Vaping could wreck decades of progress in teen smoking rates

Vaping could eliminate decades of progress in teen smoking rates: ©Fedorovacz - stock.adobe.com

Teens who regularly use e-cigarettes are just as likely to become cigarette smokers as their peers were in the 1970s, according to a new study co-led by researchers at the University of Michigan.

The findings, published in the journal Tobacco Control, come despite dramatic declines in overall teen cigarette use over the last five decades. The study, a collaboration between the University of Michigan, Penn State University, and Purdue University, reveals that teenagers who had never used e-cigarettes had less than a 1-in-50 chance of smoking cigarettes weekly. In contrast, those who had tried e-cigarettes faced more than a 1-in-10 chance, while consistent e-cigarette users had nearly a 1-in-3 chance of also reporting cigarette use.

"The use of e-cigarettes and the proliferation of e-cigarettes have really disrupted those awesome trends and improvements," said Jessica Mongilio, research fellow at the U-M School of Nursing and one of the study’s lead researchers. "For kids who have never used e-cigarettes, we do see those historic declines in risk. But for kids who do use e-cigarettes, it's almost as if all of those policies and all of those perceptions have done nothing, and they've got a really high risk of smoking cigarettes."

Researchers drew data from three U.K. longitudinal studies that tracked individuals from different birth cohorts. The Millennium Cohort Study (born 2000-2001) captured the first generation to grow up alongside commercial e-cigarettes. The British Cohort Study (born 1970) and the National Child Development Study (born 1958) offered insights into cigarette use across generations, including when smoking was culturally common and socially accepted.

"We took data from different cohorts, essentially different generations of people who live in the U.K., and looked at their probability of smoking cigarettes at least once a week, based on some well-known risk and protective factors," Mongilio said. "For the most recent cohort, we also examined how use of e-cigarettes changed those probabilities."

The study did not determine if e-cigarette use directly causes cigarette use, but researchers said the association between the two behaviors is clear. Ongoing surveys of the Millennium Cohort are expected to provide additional long-term insights.

"The more you can build evidence—the bigger the pile of support—the harder you can make it to ignore," Mongilio said. "This will lead toward policy changes and toward increased regulations for e-cigarettes and for producers of e-cigarettes. I think we're in a place where change is possible and to have increased regulations and enforcement of those regulations for companies that are producing e-cigarettes."

The study was funded by the National Cancer Institute, part of the National Institutes of Health, and supported by a seed grant from Penn State University’s Criminal Justice Research Center. Data collection was conducted by the Centre for Longitudinal Studies at University College London.

The medical and social consequences of vaping among youth

E-cigarettes were initially promoted as a harm-reduction alternative to conventional cigarettes. However, a growing body of research is uncovering troubling health effects associated with vaping, particularly in adolescents whose bodies and brains are still developing.

Medically, vaping has been linked to lung injuries, respiratory irritation, and nicotine addiction. One of the most serious health scares, EVALI (e-cigarette or vaping-associated lung injury), emerged in 2019 and resulted in hospitalizations and deaths, especially among users of THC-containing products. Though regulatory crackdowns reduced those incidents, concerns about chronic respiratory effects remain.

Nicotine exposure during adolescence can also disrupt brain development, affecting memory, attention, and impulse control. According to the CDC, youth who vape are more likely to become addicted to nicotine and are at increased risk of transitioning to other tobacco products—including combustible cigarettes.

Socially, vaping has gained traction through targeted marketing, sleek device designs, and appealing flavors like mango, mint, and cotton candy. These tactics have been especially effective among teenagers, despite federal efforts to curb flavored product sales. The 2023 National Youth Tobacco Survey found that more than 2 million U.S. middle and high school students used e-cigarettes, with many reporting daily use.

Public health advocates warn that these patterns threaten decades of progress in reducing youth smoking. With mounting evidence from studies like the University of Michigan’s, experts are calling for tighter regulation, better enforcement of age restrictions, and stronger public awareness campaigns.

The challenge now, researchers say, is to keep up with the rapidly evolving vaping industry while ensuring that health policies protect the next generation from nicotine addiction.