2017 to 2019 Rapid Increase in Nicotine Vaping Among American Teens Slows in 2020

electronic cigarette
electronic cigarette
The researchers analyzed data from the annual cross-sectional nationally representative surveys that the Monitoring the Future study conducted of 10th- and 12th-grade students about vaping.

The record increases in nicotine vaping among high school students in the United States that occurred from 2017 through 2019 stopped in 2020 as past 30-day, past 12-month, and lifetime nicotine vaping held steady and daily nicotine use declined, according to a study that was recently published in JAMA Pediatrics.

The researchers conducted statistical analysis, including 2 sensitivity analyses, of data that Monitoring the Future’s (MTF) nationally representative, cross-sectional surveys of 10th and 12th graders collected between February and June of 2017 to 2020. Some questions only appeared on a randomly selected subsample of questionnaires. The data collection in 2020 stopped on March 14, 2020, because of the COVID-19 pandemic, but MTF still collected 8660 surveys from students enrolled in 74 schools compared with the 2017 through 2019 typical average of 28,649 students from 246 schools.

Descriptive analyses indicate that the data collected in 2020 did not differ from nationally representative results from previous years in terms of sociodemographic and drug use data, the researchers said. In each year, from 2017 through 2020, 51% of the participants were female, 51% to 53% were non-Hispanic White, 26% to 29% were Hispanic, and 46% to 49% had a mother with a college degree.

Data on levels of substance use in 2020 were also highly consistent across the years: 37% to 38% for lifetime marijuana use, 5% to 6% for lifetime hallucinogen use, 50% to 53% for lifetime alcohol use, and 29% to 32% for “ever got drunk.” The first sensitivity analysis restricts data from all years to surveys collected on or before March 14, 2020, while the other tests relative influence of the 12th and 10th-grade samples on the results. The researchers said sensitivity analyses indicated that prevalence levels were similar among those calculated with the full samples and that results were similar among 12th- and 10th-grade students.

Daily JUUL use (use on at least 20 days in the last 30 days) dropped from 6% in 2019 to 2% in 2020 and past-30-day use dropped from 20% in 2019 to 13% in 2020. Use in the past 12 years also dropped from 2019 to 2020, from 29% to 21%.

JUUL use dropped from 59% in 2019 to 41% in 2020 for a relative decrease of 43%, however the percentage of students who used another brand besides those listed in the response categories increased from 11% in 2019 to 28% in 2020. SMOK brand prevalence decreased from 21% in 2019 to 13% in 2020, while the “other” write-in, “Puff Bar” (a disposable brand that comes in several flavors), became the third most prevalent brand of nicotine vaping among the youth surveyed.

Accessibility of vaping products also declined in 2020 as the percentage of students who reported they had vaped in the past 30 days and said it would be “fairly easy” or “very easy” to obtain a vaping device decreased from 92% in 2019 to 83% in 2020, and 80% said they could easily obtain nicotine solutions besides tobacco or menthol flavor.

The most popular flavor of vaped nicotine among past-30-day users was a fruit flavor (59.3% (95% CI, 55.2%-63.3%) and the second most popular was mint (26.9% (95% CI, 23.8%-30.3%)).

More students (27%) reported in 2020 that they perceived great harm from occasional nicotine vaping than had in 2019 (21%), as was the case for regular nicotine vaping perceived risk (49% in 2020 compared with 39% in 2019).

Limitations of the study included that the MTF sample does not include individuals who dropped out of high school.

The researchers said increased perceived risk of nicotine vaping and decreased accessibility of vaping products may have contributed to the leveling of 2017-2019 increases in adolescent nicotine vaping in 2020. They noted that JUUL Labs had announced its decision to stop selling all flavors besides tobacco and menthol because its other flavors were the ones adolescents preferred.


Miech R, Leventhal A, Johnston L, et al. Trends in use and perceptions of nicotine vaping among US youth from 2017 to 2020. JAMA Pediatrics. Published online December 15, 2020. doi:10.1001/jamapediatrics.2020.5667