Abstract
Introduction
The prevalence of adolescent nicotine vaping declined substantially after the COVID-19 pandemic onset in the United States during the Spring of 2020. This study examines whether the decline continued from 2022 to 2023, and the extent to which any decline reflects the lasting influence of lowered levels of initiation 3 years earlier, at the onset of the pandemic.
Aims and Methods
Data for this study come from nationally representative, cross-sectional surveys of U.S. 12th-grade (n = 9854) and 10th-grade (n = 14 663) students administered in the Spring of 2022 and 2023. The main outcomes are past 12-month nicotine vaping and grade first ever vaped nicotine.
Results
From 2022 to 2023 prevalence of past 12-month nicotine vaping declined a relative 20% for 12th-grade students, from 24.3% to 19.1%, and for 10th-grade students by a relative 16%, from 17.8% to 15.1%. Among 12th-grade students who vaped nicotine in the past 12 months, a significant decline in prevalence took place only among those who first ever vaped nicotine in ninth grade, and not among those who first ever vaped nicotine in any other grade. Among 10th grade students who vaped nicotine in the past 12 months, a significant decline in prevalence took place only among those who first ever vaped nicotine in seventh grade, and not among those who first ever vaped nicotine in any other grade.
Conclusions
These results contribute national-level evidence that forestalled initiation of nicotine use for 1 year may have a lasting effect that continues to lower adolescents’ levels of use many years afterward.
Implications
These findings caution against looking to contemporaneous policy for explanations of the large, 1-year decline in nicotine vaping from 2022 to 2023. It can be tempting to interpret the decline as a victory for current efforts to restrict adolescent access to vaping products, or current education/media campaigns that warn adolescents of the dangers of vaping. The findings of this study suggest, instead, that the 1-year vaping declines primarily result from declines in initiation that were set into place 3 years ago during the pandemic onset, more so than the immediate result of contemporaneous policy.
Introduction
Adolescent nicotine vaping declined substantially after the onset of the pandemic,1 and the potential, lasting effects of this decline have substantial implications for both policy and theory. On the one hand, forestalled initiation of substance use for 1 year can potentially lower adolescents’ levels of substance use for the rest of their lives.2 Youth who were in school during the onset of the pandemic in the Spring of 2020 may have lower levels of nicotine vaping that they are carrying with them as they age. In contrast, the decline in nicotine vaping prevalence may be fleeting, with no lasting effect after peer interactions resumed their pre-pandemic patterns.
This study presents 2023 levels of nicotine vaping for U.S. 12th and 10th-grade students. It also assesses the extent to which today’s prevalence levels reflect the lasting influence of lowered initiation 3 years earlier, at the onset of the pandemic.
Background
Declines in adolescent substance use after the onset of the pandemic rank among the largest 1-year declines recorded since national studies of adolescent drug use first commenced more than four decades ago.1 The U.S. government declared a COVID-19 public health emergency on March 13, 2020,3 after which most U.S. school buildings closed4 and social distancing protocols encouraged everyone—including adolescents—to maintain a six-foot distance from people who did not live in the same household. In 1 year prevalence of nicotine vaping subsequently fell by 23% in 12th grade, from 35% in 2020 during the months before the pandemic onset to 27% in 2021, and by 35% in 10th grade, from 31% to 20%.1
One key question these findings raised was whether the declines would persist in the following years. Forestalled initiation of nicotine use for 1 year could lower adolescents’ probability of nicotine use in future years for at least two reasons. First, it could prevent adolescents from joining peer groups that encourage and facilitate use of nicotine and other substances.5 Second, abstinence could stave off biological processes that make the adolescent brain more susceptible to nicotine and prime it for addiction.6–8 Alternatively, the prevalence of adolescent nicotine vaping could quickly rebound back to pre-pandemic levels in subsequent years, if processes that foster adolescent substance use rapidly returned to pre-pandemic levels.
If the declines in nicotine vaping continued into 2022 and 2023, grades 7 and 9 would be of central interest. These two grades are typically the first years of junior high school and high school,9–11 and they expose students to an array of new risk factors for substance use, including interactions with older students who may provide encouragement and opportunities to use drugs. In both these grades, levels of nicotine vaping initiation are higher than in all previous years.1 Disruption of initiation during the pandemic in these grades could account for declines in nicotine vaping prevalence both contemporaneously and also in later years and in higher grades if their lower levels of use continue as they age.
