Teen E-Cigarette Use Surged in 2017–2018, Reversing Years of Decline

E-cigarettes are battery-powered devices that deliver nicotine and other additives as an aerosol. They reached the U.S. market in 2007, and by 2014 they were the tobacco product most used by American youths. This report, by researchers at the Food and Drug Administration (FDA) and CDC, used the 2011–2018 National Youth Tobacco Survey — a voluntary pencil-and-paper survey taken in schools — to track how many middle and high school students were current users, meaning they had used a product on at least one of the past 30 days.

Visual abstract. Credit: Centers for Disease Control and Prevention.

The numbers

The rise in e-cigarette use over the whole period was statistically significant for both groups. Overall tobacco use in 2018 was not significantly different from 2011 — but that hides a sharp swing in the final year.

The 2017–2018 jump

After several years of decline, e-cigarette use rose steeply between 2017 and 2018, and it dragged overall tobacco use up with it:

• Middle school e-cigarette use rose 48%, from 3.3% to 4.9%. The share of users vaping on 20 or more of the past 30 days went from 12.9% to 16.2%, not a significant change.
• Among high school students, frequent e-cigarette use increased.
• Any tobacco use rose 38% among high school students (from 19.6% to 27.1%) and 29% among middle school students (from 5.6% to 7.2%).

Current use of e-cigarettes and of any tobacco product among U.S. middle and high school students, 2011–2018. "Any tobacco product" covers cigarettes, cigars, smokeless tobacco, e-cigarettes, hookahs, pipes, snus, dissolvable tobacco and bidis. Credit: Centers for Disease Control and Prevention.

Why it happened, and why it matters

The authors attribute the rise mostly to the recent popularity of e-cigarettes shaped like a USB flash drive, such as JUUL: easy to use discreetly, high in nicotine, and sold in flavors that appeal to young people.

E-cigarettes might help adult smokers if they replace cigarettes completely. But any tobacco product, e-cigarettes included, is unsafe for youths. The Surgeon General has concluded that youth and young adult e-cigarette use is a public health concern: nicotine exposure in adolescence can cause addiction and harm the developing brain.

In September 2018, FDA issued more than 1,300 warning letters and civil money penalties to retailers that illegally sold e-cigarettes to minors — mostly blu, JUUL, Logic, MarkTen XL and Vuse products — the largest coordinated enforcement effort in the agency's history. Proven population-based prevention strategies, together with FDA regulation, are key to reducing youth use of all tobacco products, the authors conclude.

Sources

Based on Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA, "Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018," Morbidity and Mortality Weekly Report 67(45), Centers for Disease Control and Prevention; a work of the United States government in the public domain. Original report.