Data on Adolescent E-Cigarette Use Reveals Threat to Ending Tobacco Use

Photo of Jeffrey Willett, PhDJeffrey Willett, PhD, Vice President for Integrated E-Cigarette Strategy, American Heart Association

The dramatic increase in adolescent e-cigarette use in the United States is alarming, jeopardizing decades of progress to eliminate youth tobacco use. In December 2018, U.S. Surgeon General Jerome Adams announced youth e-cigarette use had reached epidemic levels and called for the nation to take “aggressive steps” to protect children from these dangerous and addictive products.

E-cigarettes will be a featured issue on Nov. 17 in Philadelphia at Scientific Sessions, the American Heart Association’s annual meeting for researchers and clinicians. Among the emerging research being presented at Scientific Sessions is a national study that examined youth use of e-cigarettes in 2017.

The national study of U.S. high school students found that, in 2017, more than 2 million U.S. adolescents used e-cigarettes, and more than 7 million tried them at least once.

The Centers for Disease Control and Prevention collected the data in its national Youth Risk Behavior Survey. The YRBS monitors health behaviors that contribute to death, disability and social problems among 9th-12th grade students in U.S. public and private schools every two years.
Researchers analyzed 2017 e-cigarette use data on 14,407 participants. The 2.2 million high school students who reported using e-cigarettes in the past 30 days represent 13.2% of the survey population.

Researchers also looked at e-cigarette use by sex, age, race, sexual orientation and combustible cigarette smoking status. They found that males (15.9%) were more likely than females (10.5%) to use e-cigarettes. They also found disparities in use among the following groups:
  • 18-year-olds (21.6%), compared to younger students (8.3% for 12-14-year-olds and gradually increasing for 15-, 16- and 17-year-olds)
  • Native Americans (16.3%) and Caucasians (15.5%), compared to Hispanics (10.4%), African Americans (8.4%) and Asians (3.6%)
  • Bisexual students (18.4%), compared to gay/lesbian (14.5%) and straight (13.1%) students

Combustible cigarettes smokers were far more likely to report using e-cigarettes (69.8%) than former smokers (21.3%) or never smokers (3.4%). But even among those who’d never smoked, 26.2% tried e-cigarettes at least once.

Targeting the tobacco endgame

Many kids mistakenly believe that e-cigarettes are safe. But these products contain nicotine, and some even deliver higher concentrations of the addictive, brain-harming drug than traditional cigarettes.

Adolescence is a critical window of time because nearly 90% of smokers first try a tobacco product by age 18. And if they don’t start using tobacco by age 26, they probably won’t start.

The data help us better understand the threat to the tobacco endgame— ending tobacco use and nicotine addiction in the United States.

We must support proven strategies, such as public education campaigns, youth prevention programs and tobacco excise taxes as we advocate for policies that prohibit all tobacco product sales, including e-cigarettes, to anyone under 21.

Laws must be enforceable and include checks to ensure retailers comply and not place excessive punishment or burden on youth. In addition, the FDA must use its regulatory authority to ensure strong regulation of e-cigarettes and all tobacco products.

Though findings from the 2017 YRBS are shocking, more recent studies suggest the problem has gotten worse. The 2018 National Youth Tobacco Survey is conducted annually in public and private schools, and defines e-cigarette use the same way as the YRBS. In 2018, 20.8% of high school students reported e-cigarette use, an increase of nearly 78% compared to the 11.7% prevalence reported in 2017.

On November 5, 2019, the Journal of the American Medical Association published data from the 2019 National Youth Tobacco Survey, indicating that 27.5% of high school students reported e-cigarette use.

We support the U.S. Surgeon General in his call for aggressive action to end youth e-cigarette use.