In 2022 lowered levels of adolescent nicotine vaping persisted as a substantial portion of students who did not initiate use earlier in seventh and ninth grade continued to abstain from nicotine vaping as they aged.12 In eighth grade, the percentage of past 12-month users who had initiated use in seventh grade was significantly lower in 2022 than it had been before the pandemic onset. This smaller number of initiates in seventh grade accounted for 71% of the lowered prevalence of nicotine vaping among eighth-grade students in 2022 compared to levels before the pandemic onset.12 Similarly, among 10th grade students in 2022 a significantly lower number of initiates the year before in ninth grade accounted for 95% of the lowered prevalence of 10th grade nicotine vaping in 2022 compared to the levels before the pandemic onset.12
This study examines whether the declines in adolescent nicotine vaping continued to persist into 2023 and, if so, the potential role of lowered initiation in grades 7 and 9 3 years earlier. Students in 12th grade in Spring of 2023 had been in ninth grade in the Spring of 2020, when school closings and social distancing policies abruptly went into effect. Also, students in 10th grade in the Spring of 2023 had been in seventh grade in the Spring of 2020. Forestalled initiation in 2020 may continue to affect population prevalence of adolescent nicotine vaping today in 2023.
Materials and Methods
Data come from the annual Monitoring the Future study, which since 1975 has used questionnaires administered in classrooms to survey nationally representative, cross-sectional samples of U.S. 8th-, 10th-, and 12th-grade students in the 48 contiguous states.1,13 Monitoring the Future was approved by the University of Michigan Institutional Review Board, approval #HUM00131235. Informed consent (active or passive, per school policy) was obtained from the parents of students who were younger than 18 years and from the students who were aged 18 years or older.
The analysis uses data from surveys administered in the Spring of 2022 and 2023 and focuses on 10th- and 12th-grade students. All students completed the Monitoring the Future questionnaires using electronic devices. Student response rates in 12th grade were 75% in 2022 and 72% in 2023, and in 10th grade were 84% and 85%, respectively.
The primary outcome of the study is prevalence of past 12-month nicotine vaping. In 12th-grade this outcome is disaggregated by first ever vaped nicotine in ninth grade v. first ever vaped nicotine in other grades, and in 10th grade, it is disaggregated by first ever vaped nicotine in seventh grade v. first ever vaped nicotine other grades. The text for the survey question on past 12-month nicotine vaping was “To ‘vape’ is to use a device such as a JUUL, vape-pen, e-cigarette, e-hookah, or e-vaporizer to inhale a vapor into the lungs. During the last 12 months have you vaped nicotine? 1=’Yes’ 2= ‘No’.” The question text for the question on grade of first nicotine vaping was “When (if ever) did you FIRST do each of the following things? Don’t count anything you took because a doctor told you…. ‘Vape an e-liquid with nicotine (JUUL, e-cigarette, e-pen, etc.)’.”
The analysis was limited to respondents who received the question on grade of initiation for nicotine vaping. In 12th grade this question was administered to a two-thirds randomly selected sample and in 10th grade to a five-sixths randomly selected sample. The final analysis sample includes all respondents who provided information on grade of first nicotine vaping (86% response rate in both 12th and 10th grade), resulting in 9854 12th grade students and 14 663 10th grade students.
The analysis used multiple imputation to handle missing data for covariates (≤1%) and all estimates used the chained equations algorithm with 10 imputed data states in STATA MP 18. The analyses accounted for the survey’s complex sample design and used weights to produce nationally-representative estimates of all U.S. 10th- and 12th-grade students. Statistical analyses consisted of Wald χ2 analyses to test if prevalence estimates significantly differed across years at the p ≤ .05 level for a two-tailed test, as well as multivariable, generalized linear regression models with a binomial distribution and log link to produce risk ratios and associated 95% confidence intervals. The analysis also used the “seemingly unrelated estimation” (suest) algorithm in STATA to test if regression coefficients significantly differed across models.
