• Posted November 16, 2023

Vaping Now Outstrips Smoking Among U.S. Young Adults

Young adults are now more likely to vape than to smoke cigarettes, with more becoming addicted to nicotine through vaping than traditional smoking, researchers say.

Nearly three in five young adults who vape (56%) have never regularly smoked cigarettes, according to data from an ongoing federal study of tobacco use.

This is the first time that there are more young people who began to use nicotine through vaping rather than smoking, researchers said in a research letter published Nov. 13 in the journal JAMA Internal Medicine.

“We now have a shift such that there are more 'never smokers' who vape than established smokers,” said researcher Benjamin Toll, director of the Medical University of South Carolina (MUSC) Health Tobacco Treatment Program. “That is a massive shift in the landscape of tobacco.”

“These 'never smokers' are unlikely to start smoking combustible cigarettes -- they're likely to vape and keep vaping,” Toll added in a university news release. “And it's this group, ages 18 to 24, who are going to forecast future e-cigarette users.”

E-cigarettes could be a less harmful option than smoking, but it's not harm-free, researchers said. Because of that, it's disheartening to see young non-smokers begin to vape.

“If you currently smoke and you've smoked combustible tobacco cigarettes for a few decades -- those people are at very high risk of cancer, and so we want to help them to get off combustible cigarettes. Ultimately, we'd like to help them to quit tobacco altogether, but if they're not ready for that, switching to e-cigarettes is at least a partial win,” said co-lead researcher Naomi Brownstein, an associate professor in the MUSC Department of Public Health Sciences.

"Now, if you are an 18-year-old and your friends are like, 'Hey, let's vape some banana bread nicotine,' and you've never smoked, those are the people for whom we think starting vaping is a problem,” Brownstein added.

For the new study, researchers drew on data from the Population Assessment of Tobacco and Health Study, a nationally representative study by the National Institutes of Health and the U.S. Food and Drug Administration. The PATH Study started in 2013, and so far there have been six waves of data collection.

Wave 6 data, consisting of survey responses from 2021, found that nearly 15% of adults 18 to 24 reported regular use of e-cigarettes, a number higher than prior CDC estimates of 11%.

Toll expects that number to increase even more in future PATH waves, given that marketers of all types typically target that age demographic.

“It's a time that you've just graduated high school; you are transitioning to either college or to work, and you're changing many things, starting your life, and, importantly, it's when brand loyalty starts,” Toll said.

Advertising for e-cigarettes has exploded, particularly across social media, even as cigarette advertising has been seriously curtailed.

“We don't know yet what the long-term health consequences are, but I'm very uncomfortable that there are so many flavored and disposable e-cigarettes that are clearly marketed to young people,” Toll said.

Along with the overall increase in vaping, the survey data also showed vaping's increased popularity among young women.

“At the beginning of the survey data, young men were vaping more than young women,” Brownstein said. “And they still were at the end, but young women had a slightly steeper increase, so they were starting to catch up a bit.”

The results show that public health researchers may need to shift their focus, to learn more about the potential hazards of e-cigarettes, said co-lead researcher Brandon Sanford, a postdoctoral fellow in the MUSC Department of Public Health Sciences.

“We know if combustible tobacco use is becoming less prevalent than e-cigarette use, there are a lot of public health implications about where our efforts need to be in terms of cessation counseling and treatment development,” Sanford said. “There is a relative lack of established vaping treatments at the moment. There's a lot of research being done to see if the treatments we've used for traditional tobacco cessation are going to work well in vaping populations, but those efforts are still pretty nascent.”

“A lot of people who vape do want to quit,” Sanford added. “Even if the health problems associated with vaping aren't as extreme as smoking, it's still an uncomfortable addiction for a lot of folks.”

More information

The U.S. Centers for Disease Control and Prevention have more about e-cigarettes.

SOURCE: Medical University of South Carolina, news release, Nov. 13, 2023