Marketing of Two Vuse Solo Menthol E-Cigarette Products,” FDA, Mar. 17, 2023. https://www.fda.gov/news-events/press-announcements/fda-denies-marketing-two-vuse-solo-menthol-e-cigarette-products in the last few years, the FDA is still struggling to combat the flood of disposable e-cigarettes in the country. 

Did COVID-19 Impact Teen Vaping? 

The Healthy Behaviours During the COVID-19 Pandemic⁵J. J. Mitchell, S. J. Dicken, D. Kale, A. Herbec, E. Beard, and L. Shahab, “Longitudinal changes and correlates of meeting WHO recommended levels of physical activity in the UK during the COVID-19 pandemic: Findings from the HEBECO study,” PLOS ONE, vol. 17, no. 8, p. e0273530, Aug. 2022, doi: https://doi.org/10.1371/journal.pone.0273530 (HEBECO) study offers us an insight into the potential link between youth uptake and the pandemic. Concerns about teen vaping during the pandemic were two-pronged: firstly, there were worries that the isolation and anxiety caused by the pandemic would lead to an increase in youth uptake and, secondly, there were concerns that COVID-19 would hospitalize teen vapers. 

Analysis of cross-sectional findings concluded that there were “no differences in diagnosed/suspected COVID-19 between never, current and ex-vapers.”⁶D. Kale, A. Herbec, O. Perski, S. E. Jackson, J. Brown, and L. Shahab, “Associations between vaping and Covid-19: Cross-sectional findings from the HEBECO study,” Drug and Alcohol Dependence, vol. 221, p. 108590, Apr. 2021, doi: https://doi.org/10.1016/j.drugalcdep.2021.108590 It follows that “there was sufficient evidence to rule out small negative (protective) associations between vaping status and diagnosed/suspected COVID-19.” 

In fact, one study found that a significant number of vapers were very concerned about the effects of using e-cigarettes during the pandemic, so much so that it formed part of their motivation to quit. 

The study surveyed 3,179 adults aged over 18 and found that 12.2% of quit attempts in a three-month period were triggered by COVID-19⁷H. Tattan‐Birch, O. Perski, S. Jackson, L. Shahab, R. West, and J. Brown, “COVID‐19, smoking, vaping and quitting: a representative population survey in England,” Addiction, vol. 116, no. 5, Sep. 2020, doi: https://doi.org/10.1111/add.15251, and approximately one in 10 e-cigarette users reported attempting to quit vaping because of COVID-19. However, this study focused on a UK sample of adults, meaning it may not necessarily correlate to youth experiences of vaping in the U.S. 

That being said, it is no surprise that there was an increase in the number of young people using e-cigarettes during the pandemic. Teenagers are less aware of the consequences of using vape products, which we will discuss next. 

Teenage Perception of E-Cigarettes 

Lawmakers and campaigners question whether vape companies are clear enough about the dangers of their products. You would be forgiven for thinking that 100% of respondents for any given study are aware of the negative health impact of consuming nicotine, but this is not the case. 

One survey gathered responses from 1,129 participants between the ages of 14 to 24⁸G. G. Wood, M. E. Waselewski, A. C. Bryant, K. R. Sonneville, and T. Chang, “Youth Perceptions of Juul in the United States,” JAMA Pediatrics, May 2020, doi: https://doi.org/10.1001/jamapediatrics.2020.0491 in a one week period from January to February 2019. Researchers sent text messages to the participants to assess their perception of the popular disposable brand JUUL. One of the questions in the survey was “Do you think JUUL is dangerous? Why or why not?”

Here are the results. 

• 826 (78.7%) replied “Yes”, meaning they think that JUUL is dangerous 
• 339 (41%) said it is dangerous because of the nicotine content
• 298 (36.1%) said it is dangerous because they believe it affects physical health
• 278 (33.7%) said it is dangerous because they believe it causes addiction 
• 66 (6.3%) replied “No”, meaning they did not think that JUUL is dangerous
• 71 (6.8%) replied “Maybe” 

Other studies have shown that young people have very little understanding of what exactly is in disposable e-cigarettes, and more specifically JUUL products. One study found that 63% of people between the ages of 15 and 24 didn’t realize that the e-liquid in JUUL pods contain nicotine⁹D. Washington, “JUUL E-cigarettes Gain Popularity Among Youth, But Awareness of Nicotine Presence Remains Low New Study from Truth Initiative ® Raises Concerns over Lack of Education and Regulation of Popular E-cigarette/Vaping Devices,” 2018. Available: https://truthinitiative.org/sites/default/files/media/files/2019/03/JUUL-E-cigarettes-Gain-Popularity-Among-Youth-But-Awareness-of-Nicotine-Presence-Remains-Low.pdf. 

