Vaping has surged in popularity, even as overall smoking rates have declined. Among teens who use tobacco products, e-cigarettes are more popular than smoking traditional cigarettes or other ways to consume nicotine. That’s raised the alarm for public health experts and triggered new laws to try and curb teen vaping.
Even though vaping is far more popular now among high school students than smoking, the rates they are smoking e-cigarettes actually declined in the past few years. In 2019, an estimated 29% of high school students vaped, according to a study published in the Journal of the American Medical Association. The 2023 National Youth Tobacco survey from the Food and Drug Administration and Centers for Disease Control and Prevention shows that 10% of high schoolers vape, and 1.6% of middle and high schoolers smoked cigarettes.
In April, Gov. Ron DeSantis signed a bill that restricts use of single-use, flavored e-cigarettes. It’s designed to stop children from vaping, and won support from the Florida Smoke Free Association, an advocacy group for e-cigarette businesses and consumers. In a statement the organization said the bill “protects vaping options for adults, exempts open systems, regulates bad actors in our industry and provides an avenue to protect our kids.”
Yiota Kitsantis is a professor and chair of the Department of Population Health and Social Medicine at Florida Atlantic University’s Schmidt School of Medicine. She has a Ph.D. in statistics and specializes in biostatistics and epidemiology. FAU published a study recently that explores the rise in vaping among youth. It shows vaping trends among adolescents and highlights a couple of reasons why vaping is attractive: it’s a safer alternative to smoking and offers a range of flavors.
Kitsantis says the popularity among teenagers can be associated with the packaging and advertising of vape products.
“Advertising of vaping products has been heavily aimed at adolescents, and it's everywhere from social media to billboards,” she said. “And similar to cigarette smoking advertising, the youthful images, colors and animation used in vaping advertising tend to be very attractive to adolescents.”
She says vape products are easy to use, thus also making them more attractive to adolescents.
When it comes to an alternative to smoking, Kitsantis doesn’t believe there is a safer option, especially for young people.
“Nicotine and other harmful chemicals in vaping products can adversely affect the developing brain of an adolescent,” she explained. “Nicotine exposure and exposure to other dangerous chemicals in vaping products has been associated with cognitive deficits and impairment in memory, along with mood disorders. Teens overall are more susceptible to nicotine addiction, and therefore e-cigarettes and other vaping products, they can help create, essentially, a new generation addicted to nicotine.”
Vani Simmons doesn’t disagree, but she says more research needs to be done on people who solely vape to really see the long-term effects of nicotine. Simmons holds a Ph.D. in clinical psychology and is a senior member in the Department of Health Outcomes and Behavior at the Moffitt Cancer Center & Research Institute in Tampa.
“One of the challenges in doing research and understanding the impact of vaping is that, because most people that vape have a history of either current or former smoking, it's very hard to tease apart some of the health issues that they're dealing with, and to be able to disentangle that from their previous exposure to smoking.”
She says research does show some respiratory problems in youth who exclusively vape, such as bronchitis and increased asthma symptoms, but that they are short term effects.
Simmons says there have been concerns that vaping may serve as a gateway to combustible cigarettes, but the data just hasn’t shown that.
“If it was true that vaping would lead to more cigarette smoking, you would have seen an increase in cigarette smoking over time. But instead, we see an inverse relationship, where vaping rates have increased, and cigarette smoking rates have declined at an unprecedented speed.”
Based on a National Academies of Science Report, Simmons says she can confidently say vaping is a safer alternative to smoking cigarettes.
“It does not mean that vaping is safe, but it does mean, in terms of the relative risks to combustible cigarettes, it is much safer and therefore represents a harm-reduction product.”
This is because when smoking cigarettes, the tobacco is combusted and inhaled, something that is not happening when vaping because they are not a tobacco-containing product.
“You're getting the addictive component, which is the nicotine, but nicotine by itself has not been shown to be carcinogenic, so it does not lead to cancer,” she said. “It's the other chemicals when you smoke that are cancer causing. The reason for the reduced harm reduction is because there is no combustible tobacco and you are inhaling the nicotine aerosol, which has much fewer chemicals.”
Vaping has become most common among adults who are trying to quit smoking. In addition to providing the nicotine, it also mimics the behavioral aspects of smoking, making it more appealing than traditional nicotine replacement therapies, or NRTs.
“When you use something like a nicotine patch or nicotine gum, you don't get the hand-to-mouth. You don't get the opportunities to be in the social groups and to be able to use the product in that setting,” she said. “In terms of some of the flavors that are offered, all of these things make e-cigarettes a potentially much more appealing product for getting your nicotine as compared to what had been previously available with nicotine replacement therapies.”
The issue Simmons finds is that while a lot people are motivated to quit smoking, they don’t really know how to use their e-cigarette to do so.
“A patch, nicotine gum, things that are available over the counter, those come with very specific instructions about dosing, how long to use them and so forth,” she said.
Moffitt has been developing smoking cessation treatments, or a self-help program, to help people quit smoking but also teach them how to use their e-cigarettes to do so in the process of quitting.
Simmons says it’s a matter of having a lower dose of nicotine per vape but there is no current research to say how much of a lower dose is a good dose for weening off nicotine. But she says an alternative is nicotine-free vapes. That way you still get the behavioral aspect of smoking, which can help one stop smoking altogether.
When it comes to youth prevention of vape usage, Simmons thinks there needs to be a more balanced approach so the messaging doesn’t also turn away people looking to quit smoking.
“Some of the youth prevention has been a little bit problematic in that it's providing the anti-vaping messages that are received by adult smokers and is influencing their use of e-cigarettes. So, we really have to take a balanced approach when we're thinking about youth prevention and balancing that with e-cigarettes being a potential harm reduction tool.”
Finally, Simmons thinks there’s something to celebrate in the midst of all of the things surrounding vaping:
“We're not looking at the fact that among high school students, cigarette smoking almost doesn't exist. And that is a public health victory that nobody is really talking about. So yes, we don't want you vaping. But let's also applaud the fact that you don't see high school students smoking cigarettes anymore.”
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