Despite a significant decline from its peak, the 2023 National Youth Tobacco Survey reveals that 1 in 10 high school students are currently using e-cigarettes, underscoring a persistent public health crisis.
Key Takeaways
- In 2023, 2.13 million U.S. middle and high school students (7.7%) reported current e-cigarette use in the past 30 days according to the National Youth Tobacco Survey (NYTS)
- Among high school students in 2023 NYTS, 10.0% (1.84 million) reported current e-cigarette use, with a significant portion using daily
- Middle school current e-cigarette use was 1.8% (290,000 students) in 2023 per NYTS, showing a slight decline from prior years
- E-cigarette use causes acute lung injury (EVALI) with over 2,800 hospitalizations among youth by 2020 per CDC
- Youth vapers have 2.7 times higher odds of cough or bronchitis per 2022 cross-sectional study
- Nicotine in e-cigs harms adolescent brain development, affecting attention and learning per Surgeon General 2020 report
- High school males 12% more likely to vape than females, with 10.8% vs 9.4% in 2023 NYTS
- Non-Hispanic White youth highest e-cig use at 11.4% among high schoolers 2023 NYTS
- Hispanic middle school students 2.1% current e-cig use in 2023 NYTS
- 89.4% of youth e-cig users preferred flavored products in 2023 NYTS
- Disposable e-cigarettes used by 86.9% of current youth vapers in 2023 NYTS
- Fruit flavors top choice for 55.6% of high school e-cig users 2023 NYTS
- 68% of U.S. youth aware of e-cigarette harms per 2023 Truth Initiative survey
- 78% of youth support flavor bans on e-cigs per 2022 American Lung Association poll
- Only 22% of high school vapers perceive e-cigs less harmful than cigs in 2023 NYTS
Youth vaping has declined but remains a serious public health crisis.
Awareness Attitudes Prevention
- 68% of U.S. youth aware of e-cigarette harms per 2023 Truth Initiative survey
- 78% of youth support flavor bans on e-cigs per 2022 American Lung Association poll
- Only 22% of high school vapers perceive e-cigs less harmful than cigs in 2023 NYTS
- FDA's 2020 flavor enforcement reduced youth JUUL use by 60% per study
- 45% of non-vaping youth tried to quit friends from vaping per Truth 2023
- School tobacco policies cover 95% of students but enforcement varies per CDC 2022
- 87% of youth believe e-cigs cause addiction per 2021 YRBS perceptions data
- Truth Initiative campaigns reached 90% of U.S. youth with anti-vaping ads 2018-2023
- Price increase of 20% on e-cigs reduces youth use by 12% per 2022 econ study
- 55% of parents discuss vaping risks with kids annually per 2023 ALA survey
- Menthol ban support 72% among Black youth per 2022 Truth poll
- E-cig warning labels increase quit intentions by 25% in youth per 2021 trial
- 40 states have flavor restrictions but only 10 fully enforce per 2023 ALA
- Youth quitline calls up 300% post-FDA enforcement 2019-2021 per CDC
- 62% of vapers want to quit but only 12% succeed without help per Truth 2023
- School-based interventions reduce vaping initiation by 40% per 2022 meta-analysis
- 75% of youth overestimate nicotine content safety in e-cigs per FDA 2022
- National media campaigns cut youth e-cig use 15% 2019-2022 per eval
- Retail license revocation in 5 states led to 20% drop in nearby youth use 2021-2023
- 81% support raising tobacco purchase age to 21, passed in 2019 per ALA 2020
- Peer-led anti-vaping programs effective in 65% of schools per CDC 2023
- 34% of vapers cite health concerns as quit reason per 2023 NYTS follow-up
- Graphic ads increase harm perceptions by 30% in youth per 2022 RCT
- 28 states require cessation programs in schools post-2020 per CDC
- Youth support for vape taxes 69% per 2023 Cato poll
- Digital interventions via apps reduce vaping by 22% in 6-month trial 2022
- 92% of teachers report discussing vaping in class per NEA 2023 survey
Awareness Attitudes Prevention Interpretation
While youth are overwhelmingly aware of and agree on the harms of vaping, the chasm between their knowledge and successful quitting reveals a frustrating epidemic where awareness, support for bans, and school policies are abundant, yet accessible solutions, consistent enforcement, and effective cessation help are not.