Reasons for Teenagers Trying E-Cigarettes

Big vape would have us believe that e-cigarettes are only ever used as a smoking cessation tool. In fact, the statistics prove otherwise, especially for young vapers. 

In the same study mentioned above, researchers sent a text asking “Why do you think people your age use JUUL?” 

Here are the results. 

• 658 (62.2%) said social reasons
• 206 (19.5%) said as an alternative to other substances
• 176 (16.6%) said it feels good/gives a buzz
• 107 (10.1%) said addiction
• 96 (9.1%) said a belief that it is harmless 
• 50 (4.7%) said flavors

There are a lot of studies and surveys that attempt to define why teenagers try e-cigarettes, with varying responses for each. One study found that physically active high school students in Georgia were more likely to use e-cigarettes¹⁰J. Rajbhandari-Thapa et al., “Electronic Vapor Product Use and Levels of Physical Activity Among High School Students in Georgia,” Tobacco Use Insights, vol. 15, p. 1179173X2211017, Jan. 2022, doi: https://doi.org/10.1177/1179173×221101786 than their less active peers, suggesting that the reason for youth uptake might be stress-related. 

Another study used data from 2015 to 2016 to find reasons for vaping among 2,664 12th graders¹¹R. J. Evans-Polce, M. E. Patrick, S. T. Lanza, R. A. Miech, P. M. O’Malley, and L. D. Johnston, “Reasons for Vaping Among U.S. 12th Graders,” Journal of Adolescent Health, vol. 62, no. 4, pp. 457–462, Apr. 2018, doi: https://doi.org/10.1016/j.jadohealth.2017.10.009. Here are the findings.

• 63.4% said they were vaping for taste and entertainment
• 29.4% said they started vaping to experiment
• 7.3% said they started vaping to replace cigarettes 

When we compare this study to the above survey, it is clear to see that young people only start using e-cigarettes as a cessation tool in a small number of situations. The perception of e-cigarettes is not reflected in the real-life statistics. 

Chemicals in E-Cigarettes & E-Liquids

Compared to combustible cigarettes, e-cigarettes are in their infancy. There are far fewer studies into the harms of vaping than there are into the ill effects of smoking. Even if we don’t understand the long-term impact of e-cigarettes, we still understand the different elements that make up an e-cigarette. 

One study identified “the presence of metal and silicate particles in cartomizer aerosol”¹²M. Williams, A. Villarreal, K. Bozhilov, S. Lin, and P. Talbot, “Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol,” PloS one, vol. 8, no. 3, p. e57987, 2013, doi: https://doi.org/10.1371/journal.pone.0057987 products. In other words, some e-cigarettes contain metal particles. It has long been accepted that some e-cigarettes and day-to-day products contain metals, which might be why these sorts of studies do not create bigger headlines.

But what about e-liquids? E-liquids are always made up of two essential components: vegetable glycerin (VG) and propylene glycol (PG). The consensus is that these two substances are mostly harmless, but research tells us otherwise. A researcher at Johns Hopkins University conducted a study that found arsenic, lead, and other toxic metals in e-liquid before it had ever come into contact with a coil¹³P. Olmedo et al., “Metal Concentrations in e-Cigarette Liquid and Aerosol Samples: The Contribution of Metallic Coils,” Environmental Health Perspectives, vol. 126, no. 2, p. 027010, Feb. 2018, doi: https://doi.org/10.1289/ehp2175. This suggests that both e-liquids and e-cigarettes might be a cause for concern. 

VG and PG aside, there are also various chemicals in e-liquids. As far back as 2015, researchers have found formaldehyde in vape liquid¹⁴R. P. Jensen, W. Luo, J. F. Pankow, R. M. Strongin, and D. H. Peyton, “Hidden Formaldehyde in E-Cigarette Aerosols,” New England Journal of Medicine, vol. 372, no. 4, pp. 392–394, Jan. 2015, doi: https://doi.org/10.1056/nejmc1413069. Formaldehyde, a strong odorless chemical that appears in wallpaper and cosmetic products, is also present in cigarettes, but in lesser quantities. In fact, the same study that discovered the presence of formaldehyde also discovered that e-cigarette vapor contains five to 15 times more of the substance than combustible cigarettes. 

