A Deeper Dive into High School Vaping from the 2023 National Youth Tobacco Survey

 

The Centers for Disease Control and Prevention (CDC) reports that about 1.56 million U.S. high school students were current users (i.e., past 30 days) of e-cigarettes or other vaping products in 2023.  Although this number is substantially lower than at vaping’s peak in 2019 (here), it is still represented as a public health crisis by anti-tobacco crusaders.  This post takes a closer look at this number by examining other factors that were ignored by the CDC. 

The chart on the left breaks down the report’s 1.56 million vapers to calculate the actual number of exclusive, or “virgin” vapers.  I use a sequential subtraction method to isolate factors integral to vaping.  The chart reflects CDC weighting to estimate the numbers in detail, but in the following text, acknowledging real world facts, I’ll use abbreviated estimates.

According to the CDC, there were 15.8 million high schoolers in 2023, so about 9.9% of those were current vapers, that is, they had used the product at least once in the past 30 days.  About 204,000 of the 1.56 million current vapers were also current smokers, which leaves 1.36 million. 

Of these remaining vapers, 397,000 “ever” smoked a cigarette, even one puff, leaving 963,000.

After subtracting another 192,600 “ever” cigar smokers, we have 770,600 current vapers.

Finally, we have a factor that the CDC completely ignores, despite its coverage in the NYTS: “ever” vaping marijuana, tetrahydrocannabinol (THC) or cannabidiol (CBD).  There were 535,500 current vapers who had also vaped those marijuana-related products.

Now we have a reasonable estimate for virgin vapers, or those high schoolers who have not had any other exposure to similar tobacco or marijuana products.  The grand total is 235,021, representing only 1.5% of all high school students.

For further context, consider the frequency of vaping among virgin vapers: 63% had vaped only 1-9 days in the past month, 6% had vaped 10-19 days, and 31% had vaped 20-30 days.  While the latter group is at risk for being addicted to nicotine and vaping, these 73,092 frequent vapers represent just 4.7% of all high school vapers.  Even more importantly, they represent only 0.5% of all U.S. high school students.

Vaping among high school students is a legitimate concern, but vaping is not a new, isolated epidemic or crisis threatening to enslave a generation of teens to nicotine.  The NYTS demonstrates that vaping is connected with smoking cigarettes and cigars, and particularly with the use of THC/CBD. 

The FDA refuses to recognize that teen vapers also smoke and toke.  When the government obsesses over an imaginary “teen vaping epidemic” and denies its actual modest scope, it ignores the 480,000 adult tobacco smokers who die each year.

 

Where are the Crusades to Ban Alcohol, Marijuana & Caffeine – For the Children?

 

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) just introduced a program to discourage underage drinking, aimed specifically at middle schoolers (here). It’s called “Too Soon = Too Dangerous.”  The chart at left, based on data from the government’s Monitoring the Future Survey (MTFS), shows that attention to early substance abuse is timely.

There’s long been a broad crusade to prohibit all tobacco and nicotine products. Local and state governments are banning vaping and e-cigarette flavors (examples here, here and here), and the FDA has rejected thousands of flavored products that were already on the market (resulting in a todal wave of illicit products).

In contrast, 6% of eighth graders say they consume alcohol.  Of course, all alcoholic drinks are flavored. 

Where is the crusade against alcohol, which is inarguably much more dangerous than nicotine?  According to the CDC, “Underage drinking is a significant public health problem in the U.S.  Excessive drinking is responsible for more than 3,900 deaths and 225,000 years of potential life lost among people under age 21 each year.”  The same potential danger exists with marijuana, which is also consumed by eighth graders. 

Like alcohol and marijuana, nicotine is addictive, but no teenagers have died from using it.  Nicotine is more like caffeine, which is also represented in the chart by the 14% of eighth graders who currently consume energy drinks or shots.  Some health professionals (here, here, here, here and here) and federal agencies (here) have expressed concern, and there is at least one study claiming, “Teens who drink high-caffeine energy beverages such as Red Bull or Monster may be more likely to use alcohol, drugs and cigarettes.”  There is even a report of “a 16-year-old [who] tragically lost his life after consuming an energy drink, a soda and a latte — drinks routinely consumed by and often intensively marketed to youths — all within a few hours.”

Where is the crusade to ban energy drinks and shots?  Tobacco harm reduction advocates will be interested to know that Senators Richard Durbin (D-IL), Richard Blumenthal (D-CT) and Edward Markey (D-MA) have agitated about the marketing and advertising of these products, but no one is talking about banning them.

Let me remind you about the stakes here.  While nearly half-a-million American smokers needlessly die each year because they are unable or unwilling to quit nicotine and tobacco, there is a crusade, mostly in the name of protecting children, to ban effective and vastly safer tobacco substitutes.  In contrast, there is no organized movement to ban far more dangerous alcohol and marijuana, nor addictive caffeine, all of which are frequently consumed by American adolescents.    

 

Is Industry to Blame for Teen Substance Use?

 

I’m a member of a tobacco policy discussion group that has focused many times on the so-called epidemic of teen vaping.  One recent exchange centered on how e-cigarette and vape manufacturers and retailers might demonstrate to government regulators and policymakers that they are serious about not marketing their products to children.  Frankly, I take issue with the underlying assumption that the industry is actually responsible for teen behaviors.

First, let’s define the so-called epidemic.  The first chart at left represents “current” – that is, past-30-day – nicotine vaping prevalence rates among U.S. high school seniors, according to the federal Monitoring the Future (MTF) survey.  In 2017, the first year the MTF collected this information, 11% of seniors vaped.  Over the next five years, the percentage spiked to over 25%, then settled at around 20%.  A similar pattern is seen in National Youth Tobacco Surveys covering 2013 to 2022 (here). 

Now, ask yourself: Do vape companies play any role in this teen vaping “epidemic”? 

If you answer NO, I agree with you, but if you answered YES, please examine the next chart.

 

Here we see the same vaping numbers, but with the addition of current alcohol use rates for the past 32 years.  Although the trend is going in a welcome direction, 28% of high school seniors in 2022 were current drinkers, putting them at far greater risk than the smaller percentage who were vaping.  Note that all of these teens were under the legal age to purchase alcohol or vape products.

Does the alcohol industry play a role in teen drinking?

Oddly, in contrast to the obsession with vaping, little is said about teen drinking, despite widespread alcohol advertisements and the more immediate and greater dangers posed to underage drinkers.  Parents Against Vaping E-cigarettes (PAVE) and the Campaign for Tobacco-Free Kids (CTFK) portray nicotine vaping as the ruination of an entire generation.  Where are the pressure groups for teen drinking and binge drinking?

If you still blame corporate America for teen alcohol use, consider the next chart. It includes marijuana use, the rate of which has remained above 20% for high school seniors since 1995.

 

 

What industry is responsible for teen marijuana use?  

Until recent years, marijuana, which is still federally illegal, was prohibited in all 50 states, so there were no corporations producing or marketing it.  Industry would appear to be blameless for any underage consumption.

Conclusion

The explanation for teen substance use is that adolescents are strongly attracted to adult behaviors and adult products.  Blaming the vape industry while giving the alcohol industry a pass is illogical.  Teen marijuana use underscores the fact that young people will adopt adult behaviors regardless of industry marketing.