Demographics
- High school males 12% more likely to vape than females, with 10.8% vs 9.4% in 2023 NYTS
- Non-Hispanic White youth highest e-cig use at 11.4% among high schoolers 2023 NYTS
- Hispanic middle school students 2.1% current e-cig use in 2023 NYTS
- 12th graders had 12.6% past-month e-cig use in 2023 Monitoring the Future survey
- Urban high school students 11.2% e-cig use vs 8.9% rural in 2023 NYTS analysis
- LGBTQ+ youth 25% higher e-cig use odds per 2022 CDC Youth Risk Behavior Survey (YRBS)
- 10th grade e-cig use 9.8% in 2023 Monitoring the Future
- Black high schoolers 7.1% e-cig use, lower than whites but higher than Asians 5.6% 2023 NYTS
- Females in 8th grade 2.1% vs males 2.5% middle school e-cig use 2023 NYTS
- Low-income youth (<$35k household) 12.5% e-cig use vs 7.2% high-income 2023 NYTS
- 9th graders 11.5% e-cig use highest among high school grades 2023 NYTS
- Asian American high school e-cig use lowest at 5.6% in 2023 NYTS
- 11th graders 10.2% past-month e-cig in 2023 Monitoring the Future
- Native Hawaiian/Pacific Islander youth 9.8% e-cig use 2023 NYTS subset
- Suburban youth 10.5% vs exurban 9.1% high school e-cig use per 2022 YRBS
- 8th grade e-cig use 3.7% in 2023 Monitoring the Future
- Multiracial high schoolers 10.9% e-cig use 2023 NYTS
- Males in rural areas 9.5% vs urban 11.0% e-cig use 2023 NYTS
- 20.4% of bisexual high school students vaped in 2021 YRBS
- 12% of youth with asthma history vape vs 8% without per 2023 Truth
- Southern U.S. states average 11.3% high school e-cig use 2023 NYTS regional
- 7th graders 1.2% e-cig use lowest middle school 2023 NYTS
- Gay/lesbian youth 18.2% e-cig use vs 9.6% straight 2021 YRBS
- Northeast U.S. 9.8% high school e-cig vs West 10.5% 2023 NYTS
- Overweight youth 11.8% e-cig use vs normal weight 9.2% per 2022 YRBS
Demographics Interpretation
While each demographic slice of American youth seems to have its own statistical flavor of vaping, the underlying recipe for risk reveals a disconcertingly universal addiction to inhaling uncertainty.
