Why Aren’t We Celebrating the End of Teenage Smoking?

    When I was a teen in a small Midwestern town in the 1970s, the US high school smoking rate was over 25 percent. It was legal for 16-year-olds in many states to purchase tobacco products, and many high schools had designated smoking areas where both students and teachers took smoke breaks.

    Thankfully, by the turn of the millennium, high school smoking had dropped to about 20 percent. By 2011, high school smoking had dropped to 16 percent.

    Then, over the past decade, US high school smoking dropped a further 90 percent. “Current use” of combustible tobacco cigarettes is now 1.9 percent. But for teens, “current use” means even one puff in the past month. “Frequent use” (20 or more days per month) is now 0.38 percent. Essentially nil.

    We should all be dancing in the streets. Except we’re not. Because declines over the past decade coincide with the “e-cigarette era.”

    Most smokers start in their teens. And teens basically don’t smoke now. Let that sink in. As this age group ages, the age of smoking will be over. Today’s teens will not die horribly from smoking-related cancer, heart and lung disease. We should all be dancing in the streets.

    Except we’re not. Because declines over the past decade coincide with the “e-cigarette era.” Anyone glued to the media knows that US teen nicotine use from e-cigarettes has skyrocketed. So let’s take a closer look at that. I will use publicly available, easily obtainable data via the CDC National Youth Tobacco Survey (from 2001 to 2021) and NIH Monitoring the Future Survey (for the years prior to 2001). Spoiler: US teen nicotine vaping has gone up, down, up, and then way down.


    Teen Vaping

    US high school nicotine vaping began to creep up in 2012. By 2014, “current use” had reached 13.4 percent. It hit 16 percent by 2015.

    Then, for some reason, high school nicotine vaping dropped back down to 11.3 percent in 2016 and stayed relatively low in 2017 (11.7 percent). Ironically, the only significantly relevant thing that happened just prior to that drop was Juul’s profoundly naïve 2015 launch campaign.

    Teen vaping then began to rise again in 2018. “Current use” reached 20.8 percent and, in September 2018, the US FDA declared a “teen vaping epidemic.” High school nicotine vaping increased again in 2019, reaching 27.5 percent—something like the smoking rate had been in my teenage years. And that was the peak of the “epidemic.”

    It is important to note that these numbers are for teen “current use.” Even during 2019, teen daily use of e-cigarettes was only 5.7 percent. 

    It is strange that the FDA has not yet announced that the “epidemic” is over.

    Thankfully, US high school nicotine vaping then dropped 60 percent. Down 29 percent by 2020 (pre-pandemic), and then another 42 percent during the pandemic. By 2021, it was 11.3 percent. That percentage is, coincidentally, exactly where we were in 2016. It is lower than where we were in 2014 (13.4 percent), four years before the FDA declared an “epidemic.”

    So it is strange that the FDA has not yet announced that the “epidemic” is over. It is also strange that not one major US media outlet has emphasized this stunning 60 percent drop in just two years.

    It’s also worth noting that there are 12 million adult vapers in the United States as of 2021 (out of 255 million adults). Adult current use means what intuition would suggest: “daily” or “some days” (basically, “regular use,” suggesting you own an e-cigarette and buy products).

    Comparing that to teen “current use” is, of course, apples and oranges, because that’s “past 30-day ever-use.” US teen “current use” is now 2 million (out of 40 million middle and high school students). Teen frequent use (at least 20 days/month) may be closer in meaning to adult current use. These are the kids who may own an e-cigarette. That’s 0.8 million.

    By either measure, the number of adults who own and buy these gizmos (the market) is far higher than the number of teens who use them. (Adults in the United States, of course, far outnumber children.) Still, you’d never know any of this from US media stories about e-cigarettes. And by the way, about 40 percent of adult current users have quit smoking completely (4.8 million). Another 30 percent may be “on the journey to quit” through dual use. And another 30 percent (at least) have quit smoking with e-cigarettes and then quit vaping.

