United States: Decline in vaping among adolescents

The 2024 National Youth Tobacco and Non-Therapeutic Nicotine Survey[1] (NYTS) found that 1.63 million U.S. middle and high school students had used e-cigarettes at least once in the past 30 days, down from 2.13 million a year ago. While nicotine pouch use remains marginal, it has been rising slightly since 2023.

The Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) analyzed data from the 2024 Nationally Representative Youth Tobacco Survey (NYTS). This is a cross-sectional, school-based, self-administered, Internet-based survey of 29,861 middle and high school students at 283 schools between January 22 and May 22, 2024.

These results also echo the latest investigation CDC which showed that only 1.51% of middle and high school students reported being tobacco smokers in 2023.

Significant drop in vaping consumption

The results showed a significant decline in the number of middle and high school students who reported using an e-cigarette at the time of the survey and in the 30 days preceding it. This overall decline of 23% reduces the number of adolescent users in 2023 from 2.13 million to 1.63 million the following year. In terms of prevalence, it decreases from 7.7% to 5.9% during the period concerned. This prevalence is significantly higher among high school students: 7.8% (or 1.21 million) than among middle school students: 3.5% (410,000).

Despite this decline, a significant proportion of consumers, including 42 % high school students and 27 % middle school students, reported frequent or daily use, indicating a strong dependence on nicotine.

While these results are encouraging, public health organizations like the Truth Initiative and the Campaign for Tobacco-free Kids point out that vaping products currently on the market often contain very high levels of nicotine. Truth's research shows that between 2017 and 2022, disposable e-cigarettes have nearly tripled their nicotine content, quintupled their e-liquid capacity, and dropped their price by nearly $70 %[2].

Flavors and disposable devices remain popular

The most commonly used device types are disposables (55.6 %), followed by pre-filled or refillable pods or cartridges (15.6 %). NYTS data further demonstrates the appeal of flavors, with 87.6 % of teens reporting a preference for flavored e-cigarettes. Fruit (62.8 %), candy (33.3 %), and mint (25.1 %) are the most commonly cited flavors. Disposables remain the most popular among youth, with Elf Bar (36.1 %), Breeze (19.9 %), Mr. Fog (15.8 %), Vuse (13.7 %), and JUUL (12.6 %) topping the list. Four of the top five brands have not received prior approval for marketing from the FDA and are being marketed illegally. Despite numerous warning letters from the agency to retailers and manufacturers, these brands remain popular with young people.

A worrying consumption of nicotine pouches

The use of nicotine pouches in the survey results remains low with an overall prevalence among young respondents of 1.7%. This is 2.4 % among high school students and 1% among middle school students. However, 29.3 % of current users report using them frequently and 22.4 % use the pouches daily. This consumption is all the more worrying for health professionals as the high nicotine levels are particularly high. The Zyn brand from the manufacturer Philip Morris is the brand most consumed by 68.7 % of young pouch users. This brand is promoted through aggressive marketing and the use of "Zynfluencers", reward programs that are particularly attractive to young people. The popularity of these products has thus grown significantly at the national level, with increasing sales and increasingly high nicotine levels.

As with e-cigarettes, young people are consuming these products in the form of flavoured products. More than 8 in 10 current nicotine pouch users (85.6% %) have used flavoured nicotine pouches, with mint flavours being the most popular, followed by fruit flavours.

Continue efforts and take action on illegal vaping products on the market

In a statement, Brian King, director of the Food and Drug Administration's Center for Tobacco Products, called the decline in teen vaping rates a "major victory."

CTFK says that even though the number of users has declined, vaping among American youth "remains a serious public health problem," in part because the vaping industry is "steadfast in finding new ways to addict kids," said Yolonda C. Richardson, the organization's president.

Richardson urges the FDA and other relevant federal agencies to step up enforcement to eliminate vaping devices that remain illegally on the market. The FDA has authorized fewer than three dozen vaping products for sale, but thousands of unauthorized products are available for sale.[3].

©Tobacco Free Generation

AE

[1] Park-Lee E, Jamal A, Cowan H, et al. Notes from the Field: E-Cigarette and Nicotine Pouch Use Among Middle and High School Students — United States, 2024. MMWR Morb Mortal Wkly Rep 2024;73:774–778. DOI: http://dx.doi.org/10.15585/mmwr.mm7335a3

[2] Communicated, Significant Drop in Youth E-Cigarette Use Marks Progress, But Nearly 40% of Teens Who Vape Frequently Remain at High Risk for Nicotine Addiction, a Serious Public Health Concern, Truth Initiative, published September 5, 2024, accessed September 6, 2024

[3] Communicated, Drop in Youth E-Cigarette Use Is Great News, But FDA Must Crack Down on the Illegal, Nicotine-Loaded Products that Continue to Addict Kids, CTFK, published September 5, 2024, accessed September 6, 2024