Results
Table 1 presents descriptive statistics of the analysis sample. In 12th grade, 49% identified as female, 46% as male, 1.4% as another gender, and 3.6% preferred not to report their gender. In 10th grade, the gender distribution was similar, with 46% identifying as female, 49% as male, 1.6% as another gender, and 4% preferring not to answer. In both grades the largest race/ethnicity category was White (46% in 12th grade and 47% in 10th grade), followed by Hispanic (23% in 12th grade and 21% in 10th grade), multiracial (15% in both grades), Black (11% in 12th grade and 10% in 10th grade), Asian (5% in 12th grade and 4% in 10th grade) and then another race/ethnicity (2% in 12th grade and 3% in 10th grade).
Table 1.
Descriptive Statistics by Grade, Monitoring the Future 2022 and 2023: Prevalence and 95% Confidence Intervals in Parentheses
| 12th grade (n = 9854)a |
10th grade (n = 14 663)b |
|
|---|---|---|
| Vaped nicotine in past 12 months | 22.0 (19.0 to 24.9) | 16.6 (14.7 to 18.6) |
| Grade first vaped nicotine, among students who vaped nicotine in the past 12 months | ||
| 4c | n/a | 0.3 (0.2 to 0.4) |
| 5 | n/a | 0.4 (0.2 to 0.6) |
| 6d | 0.8 (0.5 to 1.1) | 1.1 (0.8 to 1.4) |
| 7 | 2.2 (1.8 to 2.7) | 2.6 (2.3 to 3.0) |
| 8 | 4.0 (3.0 to 5.0) | 3.8 (3.1 to 4.6) |
| 9 | 5.5 (4.4 to 6.6) | 5.1 (4.4 to 5.8) |
| 10 | 3.7 (3.1 to 4.4) | 3.3 (2.8 to 3.8) |
| 11 | 3.3 (2.8 to 3.8) | n/a |
| 12 | 2.4 (2.0 to 2.8) | n/a |
| Gender | ||
| Male | 45.9 (43.7 to 48.1) | 48.9 (47.3 to 50.5) |
| Female | 49.2 (46.8 to 51.5) | 45.5 (44.0 to 47.0) |
| Another gender | 1.4 (1.1 to 1.7) | 1.6 (1.4 to 1.9) |
| Prefer not to answer | 3.6 (3.1 to 4.0) | 4.0 (3.5 to 4.5) |
| Race/Ethnicity | ||
| Black | 10.5 (6.8 to 14.1) | 9.6 (6.9 to 12.2) |
| Hispanic | 22.5 (12.6 to 32.4) | 21.2 (15.3 to 27.1) |
| Asian | 4.6 (2.0 to 7.1) | 4.2 (2.1 to 6.3) |
| White | 46.2 (38.2 to 54.2) | 46.6 (39.9 to 53.3) |
| Another race/ethnicitye | 1.5 (0.9 to 2.2) | 3.1 (1.9 to 4.3) |
| Multiracialf | 14.6 (12.7 to 16.6) | 15.3 (13.7 to 17.0) |
| Year | ||
| 2022 | 55.0 (46.9 to 63.2) | 57.4 (50.0 to 64.8) |
| 2023 | 45.0 (36.8 to 53.1) | 42.6 (35.2 to 50.0) |
aSurvey questions for analysis asked of a two-thirds randomly selected sample of the full Monitoring the Future sample in 12th grade.
bSurvey questions for analysis asked of a five-sixths randomly selected sample of the full Monitoring the Future sample in 10th grade.
cIn 10th grade this response category for first nicotine vaping is “Grade 4 or below.”.
dIn 12th grade this response category for first nicotine vaping is “Grade 6 or below.”.
eIncludes American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and Middle Eastern.
fStudents who list two or more of the preceding race/ethnicity categories.
Table 1 also presents the prevalence of nicotine vaping in the past 12 months, disaggregated by grade when students first ever vaped nicotine. Ninth grade was the peak year when youth who had vaped nicotine in the past 12 months had first ever vaped. Specifically, 6% percent of all 12th-grade students had vaped in the past 12 months at the year of the survey and first ever vaped in ninth grade. This percentage decreases more the further the grade of initiation is from ninth grade. In 10th-grade 5% of all students had vaped nicotine in the past 12 months at the year of the survey and first began in grade 9, and this percentage decreases more the further away the grade of initiation is from ninth grade.
