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E-cigarette use among young people returning to pre-COVID-19 levels

Following a decline in the early months of the COVID-19 pandemic, 15- to 20-year-olds are as likely to be using e-cigarettes as those surveyed before the COVID-19 pandemic, according to new Truth Initiative® research published in PLOS One. The study also found that young adults ages 21 to 24 are more likely to be e-cigarette users compared to the same age group surveyed before the pandemic. The re-emergence of e-cigarette use among young people as COVID-19 restrictions fade away calls for stronger policies, including restrictions on youth-appealing flavored tobacco products and expanding quitting and prevention resources.

The findings suggest that as restrictions were lifted and people went back to work and school, the likelihood of e-cigarette use among youth and young adults increased.

Initial dips in vaping rates during the pandemic were temporary

In 2019, e-cigarette use among young people in the U.S. reached an all-time high, according to the National Youth Tobacco Survey. Social distancing policies and business restrictions in 2020 corresponded with a sharp downturn in e-cigarette use among young people as non-essential businesses shut down, schools moved to distance learning, and people shuttered in. Because most under-aged users access tobacco products through friends or from retail sources such as smoke shops and convenience stores, lockdown appeared to reduce youth access to tobacco products – at least initially, according to Truth Initiative research published in the American Journal of Public Health. The study also found that 15- to 20-year-olds had lower odds of being current e-cigarette users very early during the pandemic compared to the months immediately preceding the pandemic, and that e-cigarette users with reported reduced retail access had 1.51 higher odds of reporting reduced e-cigarette use.

Truth Initiative researchers surveyed a total of 37,331 respondents between the ages of 15 and 24 before and throughout the pandemic to gauge e-cigarette use as the pandemic continued. They found that respondents surveyed late in the pandemic (April 2021-April 2022) were significantly more likely to use e-cigarettes than those surveyed in the beginning of the pandemic (March 2020-July 2020). The findings suggest that as restrictions were lifted and people went back to work and school, the likelihood of e-cigarette use among youth and young adults increased.

The findings are in line with national surveys showing rising e-cigarette use among young people. The 2022 Monitoring the Future Survey found noteworthy upticks in vaping rates among 10th and 12th graders and increases in daily use across those who vape in all grades since 2020. The 2022 National Youth Tobacco Survey from CDC shows that 2.5 million middle and high school students reported current e-cigarette use and almost half of high schoolers who vape do so on a near daily basis.

Return to in-person school and work increases exposure to and opportunities to obtain tobacco. Those emerging from the pandemic may also encounter new school related stressors, and research has found that young e-cigarette users report increasing e-cigarette use to cope with stress.

E-cigarette use has rebounded among young people, may have increased for young adults

Researchers also compared pre-pandemic survey results with data from those surveyed later during the pandemic to find that e-cigarette usage did not significantly differ, despite the initial declines seen when the pandemic began. Researchers saw no significant difference in the odds of e-cigarette use among 15- to 20-year-olds before the pandemic (August-December 2019) and two years later (August-December 2021). Even more concerningly, young adults between the ages of 21 and 24 were significantly more likely to be using e-cigarettes in 2021 compared to those aged 21 to 24 surveyed immediately before the pandemic.

Return to normal can’t include a return to vaping

Results of this study suggest that increased access contributes to e-cigarette use among young people. Truth Initiative has long supported restrictions on the sale of flavored tobacco products to reduce youth appeal and access to e-cigarette products. Local policies restricting the sale of all flavored tobacco products, including e-cigarettes, are critical, especially while the Food and Drug Administration works to complete its review of premarket tobacco applications of e-cigarette products currently on the market. Other actions can also help the situation, including allocating resources to help current users quit, encouraging high schools and colleges to implement non-punitive policies aimed towards reducing tobacco use on campus, and increased tobacco prevention and cessation outreach towards young people. Health communication efforts that center on influencing attitudes surrounding the social acceptability of e-cigarettes may prevent rising e-cigarette use among young people. Mental health resources and outreach should be prioritized to help young people coping with stressors amplified by the pandemic.