While some youth vaping prevention programs, campaigns, and regulations seek to educate and inform, others try to eliminate the problem away with legislation.
Youth Vaping Statistics
In the U.S., young people use e-cigarettes more than any other tobacco product. The CDC’s 2023 Annual National Youth Tobacco Survey found that more than 2.1 million students currently use e-cigarettes, including:
- 550,000 (4.6%) middle school students
- 1.56 million (10%) high school students
One year previous, the 2022 Annual Youth Tobacco Survey found that more than 2.5 million students currently use e-cigarettes, including:
- 380,000 (3.3%) middle school students
- 2.14 million (14.1%) high school students
From 2022 to 2023, there was a decrease in e-cigarette use among high school students, but an increase in use among middle-school students. The overall decrease in adolescent vapers is a positive step forward, but government officials are not satisfied with the result.
“It’s encouraging to see this substantial decline in e-cigarette use among high schoolers within the past year, which is a win for public health,” said Brian King, Director of the FDA’s Center for Tobacco Products. “But we can’t rest on our laurels. There’s more work to be done to build on this progress.”
Demographic Breakdowns
According to the 2023 Annual National Youth Tobacco Survey, some groups of middle and high school students use e-cigarettes more than others.
- More females than males reported current e-cigarette use
E-cigarette use also varies by race and ethnicity.
- Non-Hispanic multiracial students: 20.8%
- Non-Hispanic White students: 18.4%
- Hispanic or Latino students: 18.2%
- Non-Hispanic American Indian and Alaska Native students: 15.4%
- Non-Hispanic Black or African American students: 12.9%
Health Risks of Youth Vaping
Age demographics aside, all vapers are at risk of conditions caused by nicotine. Nicotine increases the risk of cardiovascular, respiratory, and gastrointestinal disorders. It also impacts reproductive health, decreases immune responses, and causes DNA mutations which can result in cancer.
Research suggests that adolescent vapers are more likely to experience worse health outcomes than adult vapers. The human brain continues to develop into adulthood, with some sources saying 25 is the average age of brain development. Nicotine poses a threat to neurological development, among other physical and mental problems.
One study found that nicotine consumption via traditional cigarettes may alter cognitive function and attention performance. Another study suggests that nicotine consumption alters reward processing in the adolescent brain.
Another study found that young vapers are more likely to suffer from anxiety, and one animal study even found that exposure to e-cigarette vapor during times of rapid brain growth can cause hyperactivity and impulsive behavior changes.
Effective Youth Vaping Prevention Programs
The youth vaping epidemic might be showing slow signs of reversing, but the problem still stands. As the risks associated with youth vaping enter the spotlight, government figures, educators, and concerned groups rush to deliver effective youth vaping prevention programs.
Educational Campaigns
Educational adolescent vaping prevention programs seek to share information with young people, allowing them to make informed decisions about the risks associated with e-cigarettes. Truth Initiative and The Real Cost are just two of the prevention campaigns in the U.S.
The Real Cost Educational Campaign
The FDA created The Real Cost campaign 10 years ago to combat smoking among adolescents. In 2018, the focus shifted to preventing e-cigarette initiation. The campaign aims to inform adolescents aged 12 to 17 about the dangers of vaping.
One example is a first-hand account from Amanda, who recalls waking up short of breath, with nicotine withdrawal headaches, a racing heart, and a sore throat. She says that her nicotine addiction was a significant roadblock in her singing career. This video, which is subtitled “Real teens. Real consequences.” highlights the day-to-day side effects of using e-cigarettes.
The Real Cost campaign utilizes multiple marketing and creative advertising tactics to reach adolescents, including:
- Website advertising
- TV adverts
- Digital and streaming video advertising on YouTube, Hulu, etc
- Social media advertising on Snapchat, Instagram, etc
- Streaming audio advertising on Spotify, Pandora, etc
- Gaming-focused advertising on Twitch, Xbox, etc
- Media partnerships with youth-focused content in Marvel Comics, Overtime, etc
The Real Cost campaign also strategically places quit-smoking tools on social media and other digital platforms to capture the attention of adolescents.
- Quit Builder tool: Adolescents can make a personalized quit vaping plan
- Quizzes and surveys: Adolescents can gain a better understanding of e-cigarette addiction
- Other quitting resources: Adolescents can access information, data, and other support tools
The Real Cost Campaign Results
According to the FDA, The Real Cost e-cigarette prevention campaign has been successful, and independent researchers agree.
One study randomized 543 U.S. adolescents into group A, which watched a video from The Real Cost campaign, or group B, which watched a control video about the dangers of e-cigarettes.
It found that The Real Cost campaign:
- Increased beliefs about the harms of vaping
- Increased negative attitudes toward vaping
- Decreased intentions to vape
Another study compared The Real Cost campaign adverts to control ads on the basis of perceived message effectiveness (PME) variables. PME refers to target audience ratings of the likely impact of persuasive messages. It found that message perceptions and effect perceptions were higher among participants in Group A who saw The Real Cost advert.
Of course, there are limitations.
Educational campaigns hinge on the belief that once young people understand the issue, they won’t engage in harmful behavior. The limitations of this school of thought are clear to see; while many understand the negative effects of their addiction of choice, the benefits of the short-term effects exceed worries about the long-term impact.
School-Based Programs
School-based programs such as the Stanford Tobacco Prevention Toolkit, the Empower Vape-Free Youth Campaign, and the Catch My Breath program offer an effective way to connect with young people.
These types of adolescent prevention programs are often comprised of multiple units that cover a range of problems that can arise from vaping. More often than not, they are delivered by a trusted teacher who already has a rapport with their students.
Catch My Breath School-Based Program
Catch My Breath is an e-cigarette and JUUL prevention program created by the School of Public Health at the University of Texas. It meets national academic standards and many state standards for health education and includes four interactive in-class modules that leverage social cognitive theory.
