Teen Cigarette Use Continues to Decline Rapidly Despite Vaping Uptick

While vaping among teenagers remains a pressing public health concern, new evidence suggests it has not led as a gateway to the use of cigarettes and smokeless tobacco.

The investigators from the recently published data wanted to understand how the use of cigarettes and smokeless tobacco by teenagers has changed since e-cigarettes came on the market in the mid-2000s.

The report is based on data from the Monitoring the Future survey, which tracks drug and alcohol use among teenagers. In the new study, nearly 1.3 million responses recorded between 1991 and June 3, 2019 were used. Those responses included more than 400,000 students in each of 3 grade levels: 8th, 10th, and 12th.

The survey shows rates of daily smoking have been decreasing steadily since the late 1990s. For instance, daily smoking among 12th grade boys dropped annually by 4.9% from 1991-1998, but by 2012-2019, the annual percentage change was -17.4%. Similar decreases were seen across other age and demographic groups.

The use of smokeless tobacco was more steady until 2012, but the investigators found a consistent decrease in its use over the past 5 years.

While that news is good, public health officials have also worried that the drop in the use of traditional tobacco products might simply be the result of a shift toward using e-cigarettes, also known as vaping.

While data on e-cigarette use is newer, and has required changes in the wording of questions over the past several years, evidence shows vaping is increasing among teenagers. The National Youth Tobacco Survey found as many as 27.7% of high-schoolers reported vaping in 2018, and 5% of middle-schoolers said the same.

Taken together, the findings show cigarette and smokeless tobacco use has continued to drop at rapid rates, even as e-cigarette use has increased. That suggests vaping is not acting as a bridge to cigarette smoking.

“This is important because one of the main concerns with vaping is that it could lead to smoking,” said corresponding author Rafael Meza, PhD, of the University of Michigan. “While that certainly can be the case among some individuals, we are not seeing that at the population level.”

Meza added that the decreases in the use of cigarettes, smokeless tobacco, and little cigars are going down faster than before across demographic groups, suggesting a general phenomenon.

Meza credited public health education campaigns as well as tobacco control regulations at all levels of government with helping to drive down the use of cigarettes and smokeless tobacco. He said it is cause for celebration, but added that the vaping data suggest there’s still plenty of work to do.

“At the same time, the increases in vaping are concerning and something we need to address (and are addressing),” he said.

One such measure has been a new 2019 law limiting sales of tobacco products to those age 21 and over, instead of age 18. Meza said this will be important, since many underage teens got tobacco products from peers who were over the age of 18.

He said policies like the new age limit are also helpful because “they reinforce the message about the harms of smoking, potentially leading to synergistic effects with other policies.”

The study, “Trends in Tobacco Use Among Adolescents by Grade, Sex, and Race, 1991-2019,” was published online in JAMA Network Open.