1 in 4 High School Students Are Using E-Cigs


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More high schoolers report trying e-cigarettes. Getty Images
  • A new study found 1 in 4 high school students, and 1 in 10 middle school students, reported using e-cigs in the last month.
  • This is a significant increase from last year.
  • Additionally, another study finds the most popular flavor for teens is mint.

Youth vaping continues to rise, driven in part by flavors like mint, fruit, and candy.

More than 1 in 4 high school students used e-cigarettes in 2019, with mint the most popular flavor, according to new research.

In spite of recent vaping-related illnesses, e-cigarette use among high school students continues to rise, with a more than 30 percent jump from the year before.

Dr. Richard Seidman, pediatrician and chief medical officer at L.A. Care Health Plan in Los Angeles, says this trend is “extremely concerning.”

He points to the many health risks of vaping, including the negative effects of nicotine on the brain development of young people, as well as serious illness or death due to lung damage.

As of Oct. 29, 1,888 cases of vaping-related lung illness and 37 deaths in the United States have been confirmed, reports the Centers for Disease Control and Prevention.

“We know enough to say that e-cigarettes are dangerous, especially for adolescents, and we need to get the message out that [young people] should not use them,” said Seidman, who wasn’t involved in the new research.

Data on youth vaping rates come from the annual National Youth Tobacco Survey (NYTS) of middle and high school students in the United States. More than 19,000 young people responded to this year’s survey.

The results were published Nov. 5 in the journal JAMA.

Researchers found that 27.5 percent of high school students reported current use of e-cigarettes, or within the past 30 days. The rate was 10.5 percent for middle school students.

This is a significant increase from last year’s NYTS data, which showed that 20.8 percent of high school students and 4.9 percent of middle school students were current e-cigarette users.

Researchers estimated that if this year’s rates are similar across the country, 4.1 million high school students and 1.2 million middle school students are current vapers in 2019.

In some good news, few students are using traditional combustible cigarettes. Researchers found that in 2019, only 5.8 percent of high school students and 2.3 percent of middle school students reported they had smoked combustible cigarettes in the past 30 days.

In another study published in the same issue of JAMA, researchers found that mint was the most popular e-cigarette flavor among 10th and 12th grade students, followed by mango and fruit.

Mango was the most popular e-cigarette flavor among eighth grade students, followed by mint and fruit.

These results are based on data from the annual Monitoring the Future survey of 8th, 10th, and 12th grade students.

This survey found a lower rate of current e-cigarette use: more than 18 percent for middle and high school students combined.

Non-tobacco-flavored e-cigarettes are of particular concern because they’re linked to making it easier for young people to start — and keep — vaping.

“The appealing flavors are exactly what attracts adolescents to vaping in the first place,” Seidman said. “They are curious and figure [these products] have to be safer than cigarettes, but they are fooling themselves.”

Hannah Baker, MPH, a research associate for the Tobacco Prevention and Evaluation Program located in the department of family medicine at the UNC School of Medicine in Chapel Hill, co-authored a review in BMJ Open last month looking at previous research on the impact of flavors on e-cigarette use.

The study found that young people incorrectly perceived non-menthol flavors — especially fruit and candy flavors — as less harmful than tobacco-flavored e-cigarettes.

Studies in the review also found that flavored e-cigarettes increased the willingness of youth and young adults to try or start using e-cigarettes.

“In fact, some studies show that the availability of good flavors is the reason why many youth even try an e-cigarette in the first place,” Baker said.

Many regulatory efforts by state and federal officials have focused on limiting the access of youth to non-tobacco e-cigarette flavors.

However, Baker highlights that youth shouldn’t have access to any tobacco products, regardless of whether or not they’re flavored.

“It is the responsibility of policymakers and public health practitioners to make sure that this is the case,” she said.

The Food and Drug Administration (FDA) announced in September that it would clear the market of all unauthorized non-tobacco-flavored e-cigarette products.

Baker said this is an opportunity for the FDA to use its “regulatory power to produce policies that have the chance to make a difference when it comes to youth vaping.”

The FDA hasn’t yet released a proposed rule. But ahead of a ban, last month Juul suspended sales in the United States of its fruit-flavored e-cigarettes.

Some news reports, though, suggest the federal administration may exempt mint and menthol flavors from this ban.

This could hinder the ability of the proposed e-cigarette bans to reduce youth vaping.

“With the new study showing that mint-flavored e-cigarettes are favored by middle and high school-aged kids, any effort to delay a ban on mint-flavored products would be extremely disappointing,” Seidman said.

Baker says the FDA has had evidence for years showing that exempting mint and menthol from flavor bans “does not make sense from a public health perspective” — yet those products are still on the market, including flavored combustible cigarettes.

The two new studies, though, provide the FDA with more reasons to act soon to curb youth vaping.

“Even with all the evidence we have about how flavored products entice youth to start using tobacco products, along with how tobacco companies have historically targeted youth,” Baker said, “it feels like we’re scrambling to fix a problem that in hindsight we should have seen coming.”

Seidman, though, says the problem of youth vaping isn’t the FDA’s alone. All local and federal health agencies should be doing their part to turn things around, he says, such as banning e-cigarette marketing aimed at youth or raising the age limit for buying vaping products.

“Professional associations and healthcare providers should be getting the word out about the dangers of e-cigarettes,” Seidman added. “In fact, they need to get the word out that these vaping devices don’t always look like cigarettes at all.”

Much to the dismay of parents and school officials, vaping products come in a wide variety of shapes and sizes, including ones that “look like flash drives or pens, or can even be hidden in hoodie tie strings,” Seidman said.

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