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Examining vaping trends in adolescents

A report examines the latest trends in adolescent vaping, including the popularity of JUUL and flavors.

A decline in traditional smoking over the past couple of decades in adolescents had given public health officials and clinicians hope that nicotine use by teenagers would be a thing of the past. Unfortunately, vaping entered the market and reversed the trend. An investigation in JAMA Pediatrics examines how vaping trends in adolescents have changed over the past few years, particularly with the advent of e-cigarette or vaping use-associated lung injury in 2019 and further understanding of the risks of the activity.1

Researchers used data from Monitoring the Future, which is an annual, cross-sectional, school-based, nationally representative surveys from 2017 to 2020 that was given to 10th and 12th grade students. The survey asked about vaping along with other topics. The outcomes the researchers looked at included the prevalence of self-reported nicotine vaping; the brand and flavor of vaping product most often used; the perceived risk of nicotine vaping; and perceived ease of getting vaping products.

A total of 8660 students were given the survey in 2020. The nicotine vaping prevalence in 2020 was 22% (95% CI, 19%-25%) for past 30-day use, 32% (95% CI, 28%-37%) for past 12-month use, and 41% (95% CI, 37%-46%) for lifetime use, which did not represent a significant change from the levels found in 2019. However, daily nicotine vaping (use on ≥20 days of the last 30 days) was found to significantly decline from 9% (95% CI, 8%-10%) to 7% (95% CI, 6%-9%) over 2019 to 2020. Additionally, the prevalence in the past 30 days of the JUUL brand, which was a major force in adolescent vaping, decreased from 20% (95% CI, 18%-22%) in 2019 to 13% (95% CI, 11%-15%) in 2020, but other brands did increase. Among teenagers who vaped in the past 30 days in 2020, the most common flavors were fruit at 59% (95% CI, 55%-63%), mint at 27% (95% CI, 24%-30%), and menthol at 7% (95% CI, 5%-9%), with 80% (95% CI, 75%-84%) reporting being able to easily get a vaping flavor other than menthol or tobacco. Further good news included, teenagers also reported significantly less easy access to vaping products and they also reported higher perceived risk of vaping from 2019 to 2020.

Investigators concluded that increasing vaping trends from 2017 to 2019 stopped in 2020 and included a decline in daily vaping. Actions from public health organizations have led to declining JUUL use, but use of flavor vape products and other brands remains prevalent.


1. Miech R, Leventhal A, Johnston L, O'Malley P, Patrick M, Barrington-Trimis J. Trends in use and perceptions of nicotine vaping among us youth from 2017 to 2020. JAMA Pediatr. December 15, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.5667