Health Impact of Vaping Statistics

• As of February 2020, there have been 2,807 hospitalized cases and 68 deaths associated with e-cigarette or vaping use-associated lung injury¹⁵CDC, “Outbreak of Severe Pulmonary Disease Linked with E-cigarette Product Use,” Centers for Disease Control and Prevention, Feb. 25, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html (EVALI) 
• E-cigarette users report a significantly higher prevalence of dry mouth, black tongue, and heart palpitations¹⁶M. N. Alhajj et al., “Oral health practices and self-reported adverse effects of E-cigarette use among dental students in 11 countries: an online survey,” BMC Oral Health, vol. 22, no. 1, Jan. 2022, doi: https://doi.org/10.1186/s12903-022-02053-0
• Nicotine constricts blood vessels¹⁷N. L. Benowitz and A. D. Burbank, “Cardiovascular Toxicity of nicotine: Implications for Electronic Cigarette Use,” Trends in Cardiovascular Medicine, vol. 26, no. 6, pp. 515–523, Aug. 2016, doi: https://doi.org/10.1016/j.tcm.2016.03.001, which decreases the amount of oxygen that flows to the brain 

Concerns About Teen Vaping

So, why are professionals specifically concerned about teenagers vaping? 

Summary: 

• Lungs fully develop between the ages of 20 to 25
• Brains fully develop at around 25 
• Nicotine exposure leads to depression later in life
• Young people are more likely to use e-cigarettes than older people

Youth uptake of e-cigarettes has sparked concern for many reasons, not least because of the looming health cost of potential related illnesses in the future. Human lungs only mature between the ages of 20 and 25¹⁸“Lung Capacity and Aging,” www.lung.org. https://www.lung.org/lung-health-diseases/how-lungs-work/lung-capacity-and-aging, which is one of the main reasons why health professionals are concerned about rising EVALI cases. 

On top of that, the human brain does not fully develop until age 25. Nicotine has a negative impact on developing (and developed) brains. Adolescents who consume nicotine are at an increased risk of developing “psychiatric disorders and cognitive impairment in later life.”¹⁹N. Goriounova and H. Mansvelder, “Short- and Long-Term Consequences of Nicotine Exposure during Adolescence for Prefrontal Cortex Neuronal Network Function,” Cold Spring Harbor Perspectives in Medicine, vol. 2, no. 12, Sep. 2012, doi: https://doi.org/10.1101/cshperspect.a012120 This may be due to the fact that nicotine causes blood vessels to constrict and narrow, meaning less blood flows to the brain. Synapses, which act as the bridges between neurons, can’t form without oxygen. It follows that people under the age of 25 who consume nicotine may stunt their mental development. 

One study found that “nicotine exposure during adolescence – but not adulthood – leads to a depression-like state manifested in decreased sensitivity to natural reward (sucrose) and enhanced sensitivity to stress”²⁰S. D. Iñiguez et al., “Nicotine Exposure during Adolescence Induces a Depression-Like State in Adulthood,” Neuropsychopharmacology, vol. 34, no. 6, pp. 1609–1624, Dec. 2008, doi: https://doi.org/10.1038/npp.2008.220 and “anxiety-eliciting situations” later in life. The study concluded that exposure to nicotine in adolescence “results in a negative emotional state rendering the organism significantly more vulnerable to the adverse effects of stress.”

Research suggests that younger age groups are more likely to have used e-cigarettes than older age groups. In one study from 2022, researchers gathered a sample group of 738 smokers in mainland China and discovered that 37.5% of the 18 to 19-year-olds surveyed were currently using e-cigarettes²¹H.-X. Lin et al., “The characteristics and patterns of e-cigarette use and its association with cigarette cessation intention in a Chinese smoking population: A mediation analysis,” Tobacco Induced Diseases, vol. 20, no. February, pp. 1–9, Feb. 2022, doi: https://doi.org/10.18332/tid/144251 as opposed to the 6.5% of the 60 to 69-year-olds surveyed.

