A decade of e-cigarettes: trends and determinants among U.S. middle and high school students (2013-2022)

To analyze the 10-year trend (2013-2022) in e-cigarette use among U.S. middle and high school students, identify reasons for use across demographic subgroups, and explore factors associated with ever using e-cigarettes.

Cross sectional data from the National Youth Tobacco Survey (NYTS) from 2013 to 2022 were used to study e-cigarette use trends among middle and high school students. Descriptive, multivariable logistic regression, and joinpoint models analyzed factors associated with ever using e-cigarettes. Statistical analyses were conducted using SAS and Python, with a significance level of p < 0.05 taking into account weighting/ complex sampling.

E-cigarette use among students peaked in 2019 and then declined from 2020 to 2022. Usage was highest among Non-Hispanic White and Hispanic students, and lowest among Asian students. In 2022, females comprised over half of students who ever used e-cigarettes (53%). The main reasons for using e-cigarettes included influence from friends/family, appealing flavors, and the ability to use e-cigarettes discreetly. Males, Non-Hispanic Whites, high school students, and those with a history of cigarette use had higher odds of ever using e-cigarettes in the US from 2013 to 2022. Joinpoint regression revealed a significant increase in use among males from 2014 to 2019 and among females from 2015 to 2019 (p < 0.05). Similarly, a significant upward trend was observed after 2014, with the AAPC ranging from approximately 183% in White students to 330% in Asian students.

Our findings indicate that between 2013 and 2019, adolescents in the U.S. experienced a significant upward trend in e-cigarette use. Non-Hispanic White adolescents were the predominant adolescents who use e-cigarettes, followed by Hispanic adolescents. The study suggests this trend could be driven by peer influence and product flavors. However, in 2022, females represented over half of adolescents who had ever used e-cigarettes, indicating a shift in use patterns over time. These results underscore the importance of policy interventions to address e-cigarette use among youth in this population.