Figure 1 and Table 2 present changes in prevalence of past 12-month nicotine vaping from 2022 to 2023, disaggregated by grade when students first ever vaped nicotine. The results in Table 2 show that overall, past 12-month vaping significantly decreased from 24% to 19% from 2022 to 2023 in 12th grade, and from 28% to 15% in 10th grade. Figure 1 graphically depicts this decrease by the shorter, overall height of the 2023 column compared to the 2022 column in both grades.
Figure 1.
Prevalence of past 12-month nicotine vaping by grade when first vaped nicotine,10th and 12th-grade students in 2022 and 2023.
Table 2.
Prevalence of Past 12-Month Nicotine Vaping for 12th and 10th-Grade Students, by Year and Grade of Vaping Initiation
| Year | 2022 | 2023 |
|---|---|---|
| 12th-grade students | ||
| Vaped nicotine in 12th grade and first used it in any grade | 24.3 | 19.1** |
| (20.9 to 27.8) | (15.6 to 22.5) | |
| Vaped nicotine in 12th grade and first used it in ninth grade | 6.6 | 4.2** |
| (5.2 to 8.0) | (3.0 to 5.3) | |
| Vaped nicotine in 12th grade and first used it in grade other than ninth | 17.8 | 14.9 |
| (15.3 to 20.2) | (12.2 to 17.5) | |
| 10th-grade students | ||
| Vaped nicotine in 10th grade and first used it in any grade | 17.8 | 15.1* |
| (15.1 to 20.5) | (13.4 to 16.7) | |
| Vaped nicotine in 10th grade and first used it in seventh grade | 3.0 | 2.1* |
| (2.5 to 3.6) | (1.7 to 2.6) | |
| Vaped nicotine in 10th grade and first used it in grade other than seventh | 14.8 | 12.9 |
| (12.5 to 17.1) | (11.3 to 14.5) | |
*Prevalence significantly different from previous year, p < .05.
**Prevalence significantly different from previous year, p < .01.
Figure 1 and Table 2 show that the size of the decrease in past 12-month nicotine vaping from 2022 to 2023 differed by the grade when these students first ever vaped nicotine. Among 12th-grade students, the percentage who had vaped nicotine in the past 12 months and first ever vaped nicotine in grade 9 decreased by a relative 36%, from 6.6% to 4.2%, and this decrease was statistically significant (p < .01). The percentage of 12th graders who had vaped nicotine in the past 12 months and first ever vaped nicotine in any grade other than nine decreased by a relative 16%, from 17.8% to 14.9%, and this decrease was not statistically significant. Among 10th-grade students, the percentage who had vaped nicotine in the past 12 months and first ever vaped nicotine in grade 7 decreased by a relative 30%, from 3.0% to 2.1%, and this decrease was statistically significant (p < .05). The percentage who had vaped nicotine in the past 12 months and first ever vaped nicotine in any grade other than seven decreased by a relative 13%, from 14.8% to 12.9%, and this decrease was not statistically significant. These results are depicted in Figure 1 by stacked columns, which show that a substantial portion of the overall decrease in past 12-month nicotine vaping from 2022 to 2023 resulted from the decrease among 12th-grade students who had first ever vaped nicotine in grade 9 and among 10th-grade students who had first ever vaped nicotine in grade 7.
Table 3 presents results from multivariable regressions predicting past 12-month nicotine vaping among 12th-grade students. The first three models present bivariate associations of survey year with nicotine vaping in the past 12 months (model 1), nicotine vaping in the past 12 months and first ever vaped nicotine in ninth grade (model 2), and nicotine vaping in the past 12 months and first ever vaped nicotine in any grade other than ninth. The coefficient for the year 2023 was significantly smaller in model 2 as compared to model 3 (the difference of two unexponentiated coefficients was −0.283, with a 95% confidence interval from −0.558 to −0.007, p ≤ .05).
Table 3.
