High school students resumed taking the annual National Youth Tobacco Survey in school this year and 14% of them reported using e-cigarettes, underscoring how an upstart industry is dodging regulators' efforts to spare a generation from nicotine addiction.
The number shows a slight change from 11% last year, but researchers cautioned against drawing comparisons to 2021's survey, which was conducted differently because it took place when many schools were closed during the pandemic. The latest results were released by the Centers for Disease Control and Prevention on Thursday.
Although the age-old force of peer pressure may still be encouraging use, the percent of high school students who reported vaping in the past 30 days was still far lower than record-high levels reached in 2019 of nearly 28%.
Overall, the survey found that 2.5 million middle and high school students, or about 9%, used e-cigarettes in the past 30 days. That puts their overall rate of use several times higher than that of adults, which is estimated at about 3%.
In the survey, which was conducted from January through May of this year, high school students reported strongly favoring fruit- and candy-flavored vapes. Some mentioned PuffBar, Vuse and Juul as their favorite brand among those on the survey's list.
But many said their favored e-cigarette brand was not one of the 13 listed. That finding highlights how nimble the industry has been in stamping an array of brand names on vapes with flavors like strawberry ice cream and fresh vanilla that are largely made in China and shipped from warehouses to corner stores and into e-commerce.
"What that shows is that playing Whac-A-Mole with a few products is not going to solve the problem," said Vince Willmore, a spokesperson for the Campaign for Tobacco-Free Kids. "As long as any flavored products are still on the market, kids are going to shift to them. To solve the problem, you have to clear the market of all flavored products."
One stark finding was that one in four of the high school students who were e-cigarette users reported vaping every day. Groups opposed to e-cigarettes and tobacco products were particularly troubled by one other result that reflected the highest frequency-of-use to date: Nearly half of the high school students who were vaping said they were doing so 20 to 30 days a month.
"That's a real signal of addiction and setting up young people for a lifetime of addiction which they don't want, they didn't choose and they don't like," said Robin Koval, president of the Truth Initiative, a nonprofit organization aimed at eliminating youth tobacco use.
The Food and Drug Administration considers e-cigarettes to be generally beneficial, because they can provide an alternative to adult users of traditional cigarettes, which coat the lungs in tar. The agency's hope for health gains, though, has existed in the shadow of a youth vaping crisis that exploded in 2018-19, prompting an outcry from parents, schools, lawmakers and public health experts.
The FDA began to crack down on vape makers in 2019, banning many flavors and ordering manufacturers to apply for marketing authorization to keep their products on the market - an ongoing process. That effort has been challenged by e-cigarette makers who saw a loophole in making e-cigarettes with synthetic nicotine and jumped into the market with blueberry, kiwi and candy-flavored vapes.
This spring Congress gave the FDA the authority to rein in those devices. The agency said it was reviewing about 1 million applications to sell synthetic nicotine products. In July, the agency gained authority to remove unauthorized nontobacco products from the market but has said it needs to move methodically as it enforces the law.
The consequences for teens who develop a nicotine addiction are just beginning to be understood. Dr. Rose Marie Robertson, science and medicine officer with the American Heart Association, said scientists were seeing toxic effects from the inhaled flavoring ingredients. She said researchers were also detecting signs of e-cigarette use on the heart and lungs.
"It took us 40 years to show that women would develop lung cancer more readily if they smoked," Robertson said. "The fact that we're seeing any effects at an early stage is very worrisome."
The persistent rate of e-cigarette use among teenagers also concerns experts who were thrilled to see youth cigarette smoking rates fall steadily for years.
"To have decades of progress wiped away by e-cigarettes has been astonishing to us who've been there all along," Robertson said.
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