Nicotine vaping prevalence has rebounded among older adolescent girls following a decline in 2021, approaching its previous peak by 2024. The findings highlighted changing patterns of nicotine use among US adolescents despite continued declines in combustible cigarette smoking.
Researchers conducted a repeated cross-sectional analysis of nationally representative data from the Population Assessment of Tobacco and Health study, examining adolescents aged 12 to 17 years across 8 survey waves conducted between October 2014 and December 2024. Sample sizes ranged from 5,652 to 14,798 participants per wave. The analysis evaluated differences by sex, age, race, ethnicity, academic performance, household income, and parental educational attainment.
The outcomes were current established nicotine vaping and combustible cigarette smoking. Established vaping was defined as having used e-cigarettes fairly regularly in the preceding 30 days, whereas established smoking required a history of smoking more than 100 cigarettes and use within the preceding 30 days. Researchers assessed prevalence trends across sex and age groups, including adolescents aged 12 to 14 years and those aged 15 to 17 years.
Among adolescents aged 15 to 17 years, established vaping prevalence was higher among boys than girls in 2014 to 2015, at 3.1% vs 1.9%. By 2018 to 2019, prevalence had increased to 8.5% among boys and 8.2% among girls. Following a decline in 2021, vaping prevalence among older adolescent girls rose from 4.9% to 7.8% in 2024, while prevalence among boys remained relatively stable at 4.2% to 4.6%.
Adjusted analyses identified statistically significant sex-by-survey-wave and age-by-survey-wave interactions, supporting the observed shift in prevalence patterns.
Among adolescents aged 12 to 14 years, established vaping prevalence remained substantially lower than among older adolescents. In 2024, prevalence was1.5% among girls and 1.1% among boys. Rates in this younger age group fluctuated over time rather than demonstrating the sustained increase observed among older adolescent girls.
In contrast, established combustible cigarette smoking declined throughout the study period. Overall prevalence decreased from 1.6% in 2014 to 2015, to 0.2% in 2024. Among adolescents aged 15 to 17 years, smoking prevalence reached 0.5% among boys and 0.3% among girls in 2024.
Additional analyses identified associations between nicotine use and several demographic characteristics. Younger age, Hispanic ethnicity, Black or other race categories, higher academic performance, and parental attainment of a bachelor's degree were associated with lower established smoking and vaping prevalence. Household income was not significantly associated with established vaping in the adjusted analysis.
The study's repeated cross-sectional design limited conclusions about individual nicotine use trajectories and could not establish the factors responsible for changing vaping prevalence. Nicotine use was self-reported, introducing potential reporting bias. Additionally, the analysis focused on established use rather than experimentation or all nicotine exposure. Although the authors suggested that marketing trends, risk perceptions, anxiety, and peer influence warranted further investigation, these potential explanations were not directly evaluated.
Declining adolescent cigarette smoking prevalence has not been accompanied by sustained reductions in nicotine vaping across all demographic groups. The researchers called for further investigation and urged efforts to “explore sex-specific interventions to reduce e-cigarette use among children and adolescents in the US.” The letter was authored by co–first authors Brandon T. Sanford, PhD, and Naomi C. Brownstein, PhD, of the Medical University of South Carolina, and colleagues.
The study received support from the Donaldson Charitable Trust and National Institutes of Health grants. Naomi C. Brownstein, PhD, and Tracy T. Smith, PhD, reported research funding, while Benjamin A. Toll, PhD, disclosed testifying for plaintiffs in tobacco industry litigation. No other disclosures were reported.
Source: JAMA Pediatrics