Past 12-Month Nicotine Vaping by Grade of Initiation, 12th Grade Students; Relative Risk Ratios and 95% Confidence Intervals in Parentheses
| Vaped nicotine in 12th grade and first vaped in any grade | Vaped nicotine in 12th grade and first vaped in ninth grade | Vaped nicotine in 12th grade and first vaped in grade other than ninth | Vaped nicotine in 12th grade and first vaped in any grade | Vaped nicotine in 12th grade and first vaped in ninth grade | Vaped nicotine in 12th grade and first vaped in grade other than ninth | |
|---|---|---|---|---|---|---|
| Model # | 1 | 2 | 3 | 4 | 5 | 6 |
| Year | ||||||
| 2023a,b | 0.78** (0.66 to 0.93) | 0.63** (0.48 to 0.83) | 0.84 (0.70 to 1.01) | 0.80** (0.69 to 0.92) | 0.65** (0.51 to 0.83) | 0.85 (0.73 to 1.01) |
| 2022 (reference) | ||||||
| Race/Ethnicity | ||||||
| Black | 0.40** (0.32 to 0.52) | 0.35** (0.18 to 0.67) | 0.42** (0.32 to 0.56) | |||
| Hispanic | 0.46** (0.32 to 0.65) | 0.39** (0.20 to 0.73) | 0.48** (0.35 to 0.65) | |||
| Asian | 0.36** (0.27 to 0.48) | 0.40** (0.19 to 0.81) | 0.34** (0.24 to 0.49) | |||
| White (reference) | ||||||
| Other | 1.01 (0.78 to 1.32) | 1.43 (0.70 to 2.91) | 0.86 (0.54 to 1.37) | |||
| Multiracial | 0.79** (0.69 to 0.90) | 0.64** (0.45 to 0.91) | 0.84* (0.73 to 0.97) | |||
| Sex | ||||||
| Male | 0.86** (0.75 to 0.97) | 0.90 (0.72 to 1.13) | 0.84** (0.73 to 0.96) | |||
| Female (reference) | ||||||
| Other | 1.12 (0.77 to 1.62) | 0.56 (0.19 to 1.67) | 1.32 (0.87 to 1.99) | |||
| Prefer not say | 0.76 (0.58 to 1.00) | 0.82 (0.44 to 1.54) | 0.75 (0.55 to 1.02) | |||
| Constant | 0.24** (0.21 to 0.28) | 0.07** (0.05 to 0.08) | 0.18** (0.15 to 0.20) | 0.35** (0.31 to 0.38) | 0.10** (0.08 to 0.12) | 0.25** (0.22 to 0.28) |
aCoefficient significantly differs across models 2 and 3, p ≤ .05 (tested with “seemingly unrelated estimation” algorithm).
bCoefficient significantly differs across models 5 and 6, p ≤ .05 (tested with “seemingly unrelated regression” algorithm).
*p ≤ .05; **p ≤ .01.
The table presents relative risk ratios, using generalized linear models with a binomial distribution and log link.
These relative risks in models 1 to 3 of Table 3 are the same as what can be calculated from the information in Table 2 (with slight differences due to rounding). These relative risks provide a baseline comparison point to measure change in the 2023 year coefficients when demographics are included in the multivariable models. Models 4 through 6 show that the 2023 year coefficients change minimally with the inclusion of controls for sex and race/ethnicity. Further, the differences in the 2023 year coefficient remain statistically significant in these full models (the difference of the two unexponentiated coefficients was −0.278, with a 95% confidence interval from −0.552 to −0.004, p ≤ .05). The demographic variables show that past 12-month nicotine vaping is lower for 12th graders who are Black, Hispanic, Asian, and Multiracial in comparison to those who are White. Nicotine vaping prevalence is also lower among male as compared to female 12th-grade students.
Table 4 presents results for 10th-grade students, with a model structure parallel to Table 3. Models 1 through 3 show that the decline in past 12-month nicotine vaping was statistically significant overall and among 10th-grade students who had vaped in the last 12 months and first ever vaped nicotine in seventh grade. The decline was not statistically significant among the group of 10th-grade students who vaped in the past 12 months and first ever vaped nicotine in grades other than seventh. The difference in the coefficients for the year 2023 coefficient in models 2 and 3 was in the same direction and of similar size as it had been in 12th grade but it was not statistically significant (in 10th grade the differences of the two unexponentiated coefficients were −0.208, with a 95% confidence interval of −0.496 to 0.079, p = .15). The inclusion of demographic controls in models 4 to 6 changed the year 2023 coefficients negligibly. In 10th grade past 12-month vaping was significantly lower among Black and Asian as compared to white students. It was also significantly lower among males as compared to females.
Table 4.
