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Researchers say there’s been an increase in the number of high school and middle school students who vape. They also believe vaping is leading some students to start smoking cigarettes, too. Getty Images
  • Researchers report that 21 percent of high school and middle school students in the United States vape e-cigarettes.
  • That compares with 8 percent of teens who smoke regular cigarettes.
  • Experts express concerns that students who vape are also more likely to start using tobacco.
  • They add that the long-term health effects of vaping are still not known.

More high school and middle school students in the United States vape e-cigarettes than smoke regular cigarettes.

And it’s not even close.

A study published today reveals that 21 percent of U.S. students used e-cigarettes in the month before they were questioned, while only 8 percent of students said they smoked cigarettes.

The study also reported that fewer adolescents are current tobacco smokers, and those who do smoke do so less intensely and less frequently.

However, the report stated that more students are using e-cigarettes, and a significant percentage of youth both smoke and vape.

Researchers at the University of Utah, who analyzed 8 years of data on 11,123 middle school and high school students, found that teens who smoke are starting later, are smoking fewer cigarettes per day, and also smoking fewer cigarettes per month.

The percentage of tobacco-using teens classified as “light smokers” — smoking five or fewer cigarettes daily — rose to about 80 percent of all students and 88 percent of female students.

However, while heavy smoking declined sharply among adolescent females between 2011 and 2018, it increased significantly among male students.

“Cigarette use is decreasing, but not decreasing for everyone,” Jessica L. King, PhD, senior study author and an assistant professor at the University of Utah, told Healthline.

Matthew Triplette, MD, MPH, medical director of the Lung Cancer Early Detection and Prevention Program at the Seattle Cancer Care Alliance in Washington, told Healthline that while switching from heavy smoking to light smoking can reduce cancer risk, “light smoking has pretty much the same cardiovascular risk as heavy smoking.”

King and her colleagues urge more smoking prevention efforts targeted specifically at young men.

“Reversing this trend needs to deal with the reason they started smoking in the first place, which I suspect is vaping,” Alvin V. Singh, MD, pediatric pulmonologist at Children’s Mercy Hospital in Kansas City, Missouri, told Healthline. “Most studies report that vaping increases teens’ odds of smoking by three to four times.”

Overall, an estimated 1.2 million high school students smoked in 2018.

The study by King and colleagues found that current smoking rates decreased among male, female, high school-aged, white, and non-Hispanic students.

The study found e-cigarette use increasing between 2014 and 2018. In addition, 12 percent of current smokers also vape, notes Kiefer.

“This finding suggests that some youth might be reducing cigarette use in favor of e-cigarettes while still continuing to smoke,” the study reported.

“Although there is some evidence that e-cigarettes contain fewer toxicants than combustible cigarettes, they still contain nicotine, ultra-fine particles, chemicals, organic compounds, and heavy metals that can lead to serious health consequences, such as e-cigarette or vaping product use associated lung injury and cancer,” according to the study.

Vaping has been associated with at least 2,500 cases of e-cigarette or vaping product use-associated lung injury (EVALI), says Triplette.

Most EVALI cases have involved vaping products containing THC, the psychoactive ingredient in cannabis, according to the Centers for Disease Control and Prevention (CDC).

Nonetheless, the CDC advises “refraining from use of all e-cigarette, or vaping, products.”

“Vaping carries the short-term risk of lung injury, and we really don’t know the long-term health effects of nicotine delivery in this way,” Triplette said.

Experts agree that rather than being a less harmful substitute for smoking, vaping may be a precursor to tobacco use.

Vaping “represents the normalization of smoking for a generation where the majority does not smoke cigarettes because we’ve talked so much about the health risks of smoking,” Triplette added.

“Most teens start vaping and then go into smoking, keep vaping, or find other substances,” Singh said. “Vaping may be a substitution for smoking in an adult who wants to quit, but numerous studies have found that there is an increased risk of smoking in teenagers who vape first.”

“We haven’t really seen a lot of older smokers switching to vaping,” Triplette noted. “What we are seeing is a continuing trend of never-smokers using these e-cigarette devices.”