Public Health

More needs to be done to decrease youth access to e-cigarettes

Sara Berg, MS , News Editor

For the 10th year in a row, e-cigarettes have been the most commonly used tobacco product among middle and high school students. In 2023, about 2.8 million middle- and high-school students in the U.S. used at least one tobacco product. This is alarming because tobacco use during adolescence increases the risk of lifelong nicotine addiction and adverse health outcomes.

And while e-cigarette use among high-school students has dropped and efforts to implement tobacco-control strategies have ramped up, use among adolescents remains disturbingly high. The use of e-cigarettes among adolescents is a critical public health concern that must be addressed.

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The National Tobacco Survey reports that 2.13 million students use e-cigarettes. That includes 4.6% of middle-school and 10% of high-school students who report the use of e-cigarettes. And among students who had ever used an e-cigarette, 46.7% reported current use, 25.2% used e-cigarettes daily, and 89.4% used flavored e-cigarettes, according to a Council on Science and Public Health report adopted at the 2024 AMA Annual Meeting in Chicago.

Additionally, 60% of students reported using disposable e-cigarettes, which is the most-used device type among adolescents. Prefilled and refillable pods or cartridges and open tank and mod systems were used less frequently.

But disposable e-cigarettes went through a dramatic change between 2017 and 2022. E-cigarettes quintupled in volume capacity, nearly tripled in average nicotine strength and fell in average per-milliliter price of e-liquid by nearly 70%, says the report.

Some of the commonly reported motivations for e-cigarette use among adolescents include curiosity, appealing flavors such as fruit and candy, family and peer influence, and stress reduction. Other reasons include social acceptability, convenient and customizable features, a variety of flavors and a lack of awareness about the presence of nicotine, says the report.

Additionally, adolescents who used e-cigarettes also exhibited lower perceptions of harm and more positive attitudes compared with non-users. For example, students who used e-cigarettes were more likely to think these devices were healthier and less addictive than tobacco cigarettes. Over half believed e-cigarettes were not addictive, says the report.

Learn more from the AMA about e-cigarettes and the public health epidemic of vaping.

“E-cigarette use among our young people continues to be a significant threat to their health and well-being and threatens to get a new generation hooked on nicotine. We will continue to push for more stringent policies to keep e-cigarettes out of the hands of young people to protect their health and well-being,” said AMA Trustee Sandra Adamson Fryhofer, MD.

To address this, the AMA House of Delegates adopted policy to support “the inclusion of all forms of e-cigarettes (e.g., disposable, refillable cartridge and tank-based e-cigarettes) in the language and implementation of relevant nicotine-based policies and regulations by the Food and Drug Administration or other regulatory agencies.”

Delegates also modified existing policy on tobacco product sales and distribution to “support measures that decrease the geographic density of tobacco retail stores, including but not limited to, preventing retailers from selling tobacco products in stores in close proximity to schools.”

Read about the other highlights from the 2024 AMA Annual Meeting.