Statistics Link Vaping and Smoking 

Despite the popular idea that e-cigarettes are an alternative to cigarettes, research suggests that young people who use e-cigarettes are more likely to try combustible cigarettes.

One study analyzed the link between the initial use of e-cigarettes and subsequent cigarette use among 17,389 young people. It found that those who use e-cigarettes are 3.6 more likely to report trying combustible cigarettes²²S. Soneji et al., “Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults,” JAMA Pediatrics, vol. 171, no. 8, p. 788, Aug. 2017, doi: https://doi.org/10.1001/jamapediatrics.2017.1488.

Another study from Truth Initiative found that young people who use e-cigarettes are more than four times as likely to begin using combustible cigarettes within 18 months²³E. C. Hair et al., “Association between e-cigarette use and future combustible cigarette use: Evidence from a prospective cohort of youth and young adults, 2017–2019,” Addictive Behaviors, vol. 112, p. 106593, Jan. 2021, doi: https://doi.org/10.1016/j.addbeh.2020.106593 of trying their first e-cigarette. Far from being a smoking cessation tool, it seems that e-cigarettes act as a gateway to cigarettes for many young people.

Final Thoughts

Teen vaping is a valid concern. The statistics show that far more middle schoolers, high schoolers, and college students are using e-cigarettes than ever before. The fact that many of these young e-cigarette users begin for social reasons or for fun is worrying, especially since Big Vape markets e-cigarettes as a smoking cessation tool. 

The health impact of e-cigarettes may not be as widely understood or feared as the well-publicized problems with combustible cigarettes, but we know that the basic elements are not good for human health. 

Millions of Americans have used e-cigarettes as a smoking cessation aid. They are extremely effective as a cessation aid, but many young people have been using them as a gateway into further nicotine use.

