Days Spent Vaping By Americans Under 21 Have More Than Quadrupled Since 2013

Vaping among Americans under 21 has cooled since a 2018-19 peak, but the total number of days they spend vaping is still more than four times what it was a decade ago. A new study in Tobacco Control found that vaping days among that age group rose 337% between 2013-14 and 2022-23. Vaping days, a measure that adds up how many days people used e-cigarettes in the past 30 days across the whole population, captures both how many people vape and how often.

Counting days of use tells a different story than a simple headcount. A hundred people who each vape once in a month add up to 100 vaping days, while 50 people who vape every day add up to 1,500, even though half as many people are vaping. Between 2013-14 and 2022-23, the estimated number of Americans ages 12 and older who reported vaping in the past month grew 45%, while the estimated total number of vaping days nationwide jumped 183%.

Underage vapers, meaning anyone under the legal purchase age of 21, accounted for about 16% of all vaping days in 2022-23. That is down from a peak of 23% in 2018-19 but well above the roughly 10% share in 2013-14. Past-month vaping in that age group fell 28% after the peak, yet vaping days fell only 13%, a gap that points to more frequent use among those who kept vaping.

Seven Rounds of National Survey Data Tracked Vaping Days for a Decade

Researchers from the University of Waterloo in Canada and Roswell Park in Buffalo, New York, drew on the Population Assessment of Tobacco and Health study, a national survey that has followed Americans since 2013 and added new participants in later rounds. The analysis covered seven rounds, from 2013-14 through 2022-23, and included young people ages 12 to 17 along with adults 18 and older.

Sample sizes stayed large. The first round included roughly 46,000 interviews and the last about 41,600, with participants split almost evenly between males and females and adults spread across age groups from 18 to 65 and older. Recruitment deliberately included extra adults who use tobacco, adults ages 18 to 24, and Black adults, and the results were then adjusted so they reflect the US population. In each round, respondents were asked whether they had used an electronic nicotine product, a category that includes e-cigarettes and vape pens, in the past 30 days, and those who had were asked on how many of those days. The results are national estimates of days of use, not counts of puffs or nicotine consumed.

Underage Vaping Days Rose 337% Despite a Recent Drop in Teen Vaping

Vaping days rose in every age group. Among teens ages 12 to 17, they climbed 278%, from 4.5 million to 16.9 million. Young adults ages 18 to 20, old enough to be legal adults but still under the purchase age, saw the steepest increase, at 364%, while adults 21 and older saw 165%. Even so, adults 21 and older accounted for 84% of all vaping days in 2022-23.

Teens who vape daily or nearly daily, meaning at least 20 days a month, made up 1.7% of all teens in 2022-23. That is down from 2.3% at the 2018-19 peak but well above the 0.7% recorded in 2016-18.

JUUL’s rise and the spread of other nicotine salt e-liquids, a type of vaping liquid that earlier research has linked to easier inhalation and more frequent vaping, line up with the 2018-19 peak. This study did not test whether those products caused the increase. The authors also point to industry marketing aimed at young people, along with growth in the youth population, as likely contributors to the steeper climbs among teens and young adults.

Adults saw no comparable drop. Past-month vaping among adults rose from 6.2% in 2016-18 to 8.9% in 2022-23. Daily or nearly daily vaping among adults more than doubled, from 2.1% in 2016-18 to 4.4% in 2022-23, and adult vaping days kept climbing after the pandemic, mainly because of more frequent use.

Population Growth Cannot Account for the Rise in Vaping Days

Between 2018 and 2023, the US population grew only about 2%, according to Census figures the authors cited, while total vaping days were 26% higher in 2022-23 than in 2018-19, a gap population growth cannot explain.

Other national surveys found higher youth vaping rates than this one. The National Youth Tobacco Survey and Monitoring the Future are conducted in schools, possibly producing higher numbers because school-based surveys offer greater anonymity. This study surveyed households, which produced lower estimates and milder changes over time.

A smaller headcount of young vapers does not mean vaping fell as much. Counting only how many people vape shows a decline since 2018-19, while counting days shows underage use still far above where it began. Adding frequency measures to national surveys, the authors say, may improve how vaping is monitored, and they write that surveillance “remains essential for understanding the potential risks and benefits of vaping on public health.”

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Disclaimer: This article summarizes one published study for general information and is not medical advice. Anyone with questions about vaping, nicotine use, or their health should speak with a qualified health care professional.

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