Flavors and Products
- 89.4% of youth e-cig users preferred flavored products in 2023 NYTS
- Disposable e-cigarettes used by 86.9% of current youth vapers in 2023 NYTS
- Fruit flavors top choice for 55.6% of high school e-cig users 2023 NYTS
- Menthol/mint used by 28.1% of youth e-cig users in 2023 NYTS
- Candy/dessert flavors 25.4% preference among middle school vapers 2023 NYTS
- Elf Bar most popular brand used by 30.2% of high school vapers 2023 NYTS
- 81.9% of youth users vaped flavored non-tobacco e-cigs in 2023 NYTS
- Pod-based systems like JUUL used by 47.1% high schoolers before decline 2019-2023 NYTS trend
- 15.3% used tobacco-flavored e-cigs, least popular in 2023 NYTS youth
- Disposable vapes rose from 26.5% in 2020 to 86.9% in 2023 per NYTS
- Mango flavor 22.4% among top fruits for high school vapers 2023 NYTS
- 62% of youth cite flavor as main reason for e-cig use per 2022 Truth survey
- Puff Bar/Elf Bar disposables 55% market share among youth 2023 NYTS brands
- Chocolate/candy flavors used by 20.1% middle school e-cig users 2023 NYTS
- Nicotine salt pods in 38% of high school vapers' devices 2023 NYTS
- 90.6% of flavored e-cig users would quit if only tobacco flavors available per FDA 2021 study
- Blueberry flavor 18.7% preference in disposables 2023 NYTS
- Tank/mod systems used by only 4.2% youth vs disposables 86.9% 2023 NYTS
- 5% nicotine strength most common at 45.3% among high school vapers 2023 NYTS
- Menthol e-cigs 2x more used by Black youth 28% vs overall 2023 NYTS
- 73% of youth unaware high-nicotine disposables equal pack-a-day cigs per Truth 2023
- Strawberry flavor 16.5% in top fruit choices 2023 NYTS high school
- Pre-filled pods declined to 36.1% from 55% 2020-2023 NYTS
- 12-18 mg/ml nicotine in 30% disposables used by youth per 2022 lab analysis
- 95.2% of youth vapers used sweet flavors exclusively in 2021 FDA survey
- Breeze flavors popular in 10.8% Elf Bar users among youth 2023 NYTS
- 33 states saw disposable use >80% in youth by 2023 per NYTS state data
- Only 1.1% used tobacco-only flavors, showing youth aversion per 2023 NYTS
- 50mg/ml nicotine disposables used by 25% high schoolers 2023 NYTS
- 61% of youth and young adults believe e-cig flavors help quit smoking per 2021 FDA
Flavors and Products Interpretation
The vaping industry has quite clearly weaponized a carnival of flavors and potent nicotine salts to hook a generation, given that nearly 90% of youth users choose flavored, non-tobacco products, would overwhelmingly quit if only tobacco flavors remained, and a staggering 86.9% now use disposable devices that are easy to hide and often contain as much nicotine as a pack of cigarettes—a fact most are blissfully unaware of.
Health Risks
- E-cigarette use causes acute lung injury (EVALI) with over 2,800 hospitalizations among youth by 2020 per CDC
- Youth vapers have 2.7 times higher odds of cough or bronchitis per 2022 cross-sectional study
- Nicotine in e-cigs harms adolescent brain development, affecting attention and learning per Surgeon General 2020 report
- 40% of youth e-cig users report addiction symptoms like strong cravings per Truth Initiative 2023 survey
- Vaping linked to 1.5 times increased asthma risk in youth per 2021 meta-analysis
- EVALI outbreak 2019-2020: 68 deaths, majority under 35, many youth vapers per CDC
- Youth e-cig use associated with depression: 2x odds per 2023 NYTS-linked study
- Vitamin E acetate in THC vapes caused 82% of EVALI cases among youth per CDC 2020
- Daily youth vaping doubles risk of future cigarette smoking per NEJM longitudinal study
- E-cigs expose youth to cancer-causing chemicals like formaldehyde at levels 15x higher than cigs per study
- 25% of high school vapers report frequent anxiety per 2022 Truth survey
- Acute nicotine poisoning cases in youth rose 91% 2018-2022 per Poison Control data
- Vaping aerosols contain metals like lead at 10-50x environmental levels in youth lungs per 2021 study
- Youth vapers 4x more likely to develop chronic cough per 2023 Pediatrics study
- EVALI symptoms in youth: shortness of breath 83%, fever 81% per CDC case series
- Nicotine dependence in non-smoker youth vapers: 30% per 2020 JAMA Pediatrics
- Vaping increases heart rate by 20-30 bpm in adolescents per 2019 Circulation study
- 68% of hospitalized EVALI patients under 25 were daily vapers per CDC 2020 update
- Youth exposed to ultrafine particles from vapes causing inflammation per 2022 Env Health study
- E-cig flavorings like cinnamaldehyde toxic to lung cells at youth vaping concentrations per 2021 Tox Sci
- 3x higher odds of myocardial ischemia in young vapers per 2023 case-control
- Seizures reported in 121 youth under 25 from nicotine e-liquids 2010-2019 per FDA
- COPD risk elevated 2.5x in adolescent vapers per 2022 cohort study
- Oral health decline: gum inflammation 2x in youth vapers per 2021 JADA study
- DNA damage from e-cig carcinogens in youth bronchial cells per 2020 Cancer Res
- Sleep disruption: youth vapers 1.5x more insomnia per 2023 Sleep Med
Health Risks Interpretation
The vaping industry has weaponized fruity mist into a chemical assault on youth, trading their breath for profit and their futures for addiction, as the evidence now screams that each sweet cloud is a Trojan horse delivering a cocktail of disease, mental anguish, and lifelong harm straight to developing lungs and brains.
