Three quarters of teens who vape report using nicotine, marijuana, or multiple substances

A new study in the American Journal of Preventive Medicine provides data that highlight disturbing trends in teen e-cigarette use

Ann Arbor, December 16, 2019

More teens who vape are using addictive or mind-altering substances than previously believed,according to a new study in the American Journal of Preventive Medicine, published by Elsevier. The data paint a different picture than previous research because of the significantly higher proportion (75 percent) of teens who vape using nicotine, marijuana, or multiple substances and not just flavoring. These findings add to growing public health concerns about youth vaping.

“Our study provided a more nuanced view of youth e-cigarette use behaviors than earlier studies. We found that youth were more likely to report vaping nicotine and marijuana than ‘just flavoring’ only, and that cigarette smoking intensity was associated with an increasing proportion of students reporting vaping nicotine only,” explained co-investigator Hongying Dai, PhD, Associate Professor, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.

This study examined patterns of youth vaping nicotine, marijuana, and just flavoring in the past 30 days by analyzing data from the 2017 Monitoring the Future (MTF) cross-sectional study. Of the 14,560 teens participating in that study, 12 percent reported vaping within the prior 30 days, with 7.4 percent using nicotine and 3.6 percent, marijuana. Of that group, only 24.9 percent reported vaping just flavoring only, while a majority (75.1 percent) reported vaping nicotine, marijuana, or multiple substances.

Current cigarette smoking intensity was associated with an increased risk of reporting vaping of all three substances. Compared with 8th graders, more 10th and 12th grade students reported vaping nicotine, marijuana and just flavoring during the study period. Female students were less likely to report vaping these three substances than male students. Fewer non-Hispanic blacks reported vaping nicotine and just flavoring than non-Hispanic whites. Hispanics were also less likely to report vaping nicotine.

The prevalence of e-cigarette use among US youth increased dramatically during 2017-2019, partly due to the rising popularity of products with nicotine salt and pod-based products like JUUL, and a large number of flavors appealing to adolescents. The nationwide increases in use led the US Surgeon General to issue an advisory about the epidemic in 2018, but much more needs to be done to reverse the upward trend. Due to the recent spate of vaping-related lung injuries, calls for restrictions on flavored vaping products and e-cigarette use have become more urgent. Identifying substances vaped by youth is critical to formulating, implementing, and evaluating population-wide strategies and interventions to curb youth use of these products.

“Continuous surveillance of youth behaviors and strategies and interventions to reduce youth e-cigarette use are needed. The truth is that no form of tobacco is safe,” added co-investigator Mohammad Siahpush, PhD, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.


Notes for editors
The article is “Use of E-cigarettes for Nicotine, Marijuana, and Just Flavoring Among U.S. Youth,” by Hongying Dai, PhD, and Mohammad Siahpush, PhD ( It will appear in the American Journal of Preventive Medicine, volume 58, issue 2 (February 2020) published by Elsevier.

This research was supported by grant number [R03CA228909] from the National Cancer Institute and FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or Journalists wishing to interview the authors should contact Hongying Dai at

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers.

Media contact
Jillian B. Morgan, MPH, Managing Editor
+1 734 936 1590