Huge Increase in Teen E-Cig Use in 2018, Survey Finds

A second major survey confirms that e-cigarette use among teenagers is soaring, following a CDC report in November that said use among high school students had nearly doubled in just one year.

Reported early Monday, findings from the annual Monitoring the Future survey indicated the percentage of high school seniors who reported current vaping increased from 11% in 2017 to 21% this year. The survey tracks national substance use among U.S. adolescents.

This surge represents the largest single year increase in the use of a single monitored substance ever observed, investigators at the University of Michigan’s Institute for Social Research (ISR) said in their report, published online in the New England Journal of Medicine.

Current e-cigarette usage also nearly doubled among 10th graders in 2018, with 16.1% reporting vaping, compared to 8.2% in 2017 (change of 7.9 percentage points, 95% CI 5.6-10.2). And among 8th graders, vaping prevalence increased to 6.1% from 3.5% in 2017 (change of 2.6 points, 95% CI 1.4-3.8).

The 1-year increase translates into approximately 1.3 million additional adolescents who vaped e-cigarettes containing nicotine in 2018, the ISR researchers reported. The survey included 13,850 respondents in 8th, 10th, and 12th grades across the country. Half of the seniors were randomly selected to answer more detailed questions about their vaping and tobacco use habits.

Last month, results from the CDC’s 2018 National Youth Tobacco Survey also showed a huge single-year spike in e-cigarette usage among high school and middle school students in 2018.

That nationally representative survey showed a nearly 80% increase in e-cigarette usage among high school students and a 50% increase among middle school students, with 21% of surveyed high school students reporting current vaping.

“The first reports we heard were from the media, with schools sounding the alarm about these products,” the ISR’s Richard Miech, PhD, told MedPage Today. “Then we had the CDC report, which was the first national survey data to document the increase we had been hearing about.

“Now we have these data showing that for 10th to 12th graders this is the largest year-to-year increase for any substance that we have measured in the 43 years of doing this survey. And it is more than double the previous largest single-year increase.”

Miech explained that since 1975, when the Monitoring the Future survey began, the researchers have tracked teen use of dozens of substances. During this time they have reported more than 1,000 individual increases in current (specifically, past 30-day) substance usage.

“Out of these increases, this is the largest one we have ever seen,” he said.

In September, FDA Commissioner Scott Gottlieb blamed the popularity of the e-cigarette brand Juul among adolescents for what he called an “epidemic” of vaping among high school students. The FDA later promised to restrict sales of most types of flavored e-cigarettes in an effort to keep teens from getting hooked on nicotine.

The Monitoring the Future survey did not ask the 9th through 12th graders which brand or type of e-cigarette they used, but Miech said it does appear that Juul use among teens is largely responsible for the unprecedented increase in usage.

“From the media reports that I’ve seen, it’s hard to imagine that it isn’t responsible,” he said.

The percentage of 12th graders who reported current nicotine use increased in 2018, from 23.7% in 2017 to 28.5% in 2018. This increase was due to vaping and not combustible cigarette use.

Cigarette smoking by teens has been declining for two decades, and the decline continued in 2018 among 12th graders. The survey showed no significant decline for 8th and 10th graders, however.

Marijuana vaping did increase in 2018, with 7.5% of 12th graders reported vaping marijuana within the last 30 days in 2018, compared to 4.9% the previous year.

“Vaping is making substantial inroads among adolescents, no matter the substance vaped,” said Miech. “In 2018 we saw substantial increases in vaping across all substances, including nicotine, marijuana, and adolescents who reported vaping ‘just flavoring.’ Factors that make vaping so attractive to youth include its novelty and the easy concealability of the latest vaping devices, which better allows youth to vape without adults knowing about it. If we want to prevent youth from using drugs, including nicotine, vaping will warrant special attention in terms of policy, education campaigns, and prevention programs in the coming years.”