Surge in Adult Vaping Underlines Our Harm Reduction Priorities

    While youth vaping continues to dominate news headlines, adults who use vapes have been sidelined. Unfortunately, the Centers for Disease Control and Prevention (CDC) has been less than transparent when providing data on adult vaping in the United States. But recently, the agency did provide updated numbers, and these indicate that adult nicotine vaping is fast increasing.

    The good newsthe news that should dominate headlinesis that increases in adult vaping correlate with significant decreases in smoking.

    In 2021, according to data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) survey, 16.1 million adults, or 6.7 percent of US adults 18 years or older, were currently using vapor products (defined as having used in the past 30 days). This is a 32.6 percent increase from 2017, when 4.6 percent of US adults were current vapers. In terms of absolute numbers, approximately 4.6 million more adults were using vapes in 2021 than in 2017. 

    These figures provide valuable insight into the harm reduction path taken by growing numbers of the forgotten adults who smoke.

    Nearly half of the adults (46.4 percent) who were vaping in 2021 were between 25 and 44 years of age, the largest contingent. This proportion has increased by 6.8 percent since 2017, when 42.6 percent of adult vapers were in this age range.

    These figures provide valuable insight into the harm reduction path taken by growing numbers of the forgotten adults who smoke. Public health agencies should be educating and encouraging adults to switch. Unfortunately, US public health does a poor job in conveying relative risks.

    Although the CDC’s BRFSS does ask respondents whether they previously smoked, or currently do, the agency does not provide that critical information in a concise and accessible manner. But we know from research on other populations that a majority of vapers formerly smoked. In the United Kingdom, for example, an estimated 4.7 million adults vape; of these, 56 percent used to smoke and 37 percent currently smoke, indicating they may be on a journey to switching entirely or smoking less. Under 7 percent never smoked.

    Despite the political, media and public health rhetoric, vapes, like other tobacco harm reduction products, are far less harmful than combustible cigarettes. They have also been shown to be effective for both smoking cessation and continued abstinence from cigarettes.

    The UK Royal College of Physicians, for example, found that any harms from vapes are “unlikely to exceed 5 percent of the harms from smoking.” This is the same public health body that reported, in 1962, that combustible cigarettes cause cancer—two years before a US surgeon general’s report came to the same conclusions. Earlier this year, the UK government announced a national plan to help one million adults who smoke switch to vapes by giving out free vapor products.

    Yet, in the US, access to vapes is increasingly threatened. Five states—California, Massachusetts, New Jersey, New York, and Rhode Island—have banned sales of the flavored vaping products that most adults who switch find helpful. 

    These bans correlate with increases in young adult smoking rates. In fact, between 2020 and 2021, three out of the four states that then had active flavor bans saw increases in smoking rates among people aged 18-24. In the same period, smoking rates among young adults nationwide decreased, on average, by 19.7 percent.

    Alarmingly, US public health agencies and anti-harm reduction nonprofits continue to spew misinformation and hamper progress.

    Nicotine vapes are substitutes for combustible cigarettes. Their wider use could not only benefit the disadvantaged populations that disproportionately smoke, but help governments by reducing health care costs attributable to smoking.

    According to the CDC, approximately 23.9 percent of Medicaid enrollees were currently smoking in 2021, compared to only 10.5 percent of insured adults. One study found that in 2012, Medicaid savings could have amounted to $48 billion if every Medicaid recipient who smoked combustible cigarettes had switched to vapes.

    By failing to fully embrace vapes, governments are also missing out on substantial tax revenues. Even as things stand, vapes have been an economic boon to the US.

    In 2021, retail vapor establishments (i.e., vape shops) contributed more than $8 billion in economic output and generated more than $4.7 billion in taxes. In 2021, according to the CDC’s National Youth Tobacco Survey, only 9 percent of US middle and high school students who were currently vaping reported using a tank/mod open vapor product system. These are the types of devices commonly found in vape shops.

    Alarmingly, despite the many benefits of vape uptake, public health agencies and anti-harm reduction nonprofits continue to spew misinformation and hamper progress.

    To date, the US Food and Drug Administration has authorized the sale of a mere handful of vaping products as “appropriate for the protection of public health.” All the authorized products are available only in tobacco flavors, in the face of reams of science showing that adults rely on flavors to quit combustible cigarettes and remain smoke-free.

    Smoking-related harms to adults should massively outweigh the far more marginal and contested harms of youth vaping among our priorities.

    A 2018 survey of nearly 70,000 adult vapers (95 percent of whom reported ever smoking) found that 83.2 percent and 72.3 percent reported vaping fruit and dessert flavors, respectively. A 2020 cohort study of nearly 18,000 adult vapers found a greater likelihood of quitting smoking among vapers who had used non-tobacco flavors compared to those who vaped tobacco flavors.

    Unfortunately, the CDC’s BRFSS does not track the types of devices adults are using. Further, the CDC seems to be adding to alarmism on disposable vapes, with recent research claiming that these devices are “youth appealing.” This research only looks at data from retail scanner data. Yet, many (if not most) brick-and-mortar vape shops are not included in that data, and many adults report using disposables as a low-barrier option, particularly in the early stages of switching.

    Vapes and other novel tobacco harm reduction products have revolutionized smoking cessation efforts among adults in the US. Smoking-related harms to adultscosting over 480,000 lives each year in the US—should massively outweigh the far more marginal and contested harms of youth vaping among our priorities. It is long overdue for US public health and policymakers to recognize these realities and embrace safer alternatives to cigarettes.



    Photograph via Vaping360/Flickr/Creative Commons 2.0

    • Lindsey is a senior fellow at the Taxpayers Protection Alliance, author of TPA’s Adult & Youth E-Cigarette Use 50 State Analysis, and a tobacco harm reduction advocate. She lives in Florida.

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