Where Did Underage Vapers Get E-Cigarettes in 2019, and Why Did They Use Them?

The 2019 National Youth Tobacco Survey (link here) offers a wealth of critical data. In last week’s blog entry I noted that underage vaping increased over the prior year, as the number of frequent “virgin” vapers (those who never used other tobacco products and used e-cigarettes 20-30 days in the past month) rose from 95,000 to 172,000.  This negative news was accompanied by a dramatic decline in the use of cigarettes (2.6% to 0.8%) from 2018 to 2019, indicating that the eradication of teen smoking is within reach.

Recently, Congress enacted Tobacco 21 legislation, which the FDA implemented in December.  The agency also announced a partial ban on e-cigarette flavors. 

The 2019 NYTS survey collected information from high school vapers that is relevant to these policies.  It asked, (1) “where did you get or buy the e-cigarettes that you have used” (during the past 30 days); and (2) “what are the reasons you have used e-cigarettes?”  The results for underage current vapers are shown in the accompanying tables.  The percentages don’t add to 100, because participants could select more than one response for each question.  So the numbers indicate the relative importance of the various sources (i.e. friends versus a grocery store).

Table 1. Where Did Underage Vapers Get or Buy Their E-Cigarettes?
People
Friend	62%
Other person	14%
Family member	10%
Places
Gas station/Conv store	17%
Vape shop	13%
Internet	7%
Other place	6%
Drug store	2.9%
Mall	2.8%
Grocery store	2.4%

Clearly, most underage teens get their vape products from friends (62%), family members (14%) and/or “others” (10%).  I endorsed Tobacco 21 a year ago principally because it will diminish the black market supply by eliminating legal (age 18+) tobacco purchasers in the nation’s high schools.

Retailers supply significantly less vape products to underage teens.  Gas stations and convenience stores are the most popular in this category, with vape shops a strong second.  The internet was cited as a source by only 6% of underage vapers, while other brick-and-mortar stores were chosen less frequently.

Table 2. Reasons Underage Vapers Used E-Cigarettes
Curious about them	50%
Use them to do tricks	24%
Available in flavors	23%
Friend/family member used them	21%
Use them unnoticed at home/school	18%
Other reason	18%
Less harmful than other tobacco	17%
Peer pressured into use	8.9%
Try to quit other tobacco	7.4%
Easier to get than other tobacco	6.3%
Cost less than other tobacco	5.5%
People on TV/online/movies use them	4.1%

Unsurprisingly, underage teen vapers were mainly motivated by curiosity (50%).  That may be a response to the FDA’s poorly crafted vaping epidemic ad campaign, which was translated recently by Clive Bates: “Hey, time to get with the program. All kids, especially cooler kids are doing it...Everyone else is at it, except you...” 

Flavors (23%), with which the FDA is obsessed, placed in the second tier of reasons, along with tricks (24%). Friends and family, it turns out, are not just important suppliers, but significant influencers (21%), especially when combined with peer pressure (8.9%).  Friends and family are, in fact, dominant factors for all risky behaviors, but unlike retailers, they cannot be controlled by government regulation.

Clive Bates interpreted another portion of the FDA campaign as “… you can keep it hidden from mom,” and sure enough, the NYTS shows their use of vape products goes unnoticed (18%).  Additionally, despite a barrage of misinformation about exaggerated and fake e-cigarette illnesses, some underage vapers act on scientific reality, saying they use e-cigarettes because they are less harmful than other tobacco products (17%).

The 2018 American Teen Vaping Epidemic, Recalculated

Former FDA Commissioner Scott Gottlieb and other government officials have repeatedly asserted that the U.S. is in the midst of a teen vaping epidemic (example here).  Their claim is based on last year’s National Youth Tobacco Survey, the full contents of which was finally released six weeks ago by the Centers for Disease Control and Prevention.  With that data in hand, I have confirmed some of the assertions made by anti-vapers but easily put the lie to others (here).

Federal officials claim there were over three million high school vapers in 2018.  Let’s take a look at the actual numbers.  Each table below lists the number of high school students who used e-cigarettes 0, 1-5, 6-19 or 20-30 days in the past month, according to whether they were underage or of legal age (18+ years).   

Table 1 shows that 3.13 million high schoolers vaped, with 877,500 using the products 20-30 days in the past month.

Table 1. Number of High School Students in 2018 Who Vaped in the Past Month, According to Age
Days Vaped	Less than 18 years	18+ years	All
1-5	1,303,366	200,264	1,503,630
6-19	602,392	150,841	753,233
20-30	630,490	247,000	877,490
All	2,536,248	598,105	3,143,353

Next, let’s remove any high school students who ever tried CIGARETTE SMOKING.  As shown in Table 2, that leaves 1.36 million, with 198,000 using the products 20-30 days in the past month.

Table 2. Number of High School Students in 2018 Who Vaped in the Past Month But Never Tried Cigarette Smoking, According to Age
Days Vaped	Less than 18 years	18+ years	All
1-5	762,023	92,035	854,058
6-19	259,450	43,231	302,681
20-30	151,176	47,150	198,326
All	1,172,649	182,416	1,355,065

Removing students who ever tried CIGARS, the total drops to 978,000, with 132,500 using the products 20-30 days in the past month (Table 3).

Table 3. Number of High School Students in 2018 Who Vaped in the Past Month But Never Tried Cigarette or Cigar Smoking, According to Age
Days Vaped	Less than 18 years	18+ years	All
1-5	607,894	50,784	658,678
6-19	163,699	22,841	186,540
20-30	109,123	23,392	132,515
All	880,716	97,017	977,703

Finally, subtracting students who ever tried SMOKELESS TOBACCO, Table 4 reveals that the vaping epidemic consists of 897,000 individuals, with 116,000 using the products 20-30 days in the past month.  Of those, 95,316 were underage.

Table 4. Number of High School Students in 2018 Who Vaped in the Past Month But Never Tried Cigarette or Cigar Smoking or Smokeless Tobacco, According to Age
Days Vaped	Less than 18 years	18+ years	All
1-5	572,091	47,539	619,630
6-19	139,881	20,942	160,823
20-30	95,316	21,053	116,369
All	807,288	89,534	896,822

For comparison, I conducted the same analysis on the 2017 NYTS, which yielded 26,660 underage teens who vaped 20-30 days in the past month but never used other products.  That was less than 0.2% of all high school students. 

It is true that frequent vaping among underage high school teens increased substantially from 26,660 in 2017 to 95,316 in 2018.  These numbers translate into an increase from less than 0.2 to 0.6% of all high school students.

In summary, the oft-cited teen vaping epidemic involves not three million youths, but rather 95,000 underage teens who vaped frequently but never used other tobacco products – or 0.6% of the nation’s 14.8 million high school students.