Teenagers' use of e-cigarettes drops by 1/3 following 'T-21' law, but many now use disposable e-cigs, which the law didn't cover

Puff Bars are disposable electronic cigarettes meant for one-time use. Survey shows use of  disposables
by youth has surged since last year. Other brands include Blu, Posh and Stig. (Photo: The Truth Initiative)

By Melissa Patrick
Kentucky Health News

The number of U.S. teenagers who use electronic cigarettes has declined by one-third, according to the latest national poll on their use of tobacco products.

The poll followed passage of a federal law raising to 21 the legal age to buy tobacco products, including e-cigarettes, but not one-use, disposable e-cigs that have quickly become popular. Kentucky and other states passed similar "T-21" laws. The poll report did not give state figures for youths' e-cig use.

As e-cigarette makers' youth market is shrinking, they are making them easier to inhale than traditional cigarettes, and continuing to offer flavors that appeal to youth, the U.S. Centers for Disease Control and Prevention reports. It notes that most e-cigs contain nicotine, which is highly addictive, can harm the adolescent brain and can increase risk for future addiction to other drugs. 

The 2020 National Youth Tobacco Survey found that 19.6 percent, or nearly one in five, high-school students and 4.7% of middle-school students said they currently used e-cigarettes or some other vaping product. That's down from a record high of 27.5% of high-school students and 10.5% percent of middle-school students in last year's survey. 

The percentages translate to 3.6 million U.S. youth currently using e-cigarettes, down one-third from the 5.4 million estimated from the 2019 survey.

"This is good news," Stephen Hahn, commissioner of the Food and Drug Administration, said in a statement. "However, the FDA remains very concerned about the 3.6 million U.S. youth who currently use e-cigarettes, and we acknowledge there is work that still needs to be done to curb youth use." 

Of great concern is an alarming uptick in young people's use of one-time-use, disposable e-cigarettes. The 2020 survey shows disposables being used by 26.5% of high-school e-cigarette users, up from only 2.4% in 2019. Among middle-school students who vape, the use of disposables rose from 3% in 2019 to 15.2% in 2020.

That said, the most commonly used type of device used by teenagers continues to be pre-filled pods or cartridges, such as Juul. They are used by 48.5% of high-school and 41.3% of middle-school vapers. 

The survey also found that most teens continue to prefer flavored products. The poll found that 83% who vape use flavored products, with fruit, mint, menthol and candy among the most common. This is the first year the poll has distinguished between mint and menthol flavors.

“As long as any flavored e-cigarettes are left on the market, kids will get their hands on them, and we will not solve this crisis,” Matt Myers of the Campaign for Tobacco Free Kids and other advocates said in a joint statement.

Menthol products and disposables are popular for a common reason: They were exempted from the new federal laws that regulate most flavored e-cigarettes.

The poll also shows that the percentage of youth who vape frequently has grown every year since 2015, the Tobacco Free Kids statement noted.

The poll found that 39% of high-school students and 20% of middle-school students who use e-cigarettes said they use them more than 20 days a month. It also found that 22.5% of high-school students and 9.4% of middle school students reported daily use. 

"The message is clear," the Campaign for Tobacco Free Kids said. "Unless we reverse that trend quickly and decisively, we are condemning this generation of youth to a long-term addiction."

The FDA report did not give figures for states. According to the 2019 Youth Risk Behavior Surveillance System, which has the latest Kentucky data available, 26.1% of high schoolers in the state said they currently used e-cigarettes, meaning they vaped at least one day in the month prior to the survey. That was up from 14.1% in 2017. The survey found that 11.1% of them vaped on 20 or more days prior to the survey, up from 2.7% in 2017; and 8.7% of them vaped daily, up from 1.9% in 2017,  

The 2019 survey found that 17.3% of Kentucky's middle-school students used e-cigarettes or similar products, up from 3.9% in 2017; 2% of them vaped on 20 or more days prior to the survey, up from 0.3% in 2017; and 1.2% of them vaped daily, up from 0.1% in 2017. 

The national survey was released on the same day all U.S. vaping manufacturers were required to submit their products for FDA review to keep their products on the market. Among other things, the FDA will assess if a company's products show they can help addicted smokers who are trying to quit, while also weighing their popularity among young people. 

The Tobacco Free Kids statement said it looks at this as another opportunity for the FDA "to get this right and eliminate all flavored e-cigarettes." 

The CDC report calls for the comprehensive implementation of evidence-based strategies at the national, state and local levels, in coordination with FDA regulation, to prevent and reduce youth use of tobacco products. Such strategies include strong public health media campaigns, price increases and comprehensive smoke-free policies.