Trends in Use and Perceptions of Nicotine Vaping Among US Youth From 2017 to 2020

Importance: US adolescent nicotine vaping increased at a record pace from 2017 to 2019, prompting new national policies to reduce access to flavors of vaping products preferred by youth.

Objective: To estimate prevalence, perceived harm, and accessibility of nicotine vaping products among US adolescents from 2017 to 2020.

Design, Setting, And Participants: This survey study includes data from Monitoring the Future, which conducted annual, cross-sectional, school-based, nationally representative surveys from 2017 to 2020 of 10th- and 12th-grade students (results pooled grades, n = 94 320) about vaping and other topics.

Main Outcomes And Measures: Prevalence of self-reported nicotine vaping; vaping brand and flavor used most often; perceived risk of nicotine vaping; and perceived ease of getting vaping devices, nicotine solutions for vaping, and flavored solutions.

Results: In 2020, Monitoring the Future surveyed 8660 students in 10th and 12th grade, of whom 50.6% (95% CI, 47%-54%) were female, 13% (95% CI, 8%-21%) were non-Hispanic Black, 29% (95% CI, 21%-40%) were Hispanic, and 53% (95% CI, 42%-63%) were non-Hispanic White. Nicotine vaping prevalence in 2020 was 22% (95% CI, 19%-25%) for past 30-day use, 32% (95% CI, 28%-37%) for past 12-month use, and 41% (95% CI, 37%-46%) for lifetime use; these levels did not significantly change from 2019. Daily nicotine vaping (use on ≥20 days of the last 30 days) significantly declined from 9% (95% CI, 8%-10%) to 7% (95% CI, 6%-9%) over 2019 to 2020. JUUL brand prevalence in the past 30 days decreased from 20% (95% CI, 18%-22%) in 2019 to 13% (95% CI, 11%-15%) in 2020, while use of other brands increased. Among youth who vaped in the past 30 days in 2020, the most often used flavor was fruit at 59% (95% CI, 55%-63%), followed by mint at 27% (95% CI, 24%-30%) and menthol at 7% (95% CI, 5%-9%); significantly fewer reported easy access to vaping devices and nicotine solutions compared with 2019; and 80% (95% CI, 75%-84%) reported they could easily get a vaping flavor other than tobacco or menthol. Among all youth, perceived risk of both occasional and regular nicotine vaping increased from 2019 to 2020.

Conclusions And Relevance: Increasing US adolescent nicotine vaping trends from 2017 to 2019 halted in 2020, including a decline in daily vaping. Decreases in perceived accessibility of some vaping products, as well as increases in perceived risk of nicotine vaping, occurred from 2019 to 2020. Yet, adolescent nicotine vaping remains highly prevalent, flavors remain highly accessible, and declines in JUUL use were countered by increased use of other brands.