Past 12-Month Nicotine Vaping by Grade of Initiation, 10th-Grade Students
| Vaped nicotine in 10th grade and first used it in any grade | Vaped nicotine in 10th grade and first used it in seventh grade | Vaped nicotine in 10th grade and first used it in grade other than seventh | Vaped nicotine in 10th grade and first used it in any grade | Vaped nicotine in 10th grade and first used it in seventh grade | Vaped nicotine in 10th grade and first used it in grade other than seventh | |
|---|---|---|---|---|---|---|
| Model # | 1 | 2 | 3 | 4 | 5 | 6 |
| Year | ||||||
| 2023 | 0.85* (0.73 to 0.98) | 0.71* (0.54 to 0.93) | 0.87 (0.75 to 1.02) | 0.84* (0.73 to 0.97) | 0.70** (0.54 to 0.91) | 0.87 (0.75 to 1.02) |
| 2022 (reference) | ||||||
| Race/Ethnicity | ||||||
| Black | 0.72** (0.58 to 0.89) | 0.55* (0.32 to 0.95) | 0.75* (0.58 to 0.96) | |||
| Hispanic | 0.81 (0.57 to 1.17) | 0.76 (0.49 to 1.18) | 0.82 (0.56 to 1.19) | |||
| Asian | 0.40** (0.26 to 0.62) | 0.34** (0.17 to 0.7) | 0.41** (0.24 to 0.70) | |||
| White (reference) | ||||||
| Other | 0.79 (0.58 to 1.06) | 1.36 (0.79 to 2.36) | 0.68* (0.46 to 0.99) | |||
| Multiracial | 1.08 (0.92 to 1.26) | 1.29 (0.87 to 1.89) | 1.04 (0.88 to 1.22) | |||
| Sex | ||||||
| Male | 0.65** (0.56 to 0.75) | 0.57** (0.41 to 0.80) | 0.84** (0.73 to 0.96) | |||
| Female (reference) | ||||||
| Other | 0.92 (0.68 to 1.23) | 1.02 (0.50 to 2.06) | 0.90 (0.63 to 1.28) | |||
| Prefer not say | 1.12 (0.95 to 1.33) | 1.72* (1.08 to 2.73) | 1.01 (0.82 to 1.23) | |||
| Constant | 0.18** (0.15 to 0.21) | 0.03** (0.03 to 0.04) | 0.15** (0.13 to 0.17) | 0.23** (0.21 to 0.26) | 0.04** (0.03 to 0.05) | 0.20** (0.17 to 0.22) |
*p ≤ .05; **p ≤ .01.
The table presents relative risk ratios, using generalized linear models with a binomial distribution and log link.
Discussion
The prevalence of nicotine vaping among adolescents significantly decreased from 2022 to 2023. For 12th-grade students it declined a relative 20% in this one year, from 24.3% to 19.1%, and for 10th-grade students it declined a relative 16%, from 17.8% to 15.1%.
These declines are linked to processes set into place 3 years earlier. In 2020, ninth-grade students initiated nicotine vaping at record low levels, as the pandemic and the associated social response shut down school buildings and disrupted processes that recruit youth to vaping.12 These low levels of initiation continued to play a role in vaping prevalence years later. In 2023 when these students were in 12th grade the percentage who vaped nicotine in the past 12 months and first ever vaped in ninth grade was a striking 36% lower (p < .01) than it had been for 12th graders in 2022, whose ninth-grade experience was not disrupted by the pandemic. In contrast, from 2022 to 2023 no significant decline took place among 12th grade students who vaped nicotine in the past 12 months and first ever vaped in any grade other than ninth.
The results follow a similar pattern in 10th grade. In 2020, seventh-grade students initiated nicotine vaping at record low levels, which continued to play a role in vaping prevalence years later.12 In 2023 when these students were in 10th grade the percentage who had vaped nicotine in the past 12 months and first ever vaped nicotine in seventh grade was 29% lower (p < .05) than it had been for 10th graders in 2022, whose seventh-grade experience was not disrupted by the pandemic. In contrast, from 2022 to 2023 no significant decline took place among 10th-grade students who vaped nicotine in the past 12 months and first ever vaped in any grade other than seventh.
For policy, these findings caution against looking to contemporaneous policy for explanations of the large, 1-year decline in nicotine vaping from 2022 to 2023. It can be tempting to interpret the decline as a victory for current efforts to restrict adolescent access to vaping products,14–16 or current education/media campaigns that warn adolescents of the dangers of vaping.17–21 The findings of this study suggest, instead, that the 1-year vaping declines primarily result from declines in initiation that were set into place 3 years ago during the pandemic onset, more so than the immediate result of contemporaneous policy.