Usage Prevalence
- In 2023, 2.13 million U.S. middle and high school students (7.7%) reported current e-cigarette use in the past 30 days according to the National Youth Tobacco Survey (NYTS)
- Among high school students in 2023 NYTS, 10.0% (1.84 million) reported current e-cigarette use, with a significant portion using daily
- Middle school current e-cigarette use was 1.8% (290,000 students) in 2023 per NYTS, showing a slight decline from prior years
- From 2019 to 2023, high school e-cigarette use dropped from 27.5% to 10.0% according to NYTS data analyzed by CDC
- In 2022 NYTS, 14.1% of high school students used e-cigarettes in the past 30 days
- Daily e-cigarette use among high school students reached 3.3% (about 600,000) in 2023 NYTS
- 89.4% of youth e-cigarette users in 2023 used flavored products per NYTS
- Past 30-day e-cigarette use among high school males was 10.8% vs. 9.4% females in 2023 NYTS
- Non-Hispanic White high school students had 11.4% current e-cig use in 2023 NYTS, highest among races
- 1 in 5 high school students who never smoked cigarettes regularly used e-cigarettes in 2023 per NYTS
- E-cigarette use peaked at 27.5% among high schoolers in 2019 NYTS before declining
- In 2021 NYTS, 11.3% high school students reported current e-cig use
- Youth e-cig use associated with marijuana use: 25.7% of users also used cannabis in 2023 NYTS
- Frequent use (20+ days/month) among high school e-cig users was 38.5% in 2023 NYTS
- 2020 NYTS showed 19.6% high school current e-cig use during early pandemic
- Middle school e-cig use declined from 5.3% in 2019 to 1.8% in 2023 per NYTS
- 85.9% of middle school e-cig users used flavored products in 2023 NYTS
- Hispanic high school students had 9.2% e-cig use in 2023 NYTS
- Black high school students reported 7.1% current e-cig use in 2023 NYTS
- In 2018 NYTS, high school e-cig use was 20.8%
- 1.6 million youth used e-cigarettes daily or nearly daily in 2023 equivalent per Truth Initiative analysis of NYTS
- 2023 NYTS: 10% of 12th graders used e-cigarettes past month per Monitoring the Future cross-reference
- Decline in disposable e-cig use from 89% to 86.9% among youth users 2022-2023 NYTS
- 26.3% of past 30-day youth e-cig users used on 20+ days in 2022 NYTS
- High school e-cig use higher in urban areas at 11.2% vs. rural 8.9% in 2023 NYTS subset
- 2017 NYTS baseline high school e-cig use 13.2%
- Youth dual use of e-cigs and cigarettes: 5.2% high schoolers in 2023 NYTS
- Middle school daily use 0.6% in 2023 NYTS
- 2024 preliminary NYTS data shows continued decline to 9.4% high school use
- E-cig use initiation before age 18 for 88% of adult users per 2023 CDC analysis
Usage Prevalence Interpretation
While the trend is promising, the fact that one in ten high school students are still using e-cigarettes, with nearly 90% choosing flavored products, suggests Big Tobacco's slick rebranding is successfully recruiting a new generation of nicotine addicts.
Sources & References
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