Why Do High Schoolers Vape? National Youth Tobacco Surveys Suggest Answers

 

 

 

Federal officials blame vape manufacturers and retailers for teen vaping, focusing in particular on the industry’s use of flavoring, but government surveys indicate the truth is more nuanced.

The government’s National Youth Tobacco Surveys (NYTS) routinely collect information on teenage e-cigarette use.  I examined survey data for the years when vaping accelerated (2018 and 2019), and when it declined (2020 and 2021).  In the first three years, the survey asked, “What are the reasons that you have used e-cigarettes?”  In 2021, the question changed to, “Why do you currently use e-cigarettes?”  Other survey modifications occurred, as noted in the Table footnotes.

 

High School Vapers: Percentage Reporting Why They Have Used [Currently Use*] E-cigarettes, NYTS 2018-2021
Reason	2018	2019	2020	2021
Used by friend	30%*	21%*	37%	27%
Used by family member			8	6
To quit other tobacco	11	9	8	4
Costs less than other tobacco	6	6	3	4
Easier to get than other tobacco	6	6	5	5
Used by people on TV, online, movies	1	4	3	2
Less harmful than other tobacco	25	18	14	10
Flavors	36	23	20	13
Use unnoticed	8	18	17	14
Other reason	30	18	25	19
Peer pressure	---	8	---	---
Used to do tricks	---	23	24	19
Curious	---	48	42	9
Use when anxious, stressed, depressed	---	---	---	42
Nicotine buzz	---	---	---	44

 

*Friend and family member combined

--  Reason not asked

Participants could choose multiple reasons

 

Let’s look at some of the bigger trends.  First, among reasons measured in all four years, “friends’ use” is consistently the most important, which jibes with the common observation that most teens obtain e-cigarettes from friends rather than retail stores.  “Other” reasons ranks second, followed by “flavors”, “less harmful”, and “use unnoticed at home or school”.  Note that the percentage of respondents mentioning flavors fell from 36% in 2018, to 13% in 2021, undercutting activist arguments to ban them.  The percentage mentioning less harmful also declined, from 25% to 10%, likely reflecting the success of the FDA’s grossly misleading “Real Cost” campaign that asserts that e-cigarettes are equally or more harmful than cigarettes.

Additional reasons for vaping, offered in NYTS after 2018, were also selected at high rates; these included “performing tricks” and “curiosity”.  In 2021, 42% of vapers said they vaped because they were anxious, stressed or depressed, and 44% were trying to get a nicotine buzz.

Also of note: “Quitting other products”, “costing less”, “easier to get”, and “celebrities” were not frequently cited as important reasons to vape. 

Why, one might ask, was there so much variation across the four years?  The answer may well lie with the inherent variability of self-reporting by teenage respondents.

 

More Vaper Insights Drawn from the FDA PATH Survey, 2013-14

Following are additional insights into smoking and vaping from my Nicotine & Tobacco Research study (abstract here), coauthored by my economist colleague Dr. Nantaporn Plurphanswat.  Earlier blog notes on this analysis of the 2013-14 FDA-funded Population Assessment of Tobacco and Health (PATH) Survey are here.

Flavors and Nicotine

Flavors are important to vapers, but the PATH questionnaire inquired about flavoring only by grouping them: “menthol, mint, clove, spice, candy, fruit, chocolate, alcohol (such as wine or cognac), or other sweets.”  Nevertheless, we report that flavors “were consumed by 7 out of 10 current users.  Never-smokers were significantly more likely to use them than current and former smokers (84% vs. 67% and 69%), and they were significantly less likely to use liquid containing nicotine (69% vs. 93% and 88%).  Notably, …5.2% of current smokers, 7.8% of former smokers, and 25.9% of never-smokers used e-cigarettes that contained flavor, but no nicotine.”

Buying E-Cigarettes

We found that “The majority of users bought e-cigarettes in person (81%).  Former smokers were significantly more likely to buy them from the internet than current and never-smokers (21% vs. 10.3% and 13.0%).  Never-smokers were the least likely to buy their own e-cigarettes.  Two-thirds of former smokers purchased their e-cigarettes in a smoke shop or vape shop, which was significantly higher than current or never-smokers (55% and 45%).”

Reasons for Vaping

The PATH Survey asked vapers why they used e-cigarettes.  The top five reasons among former smokers who vaped were:

1.     “less harmful to me” (94%),

2.     “less harmful to persons around me,” (88%)

3.     “help to quit smoking,” (86%)

4.     “don’t smell” (80%)

5.     “use when/where smoking not allowed” (78%).

Current smokers who vaped listed the same top five reasons in slightly different order.  Understandably, #5 moved to the #2 slot.  Notably, “E-cigarette use by other people (‘important to me’ or ‘in the media or other public figures’) and appealing advertising were the least popular

reasons for use among all groups.”

Perceptions of Nicotine and E-Cigarette Harm

Regardless of smoking status, most vapers were misinformed about nicotine: 84% of never smokers believed that nicotine causes most cancers, as did 77% of current smokers and 66% of former smokers.  There was better news with respect to relative risk of vaping versus smoking: “The majority of users thought that e-cigarettes were less harmful than cigarettes. Ninety-four percent of former smokers thought that e-cigarettes were less harmful, which was significantly higher than either current or never-smokers (78% and 77%).”

This is meaningful, as a 2015 National Cancer Institute survey showed that only 26% of U.S. adults believed that e-cigarettes were less harmful than traditional cigarettes (discussed here).  The PATH results show that, despite a tsunami of misinformation from government agencies and health organizations, e-cigarette users are much better informed than the general public about differential risks of vaping and smoking.