Sources

• 1
  E. Park-Lee, “Tobacco Product Use Among Middle and High School Students — United States, 2022,” MMWR. Morbidity and Mortality Weekly Report, vol. 71, no. 45, 2022, doi: https://doi.org/10.15585/mmwr.mm7145a1
• 2
  “Morbidity and Mortality Weekly Report Tobacco Product Use and Associated Factors Among Middle and High School Students – National Youth Tobacco Survey, United States, 2021.” Available: https://www.cdc.gov/mmwr/volumes/71/ss/pdfs/ss7105a1-H.pdf
• 3
  Center for Tobacco Products, “Premarket Tobacco Product Applications,” U.S. Food and Drug Administration, 2019. https://www.fda.gov/tobacco-products/market-and-distribute-tobacco-product/premarket-tobacco-product-applications
• 4
  O. of the Commissioner, “FDA Denies Marketing of Two Vuse Solo Menthol E-Cigarette Products,” FDA, Mar. 17, 2023. https://www.fda.gov/news-events/press-announcements/fda-denies-marketing-two-vuse-solo-menthol-e-cigarette-products
• 5
  J. J. Mitchell, S. J. Dicken, D. Kale, A. Herbec, E. Beard, and L. Shahab, “Longitudinal changes and correlates of meeting WHO recommended levels of physical activity in the UK during the COVID-19 pandemic: Findings from the HEBECO study,” PLOS ONE, vol. 17, no. 8, p. e0273530, Aug. 2022, doi: https://doi.org/10.1371/journal.pone.0273530
• 6
  D. Kale, A. Herbec, O. Perski, S. E. Jackson, J. Brown, and L. Shahab, “Associations between vaping and Covid-19: Cross-sectional findings from the HEBECO study,” Drug and Alcohol Dependence, vol. 221, p. 108590, Apr. 2021, doi: https://doi.org/10.1016/j.drugalcdep.2021.108590
• 7
  H. Tattan‐Birch, O. Perski, S. Jackson, L. Shahab, R. West, and J. Brown, “COVID‐19, smoking, vaping and quitting: a representative population survey in England,” Addiction, vol. 116, no. 5, Sep. 2020, doi: https://doi.org/10.1111/add.15251
• 8
  G. G. Wood, M. E. Waselewski, A. C. Bryant, K. R. Sonneville, and T. Chang, “Youth Perceptions of Juul in the United States,” JAMA Pediatrics, May 2020, doi: https://doi.org/10.1001/jamapediatrics.2020.0491
• 9
  D. Washington, “JUUL E-cigarettes Gain Popularity Among Youth, But Awareness of Nicotine Presence Remains Low New Study from Truth Initiative ® Raises Concerns over Lack of Education and Regulation of Popular E-cigarette/Vaping Devices,” 2018. Available: https://truthinitiative.org/sites/default/files/media/files/2019/03/JUUL-E-cigarettes-Gain-Popularity-Among-Youth-But-Awareness-of-Nicotine-Presence-Remains-Low.pdf
• 10
  J. Rajbhandari-Thapa et al., “Electronic Vapor Product Use and Levels of Physical Activity Among High School Students in Georgia,” Tobacco Use Insights, vol. 15, p. 1179173X2211017, Jan. 2022, doi: https://doi.org/10.1177/1179173×221101786
• 11
  R. J. Evans-Polce, M. E. Patrick, S. T. Lanza, R. A. Miech, P. M. O’Malley, and L. D. Johnston, “Reasons for Vaping Among U.S. 12th Graders,” Journal of Adolescent Health, vol. 62, no. 4, pp. 457–462, Apr. 2018, doi: https://doi.org/10.1016/j.jadohealth.2017.10.009
• 12
  M. Williams, A. Villarreal, K. Bozhilov, S. Lin, and P. Talbot, “Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol,” PloS one, vol. 8, no. 3, p. e57987, 2013, doi: https://doi.org/10.1371/journal.pone.0057987
• 13
  P. Olmedo et al., “Metal Concentrations in e-Cigarette Liquid and Aerosol Samples: The Contribution of Metallic Coils,” Environmental Health Perspectives, vol. 126, no. 2, p. 027010, Feb. 2018, doi: https://doi.org/10.1289/ehp2175
• 14
  R. P. Jensen, W. Luo, J. F. Pankow, R. M. Strongin, and D. H. Peyton, “Hidden Formaldehyde in E-Cigarette Aerosols,” New England Journal of Medicine, vol. 372, no. 4, pp. 392–394, Jan. 2015, doi: https://doi.org/10.1056/nejmc1413069
• 15
  CDC, “Outbreak of Severe Pulmonary Disease Linked with E-cigarette Product Use,” Centers for Disease Control and Prevention, Feb. 25, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
• 16
  M. N. Alhajj et al., “Oral health practices and self-reported adverse effects of E-cigarette use among dental students in 11 countries: an online survey,” BMC Oral Health, vol. 22, no. 1, Jan. 2022, doi: https://doi.org/10.1186/s12903-022-02053-0
• 17
  N. L. Benowitz and A. D. Burbank, “Cardiovascular Toxicity of nicotine: Implications for Electronic Cigarette Use,” Trends in Cardiovascular Medicine, vol. 26, no. 6, pp. 515–523, Aug. 2016, doi: https://doi.org/10.1016/j.tcm.2016.03.001
• 18
  “Lung Capacity and Aging,” www.lung.org. https://www.lung.org/lung-health-diseases/how-lungs-work/lung-capacity-and-aging
• 19
  N. Goriounova and H. Mansvelder, “Short- and Long-Term Consequences of Nicotine Exposure during Adolescence for Prefrontal Cortex Neuronal Network Function,” Cold Spring Harbor Perspectives in Medicine, vol. 2, no. 12, Sep. 2012, doi: https://doi.org/10.1101/cshperspect.a012120
• 20
  S. D. Iñiguez et al., “Nicotine Exposure during Adolescence Induces a Depression-Like State in Adulthood,” Neuropsychopharmacology, vol. 34, no. 6, pp. 1609–1624, Dec. 2008, doi: https://doi.org/10.1038/npp.2008.220
• 21
  H.-X. Lin et al., “The characteristics and patterns of e-cigarette use and its association with cigarette cessation intention in a Chinese smoking population: A mediation analysis,” Tobacco Induced Diseases, vol. 20, no. February, pp. 1–9, Feb. 2022, doi: https://doi.org/10.18332/tid/144251
• 22
  S. Soneji et al., “Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults,” JAMA Pediatrics, vol. 171, no. 8, p. 788, Aug. 2017, doi: https://doi.org/10.1001/jamapediatrics.2017.1488
• 23
  E. C. Hair et al., “Association between e-cigarette use and future combustible cigarette use: Evidence from a prospective cohort of youth and young adults, 2017–2019,” Addictive Behaviors, vol. 112, p. 106593, Jan. 2021, doi: https://doi.org/10.1016/j.addbeh.2020.106593