To the Editor:
The rapid increase in adolescents’ use of electronic cigarettes (known as vaping) during the past decade has aroused public health concern,1 recently heightened by potential links between vaping and acute lung injury.2 Adolescents who vape use a device such as an e-cigarette to inhale a heated aerosol that typically contains nicotine. We assessed whether adolescents’ vaping of nicotine continued to increase from 2018 to 2019, after the previous year’s record increase, the largest for any substance tracked by Monitoring the Future over the past 44 years.1
Monitoring the Future surveys nationally representative samples of 12th-, 10th-, and 8th-grade students annually.3 The project surveyed 43,703 respondents in 2017, 44,482 in 2018, and 42,531 in 2019. Overall response rates for these 3 years were 80% in 12th grade, 86% in 10th grade, and 88% in 8th grade, with most nonresponses due to students’ absence. Analyses are based on responses from participants who received questions on nicotine vaping (a randomly selected subset, one third of the total sample for that year). (Additional details on methods are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.)
Table 1 shows significant increases in 30-day nicotine vaping in samples at each of the three grade levels from 2018 to 2019. As a result of these (and previously reported1) annual increases, vaping prevalence more than doubled in each of the three grades from 2017 to 2019. In 2019, the prevalence of use during the previous 30 days was more than 1 in 4 students in the 12th grade, more than 1 in 5 in the 10th grade, and more than 1 in 11 in the 8th grade. Students who had vaped nicotine during the previous 12 months and those who had ever vaped nicotine also significantly increased in each grade from 2018 to 2019.
Table 1.
Prevalence of Nicotine Vaping among Adolescents, 2017–2019.*
| Reporting Interval and Grade in School | Prevalence in 2017 (95% CI) |
Prevalence in 2018 (95% CI) |
Prevalence in 2019 (95% CI) |
Change, 2018 to 2019 (95% CI)† |
|---|---|---|---|---|
| Past 30 days | ||||
| 12th grade | 11.0 (9.2–13.0) | 20.9 (17.7–24.5) | 25.4 (22.6–28.4) | 4.5 (0.9–8.1) |
| 10th grade | 8.2 (6.6–10.2) | 16.1 (14.0–18.6) | 20.2 (17.8–22.8) | 4.1 (0.9–7.2) |
| 8th grade | 3.5 (2.9–4.2) | 6.1 (5.1–7.4) | 9.0 (7.6–10.5) | 2.8 (1.2–4.4) |
| Past 12 months | ||||
| 12th grade | 18.8 (16.5–21.4) | 29.7 (26.1–33.6) | 35.1 (31.8–38.6) | 5.4 (1.1–9.6) |
| 10th grade | 15.8 (13.6–18.3) | 24.7 (21.9–27.7) | 31.1 (28.3–34.0) | 6.4 (2.7–10.1) |
| 8th grade | 7.5 (6.6–8.5) | 10.9 (9.4–12.6) | 16.1 (14.1–18.2) | 5.2 (2.8–7.6) |
| Ever | ||||
| 12th grade | 25.0 (22.4–27.7) | 34.0 (30.3–38.0) | 40.5 (37.3–43.8) | 6.5 (2.3–10.7) |
| 10th grade | 21.4 (19.2–23.9) | 28.6 (25.8–31.6) | 36.4 (33.5–39.4) | 7.7 (4.0–11.5) |
| 8th grade | 10.6 (9.5–11.8) | 13.5 (11.8–15.3) | 20.7 (18.5–23.1) | 7.2 (4.6–9.9) |
| Daily‡ | ||||
| 12th grade | — | — | 11.7 (9.8–14.0) | — |
| 10th grade | — | — | 6.9 (5.7–8.0) | — |
| 8th grade | — | — | 1.9 (1.4–2.5) | — |
In all years, increases in prevalence are significant at P<0.05. The 95% confidence intervals (CI) have not been adjusted for multiple comparisons. Unweighted sample sizes vary slightly by outcome. In 12th grade, the range is from 4077 to 4310; in 10th grade, from 4420 to 4721; and in 8th grade, from 4382 to 4909. (For trends in cigarette smoking during the previous 30 days in 2018–2019, see the Supplementary Appendix.)
Values may differ slightly from the difference between the 2019 and 2018 estimates because of rounding.
Daily nicotine vaping was defined as vaping nicotine on 20 or more of the previous 30 days and was first assessed in 2019.
Table 1 also shows the prevalence of daily nicotine vaping, which was defined as nicotine vaping on at least 20 days during the previous 30 days. These levels were 12%, 7%, and 2% in 12th, 10th, and 8th grade, respectively.
Current efforts by the vaping industry, government agencies, and schools have thus far proved insufficient to stop the rapid spread of nicotine vaping among adolescents. Of particular concern are the accompanying increases in the proportions of youth who are physically addicted to nicotine, an addiction that is very difficult to overcome once established. The substantial levels of daily vaping suggest the development of nicotine addiction. New efforts are needed to protect youth from using nicotine during adolescence, when the developing brain is particularly susceptible to permanent changes from nicotine use4 and when almost all nicotine addiction is established.5
Supplementary Material
Acknowledgments
Supported by the National Institute on Drug Abuse, National Institutes of Health (grant R01-DA-001411, to Dr. Miech).
Footnotes
References
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