While youth vaping rates have increased in recent years, most middle and high school students don’t vape or smoke and very few vape or smoke daily, finds a study led by researchers at NYU School of Global Public Health.

The study, published this month in the journal Nicotine & Tobacco Research, finds that over 80 percent of youth do not use any tobacco and over 86 percent don’t vape—and among the minority who do vape, most are not regular users. In addition, the study reveals that most youth who are vaping are also current or former smokers.

“Our findings underscore the importance of examining the full context of how youth are using vaping and tobacco products,” said Allison Glasser, an assistant research scientist at NYU School of Global Public Health and the study’s lead author. “The key to protecting youth in the United States is determining the patterns of frequency of use and co-use of vaping and tobacco products, which will give public health decision makers the best possible information to protect the public’s health.”

While the FDA and CDC’s National Youth Tobacco Survey has shown a concerning increase in youth vaping in recent years, little is known about the frequency with which youth use e-cigarettes—if it’s an occasional occurrence or a daily habit—as well as whether they also use more harmful smoked tobacco products like cigarettes and inexpensive cigars or cigarillos.

In this study, the researchers analyzed the 2018 National Youth Tobacco Survey in which more than 20,000 middle and high school students were asked about their use of various tobacco and vaping products in the past 30 days. The analysis was conducted on the 2018 survey, the latest available full data set; the 2019 National Youth Tobacco Survey, which showed that youth vaping continued to grow from 2018 to 2019, has not yet been made available for public analysis.

A critical finding across all surveys from 2013 to 2019 is that smoking actually decreased much more rapidly to a record low during the very same years vaping increased. From 2015 to 2018, daily cigarette smoking among youth declined from 1.2 percent to 0.9 percent, while regular vaping (20 or more out of the past 30 days) increased from 1.7 percent to 3.6 percent.

“The faster drop in smoking suggests vaping is helping displace youth use of much more deadly smoking—a net harm reduction benefit to the population as a whole,” said David Abrams, a professor of social and behavioral sciences at NYU School of Global Public Health and a study coauthor.

The researchers also found that while youth vaping increased from 2017 to 2018, the increase was driven by infrequent e-cigarette use rather than regular use: in 2018, while 13.8 percent of students had vaped in the past 30 days, more than half of them vaped five days or fewer.

Critically, the majority of youth vapers also use or have used more deadly tobacco products (60 to 88.9 percent, depending on the frequency of vaping). While there has been fear that e-cigarettes are introducing nicotine to many young people who otherwise would not have smoked, the data show otherwise—only a small proportion of tobacco-naïve youth report vaping.

“Examining tobacco and e-cigarette use patterns in youth is informative about the risk of continued use in adulthood. While in a perfect world young people would not be smoking or vaping, if the vast majority of youth who vape are already current or former smokers, vaping could offer them a safer alternative than cancer-causing cigarettes,” said Ray Niaura, a professor of social and behavioral sciences at NYU School of Global Public Health and a study coauthor.

“This study provides us with a better understanding of youth vaping patterns, which is critical for creating effective public health policies around nicotine and tobacco. Reacting too quickly to reports of youth vaping without considering the full context could do more harm than good,” added Abrams. “We need to avoid prohibitionist regulations like banning e-cigarettes—while leaving much more deadly cigarettes and cigars in corner stores—and instead should consider strong enforcement of age 21 sales restrictions. Prohibition creates a black market for vaping products or inadvertently pushes individuals back to smoking tobacco.”

In addition to Glasser, Niaura, and Abrams, study authors include Amanda Johnson of the University of Oklahoma Health Sciences Center and Jennifer Pearson of the University of Nevada, Reno School of Community Health Sciences.

About NYU School of Global Public Health

At the NYU School of Global Public Health (NYU GPH), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen, and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, interdisciplinary model, NYU GPH aims to improve health worldwide through a unique blend of global public health studies, research, and practice. The School is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching. For more, visit: http://publichealth.nyu.edu/