    To summarize: Teen nicotine use from deadly cigarettes is now near zero. And “current use” of e-cigarettes is 11.3 percent.  And most “current use” is infrequent experimentation. Daily use is 3.1 percent. 


    Where Are We Now?

    I am fully aware that everything you just read flies in the face of everything that the media has been telling you for several years now. I’m just not sure what to make of that. These are the facts. Fact-check me. The numbers are not difficult to extrapolate from NIH and CDC survey websites and CDC Morbidity and Mortality Weekly Reports (MMWR).

    Teens should not vape or smoke. But because so few US teens now smoke and there is some dual use, total current US teen nicotine use from both sources is now 11.7 percent. Remember: Just 10 years ago, 16 percent of them were smoking and none vaped. And that 16 percent was much lower than previous decades.

    The only thing that truly is way up is US adult moral panic over teen nicotine use.

    There is no escaping this simple fact: Total teen nicotine use from cigarettes and e-cigarettes is lower today than any time in the past 50 years. So “what’s up with teen nicotine use?” The short answer is nothing. It’s way down. Like so many hot button issues in America today, there is a profound disconnect between public perception and reality. The only thing that truly is way up is US adult moral panic over teen nicotine use.

    I believe this raises serious questions about the motivations of health “experts” who continue to insist that teen vaping is a gateway to smoking, that we’re in the midst of a teen vaping epidemic, and that a “whole new generation” is now “addicted to nicotine.” All of those claims bear an uncanny resemblance to 1930s Reefer Madness.



    Photograph by Rawpixel/Public Domain

    Both The Influence Foundation and INNCO, the organization led by the author, have received grants from the Foundation for a Smoke-Free World. The Influence Foundation has also received grants from Juul Labs, Inc. Filter‘s Editorial Independence Policy applies.

    • Dr. Charles A. Gardner has a PhD in developmental neurobiology from the University of Michigan. He has worked for the US Congress, the National Institutes of Health and as a senior advisor to the World Health Organization. From 1998 to 2003, Dr. Gardner served as the health attaché in the US Embassy New Delhi and senior representative of the US Department of Health and Human Services to South Asia. He has also taught healthcare ethics as an assistant professor at Howard University. Dr. Gardner has 10 years of experience in global health philanthropy as a program officer in the Rockefeller Foundation, Optimus Foundation and Foundation for a Smoke-Free World. He now serves as executive director of INNCO.

      INNCO is a global community of ex-smokers helping smokers quit, and defending the rights of 112 million People Who Use Safer Nicotine (PWUSN). We believe that current global efforts to deny 1.3 billion people—who use toxic forms of tobacco—access to safer nicotine alternatives is a form of mass murder. Safer alternatives include nicotine patches, nicotine gum, nicotine lozenges, prescription nicotine inhalers, nicotine pouches, nicotine vapes, snus and heated tobacco products. Almost all of us have lost a loved one to smoking. Almost all of us experienced health improvements after we quit smoking. This is neither a game nor a personal affectation. Access to harm reduction is a human right, a social justice imperative and a life-or-death issue. INNCO is a non-profit alliance of 35 independent volunteer-led Member Organizations around the world. We are funded by individual in-kind contributions and small donations from thousands of adult ex-smokers. INNCO’s Secretariat (but not our Member Organizations or Governing Board) is supported by a grant from the Foundation for a Smoke-Free World (FSFW), a US non-profit 501(c)(3) private foundation with a mission to end smoking in this generation. The FSFW is funded by a tobacco company. We are not comfortable with that. But we are transparent about it. INNCO is independent. We were founded in 2016, two years before FSFW came into existence. Our mission, purpose and goals are driven solely by our Members and Governing Board. Our Member Organizations are led by unpaid volunteers who, as a condition of membership, accept no funding from industry. In contrast, numerous organizations around the world oppose safer nicotine alternatives. Many, if not most, are funded by wealthy harm reduction deniers. None declare this as a conflict of interest. And that is a profound violation of public trust.

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