2022 survey shows youth e-cigarette epidemic remains a serious public health threat

Over 2.5 million teens use e-cigarettes with nearly half (46%) of high schoolers who vape doing so on a frequent basis putting a new generation at risk for a lifetime of nicotine addiction

Statement by Robin Koval, CEO and President of Truth Initiative

The results of the 2022 National Youth Tobacco Survey (NYTS) released today show that the youth e-cigarette epidemic remains a serious public health threat driven by the actions of the tobacco industry to flood the market with cheap, youth-appealing flavored e-cigarettes while keeping brands already popular among teens easily accessible on shelves across the country. The vast majority of these products have not received Food and Drug Administration (FDA) authorization, a requirement to legally enter the market. The industry is playing a dangerous game of “catch me if you can” with the FDA at the expense of young people’s physical and mental health.

In 2022, over 2.5 million middle and high school students reported current e-cigarette use, a higher number than in 2021. Among all youth who currently used e-cigarettes, 42.3% used them on 20 or more of the past 30 days, with nearly half (46%) of high schoolers who vape doing so near daily, putting them on a trajectory for a potential lifetime of nicotine addiction and at increased risk for addiction to other substances.

This troubling news comes at a time when the U.S. Surgeon General has issued a national advisory on the youth mental health crisis which can connect to vaping nicotine. Many young people are turning to e-cigarettes to relieve stress, a myth that the tobacco industry continues to perpetuate, when in fact the opposite is true. Years of scientific, peer-reviewed research shows nicotine can amplify feelings of anxiety and depression and increase stress. Nicotine is also harmful to developing brains and its use during adolescence can disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction.

Today’s announcement is disheartening but not surprising given the e-cigarette market overall is expected to have its best year yet with sales up 12% over last year. While sales data are not specific to youth, we know that youth prevalence of e-cigarette use is nearly four times that of adults, driven in large part by the broad availability and appeal of flavored products which are used by 84.9% of youth who vape, and the growing popularity of disposable products used by 55.3% of young e-cigarette users. Disposable products with flavors like “Cheesecake,” “Bubble Gum,” and “Strawberry Ice Cream,” now make up 35% of the market, which is likely a significant understatement as retail sales scanner data are having trouble keeping up with the influx of products. The number of new product bar codes has more than tripled in less than a year, from nearly 500 in June 2021 to almost 1,600 by March 2022. An expanding array of flavors using synthetic coolants are also hitting the market in flavors like “Banana Ice,” “Strawberry Freeze,” or “Frosted Apple,” adding to the number of menthol and other cooling e-cigarettes available, which now represent 56% of e-cigarette sales.

We are calling on FDA’s leadership to hit the reset button on the Premarket Tobacco Application (PMTA) process. The industry is gaming the system and the FDA needs to change its game plan as the application volume and flood of new products illegally on the market have become untenable. Simply put, ‘pre-market’ review is supposed to be conducted before any product is allowed on the market ⁠— not the ‘post-market’ process that is in actuality what we have today. All unauthorized e-cigarettes including flavors, menthol and disposables should be removed from the market immediately and no new product should be allowed on the shelf while FDA accelerates its pre-market review process to protect public health as the law intended and requires. It should prioritize the application reviews for tobacco derived and synthetic nicotine e-cigarette products that make up the majority of sales (65%) and are the most popular among youth.

Every day of delay allows for the continued proliferation of new, flavored e-cigarettes to hit the market and the top brands to remain readily accessible. These delays have major consequences: According to our Truth Longitudinal Cohort data, up to 2.5 million youth and young adults (aged 15-24 years) have started using e-cigarettes following the missed court-ordered FDA deadline of September 9, 2021, to review e-cigarette marketing applications. It also leaves smokers uncertain whether these products will truly help or are even safe to use.

In the meantime, bold actions taken by many states to remove flavored e-cigarettes and tobacco products from the market, and by public health organizations dedicated to ending youth tobacco use are having an impact and making progress, but we need more help to put an end to this epidemic that is putting a new generation at risk for nicotine addiction. Truth Initiative’s peer-reviewed research shows that strong awareness of the nationally acclaimed truth^® campaign, which offers a holistic suite of products and services to empower young people to live free from smoking, vaping, and nicotine addiction, is significantly associated with lower likelihood of vaping among 15- to 24-year-olds. Further research shows truth^® brand awareness is associated with lower odds of both current e-cigarette use and intention to vape in the future. Our evidence-based, first-of-its-kind, free quit vaping program This is Quitting, the largest in the country and the only one that has been validated by peer-reviewed research, is helping nearly 500,000 young people on their journeys to quit vaping. Our digitally delivered, peer-led school curriculum, Vaping: Know the truth, has reached over 460,000 students in almost 6,000 schools across the country. For more information on these programs visit truthinitiative.org.