A corollary implication is that policies and programs to reduce adolescent nicotine vaping are not necessarily to blame if nicotine vaping increases in the next few years. In 2024 and 2025 youth cohorts will come of age who were not as severely disrupted by the pandemic in seventh and ninth grade, and these cohorts may accordingly not have the same downward pressure on prevalence stemming from lower levels of initiation in these grades. In general, national policies designed to restrict availability or reduce adolescent demand for adolescent vaping would not be expected to have large, dramatic effects in a single year. At least in the case of adolescent cigarette smoking, the seven-fold decline in its population prevalence took place over decades and resulted from slow yet gradual and cumulative decreases year after year.1
For both policy and research, the study findings contribute new evidence that forestalled nicotine vaping for 1 year may hold the potential to lower adolescents’ levels of substance use for years to come. This study makes two contributions along these lines. First, the study results suggest that seventh and ninth grades warrant special consideration for intervention efforts to reduce adolescent substance use. It was decreased initiation in these two grades—and just these two grades—that this study links to a lasting effect on the prevalence of adolescent nicotine vaping in this study. Furthermore, these findings show that the initiation decline in these grades continued to remain strong and influential on the prevalence of nicotine vaping at least 3 years after it took place. Second, this study is one of few to demonstrate that the long-term consequences of forestalled initiation have the potential to operate at the national level. These results can therefore motivate national expansion of programs and policies proven to disrupt substance use initiation, as well as to potentially consider national legislation intended to delay substance use among adolescents.
One limitation of this study is that the estimates of past 12-month nicotine vaping prevalence are a few percentage points lower than estimates reported in the project’s national reports.1 This discrepancy results because a small number of respondents who had vaped nicotine in the past 12 months did not provide data on the grade of first use, and were therefore excluded from this study’s analysis pool (but not from the analyses for the national reports). This risk of exclusion affected only students who had vaped nicotine in the last 12 months, and did not logically apply to those who did not, consequently lowering prevalence estimates in comparison to the national reports that did not have this exclusion criteria. The resulting, slight underestimation is expected to have little effect on the substantive conclusions of this study because it will theoretically cancel out in comparisons of estimates across years, which is the main focus of this study.
Another limitation is that the sample does not contain adolescents who have dropped out of school. We expect that inclusion of dropouts would not change the main study results or substantive conclusions because the findings replicate for 10th-grade students, who have very low levels of school dropout. In addition, if school dropout rates changed little between 2022 and 2023—and we have little reason to expect large changes—then any bias would cancel out in comparison of prevalence levels across the 2 years.
Conclusion
This study links declines in adolescent nicotine vaping from 2022 to 2023 to lower levels of initiation 3 years earlier. These results contribute national-level evidence that forestalled initiation of substance use for 1 year may have a lasting effect that continues to lower adolescents’ levels of use many years afterward.
Funding
This study funded by the National Institute of Drug Abuse, part of the National Institutes of Health, grant #DA001411 (Miech, P.I.).
Conflict of interest
The author reports no conflicts of interest.
Data Availability
Monitoring the Future data available for no charge at the National Addiction & HIV Data Archive Program, which is part of the Inter-University Consortium for Social and Political Research, housed in the Institute of Social Research at the University of Michigan. (links: https://www.icpsr.umich.edu/web/NAHDAP/series/35 & https://www.icpsr.umich.edu/web/NAHDAP/series/746).
Author Contributions
Richard Miech (Conceptualization [lead], Data curation [lead], Formal analysis [lead], Funding acquisition [lead], Investigation [lead], Methodology [lead], Project administration [lead], Resources [lead], Software [lead], Supervision [lead], Validation [lead], Visualization [lead], Writing—original draft [lead], Writing—review & editing [lead]).
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Monitoring the Future data available for no charge at the National Addiction & HIV Data Archive Program, which is part of the Inter-University Consortium for Social and Political Research, housed in the Institute of Social Research at the University of Michigan. (links: https://www.icpsr.umich.edu/web/NAHDAP/series/35 & https://www.icpsr.umich.edu/web/NAHDAP/series/746).