Overview of adolescent e-cigarette use

“Electronic cigarette use among adolescents is dropping but remains at epidemic levels. In 2020, 3.6 million U.S. youths reported using e-cigarettes, including 3.02 million high school students and 550,000 middle school students (Morbidity and Mortality Weekly Report [MMWR], 2020). Even though 1.8 million fewer U.S. youths used e-cigarettes than in 2019, “the number of youth e-cig users remains concerningly high” because of the overall alarming increases since 2011 (U.S. Food and Drug Administration [FDA], 2020).

E-cigarettes, also known as e-cigs or vapes, are not safe for adolescents, pregnant women, breastfeeding women or anyone not currently smoking cigarettes (CDC, 2020). The act of using an e-cigarette is called “vaping” because the aerosol vapor is inhaled into the lungs.

Recent studies show e-cigarettes:

• Contain cancer-causing chemicals.
• Produce an aerosol of chemicals, not a harmless water vapor.
• Usually contain the toxic and powerfully addictive drug nicotine, which can damage adolescent and young adult brains, which continue developing until about age 25 (CDC, 2020).
• Are associated with a higher likelihood of smoking cigarettes or other substance use.

Teens Think JUULs are Cool and Puff Bars are Stars

JUULs have become the top-selling e-cigarette, accounting for 63 percent of U.S. e-cigarette sales from June 2019 to June 2020, according to Statista, an international data company. The JUULS brand name has become a verb—JUULing—that adolescents use to refer to smoking any brand of e-cigs.

In 2020, the FDA barred distribution of flavored pod-based and disposable e-cigarettes. The ban included Puff Bars, a disposable e-cigarette brand favored by teens. Although retail and online sales of Puff Bars were ordered halted in the United States, the product may still be available from some online providers.

Note: Federal and state regulations for e-cigarettes are covered in more detail below.

“If anyone thought the new flavored e-cigarette regulations were going to solve the youth vaping epidemic, they haven’t heard of Puff Bars,” which are now available only online, according to a 2020 news release from the nonprofit public health organization Truth Initiative, which works to reduce tobacco use. “Flavors play a significant role in drawing youth and young adults to start smoking. In fact, 97% of all youth who vape use flavored e-cigarettes.”

Puff Bars and JUULs don’t look like traditional cigarettes. Instead, they look like a popular high-tech device—a small, flat flash drive that stores digital data. They are difficult to detect when carried or used. They are small enough to fit in the palm of a hand and emit little visible vapor.

JUULs are more potent than some other types of e-cigarettes. “According to the manufacturer, just one JUUL ‘pod’ (the cartridge inserted into the device) delivers about as much nicotine to the user as a wholepack of cigarettes” (National Institute on Drug Abuse for Teens [NIDA], 2018).

According to Truth Initiative, “Nicotine strength can be as high as 5% in Puff Bars, just like JUUL” (2020).

Young people may use e-cigarettes because they like the flavors or think e-cigs are safer than regular cigarettes. Or, they may be curious about vaping or be influenced by peers to try it.

According to the National Youth Tobacco Use Survey, 2020:

• 19.6 percent of U.S. high school students currently vape.
• 4.7 percent of U.S. middle school students currently vape.

According to the Texas School Survey of Drug and Alcohol Use, 2020:

• 10.9 percent of middle and high school students reported using electronic vapor products in the past month
• 15.1 percent of middle and high school students reported using electronic vapor products in the past school year
• 27 percent of middle and high school students reported ever using electronic vapor products

Nationally, “e-cigarette use has been documented as highest among boys, non-Hispanic white youth, and Hispanic youth” (American Academy of Pediatrics [AAP], (2019).