Thanks to funding from CVS Health, schools across the U.S. can teach one or multiple “tracks” free of charge. Each track is standalone and runs from 5th to 12th grade. Once a school signs up for Catch My Breath, teachers can access all the online learning materials on the Catch.org platform and inform their students about the dangers of e-cigarettes.
Catch My Breath Program Results
Twelve middle schools in Texas took part in the Catch My Breath pilot program from 2016 to 2017. Researchers analyzed the impact of the campaign on six intervention schools and six control schools over 16 months.
Here are the findings.
- Increases in ever e-cigarette use prevalence were 2.8% to 4.9% lower among intervention schools
- Intervention schools had significantly greater improvements in e-cigarette knowledge than control schools, with intervention students displaying knowledge of key psychosocial determinants of e-cigarette use behavior
- Intervention schools had significantly greater improvements in perceived positive outcomes than control schools
- Past 30-day combustible tobacco product use decreased in intervention schools
Despite adolescents having far greater knowledge about the ill effects of e-cigarettes, the number of students who started using e-cigarettes only decreased by an average of 3.85% across the board.
Government Regulations
As concerns over adolescent vaping continue to grow, the U.S. government is under increasing pressure to pass stricter anti-vape legislation, including the infamous flavor ban and PMTA Registry law.
Flavor Bans & PMTA Registry
In 2020, the FDA released a policy outlining Premarket Tobacco Product Applications (PMTAs) which effectively bans all e-cigarette products until they pass a rigorous application process. As of February 2024, the FDA has approved 45 products, including 34 tobacco and menthol-flavored e-cigarette products and devices.
At the same time, the FDA also banned all capsule-based e-liquids that might appeal to adolescents, leaving just tobacco and menthol flavors on the market.
“The United States has never seen an epidemic of substance use arise as quickly as our current epidemic of youth use of e-cigarettes. HHS is taking a comprehensive, aggressive approach to enforce the laws passed by Congress, under which no e-cigarettes are currently on the market legally,” said the then-United States Secretary of Health and Human Services (HHS) Alex Azar.
Flavor Bans & PMTA Registry Results
The effectiveness of the FDA’s tactics is up for debate. Some argue that banning e-liquids and e-cigarettes that appeal to children can only lead to positive outcomes, while others say that the ban props up a flourishing black market for illicit vape products.
One study surveyed 3,533 adults who currently use flavored e-cigarettes and found several behavior changes.
Here are the top four:
- 29.4% switched to other flavored e-cigarette products
- 18.09% switched to menthol-flavored pod systems
- 14.12% switched to combustible tobacco products
- 12.03% switched to tobacco-flavored pod systems
Only 4.9% of participants stopped using e-cigarettes entirely.
The new regulations seem to have little effect on levels of e-cigarette use among adults, but they do have a big impact on the flavor and type of e-cigarette product. Can the same be said for adolescents?
Although the ban is designed to protect adolescents from the harms of e-cigarettes, it’s a blanket ban that also impacts adults. This, paired with the short timespan for research, means that there is no consensus on how e-liquid flavor bans impact youth uptake. However, we can draw together disparate strands of research to see a clearer picture.
One of the most notable studies on the issue was published in JAMA Pediatrics in 2021. Using data from the 2011 to 2019 Youth Risk Behavior Surveillance System (YRBSS) school district surveys, researchers found that San Francisco’s ban on flavored tobacco product sales was associated with higher odds of self-reported combustible cigarette use among high school students.
Another study also found that the regulations intended to decrease e-cigarette and nicotine dependence had the opposite effect.
- For every 0.7 milliliters of e-cigarette e-liquid that goes unsold due to flavor restrictions, 15 additional combustible cigarettes are sold
- E-cigarette flavor restrictions in place for a year or longer yielded 20% increases in sales of cigarette brands disproportionately used by underage smokers
As well as evidence suggesting that adolescents switch to combustible cigarettes for their nicotine fix, there is evidence that banning e-cigarettes has been instrumental in the growth of the black market.
Officials expected the PMTA Registry law and flavor ban to eliminate hundreds of e-cigarette brands and millions of devices from the market, but the numbers suggest otherwise. From January 2020 to December 2022, e-cigarette unit sales in the U.S. increased by 46.6%, from 15.5 million units to 22.7 million units.
Overview of Youth Vaping Prevention Programs
In May 2020, researchers conducted an overview of the effectiveness of youth vaping prevention programs. It included eight prevention programs, seven cessation programs, and one program that identified both prevention and cessation.
They found that most youth vaping prevention programs addressed the importance of understanding flavored e-cigarette products and industry-targeted marketing. The programs also included social learning activities to develop refusal skills.
Researchers concluded that the prevention programs lacked “dedicated e-cigarette materials” and could benefit from more “evidence-based tools, resources, and evaluations.” They noted that the gaps in knowledge represent a problem on “multiple systemic levels” which will only be solved by a full-scale intervention.
Final Thoughts
The programs mentioned are by no means comprehensive, but they offer an overview of the types of educational, school-based, and government responses to the issue of adolescent vaping.
From the research gathered, we can conclude that hard-line, absolute government bans don’t have the desired effect. In fact, government intervention has several unintended consequences, including bolstering the e-cigarette black market, causing young people to switch to cigarettes, and even fostering resentment between itself and the young people it’s trying to reach.
Interestingly, the best approach seems to be one of self-determination. When programs such as Catch My Breath and The Real Cost provide adolescents with the information they need to make informed decisions, adolescent uptake of e-cigarettes decreases. These programs leverage the power of social media, entertainment platforms, and school partnerships to repackage the discourse around e-cigarettes into easily digestible, relatable chunks of information.
