Drawing on data from the Population Assessment of Tobacco and Health Study, a large nationally representative survey of tobacco use in the United States, the researchers tracked adolescents ages 12 to 17 from 2014 through 2024. That wider lens captured the entire arc of the youth vaping era, from the initial rise of e-cigarettes through the explosive surge of 2018 and 2019 to the shifting patterns seen today. Importantly, the researchers did not count casual experimentation.

The study focused on what is called current established use, meaning participants had to report using the product regularly and within the past 30 days. That makes the figures a conservative estimate of the problem. From 2014 through 2018, vaping followed the historical pattern, with higher rates among boys and among older teens ages 15 to 17 compared with younger adolescents ages 12 to 14.

Then came the dramatic surge of 2018 and 2019, when rates climbed sharply among both sexes and the longstanding gender gap largely disappeared. Rates fell by 2021, but what happened next depended on who was looking at the numbers. Among younger adolescents ages 12 to 14, vaping rates stayed relatively low and fluctuated from year to year, with girls generally showing higher rates than boys after 2021, although vaping among girls declined in the most recent data.

Brownstein cautioned against reading that dip as evidence that the problem has faded. Even though the rate dropped from 2023 to 2024, she noted, it remains high, and there are still many middle school girls vaping. Among older teens ages 15 to 17, the shift was far more pronounced: regular vaping among girls climbed steadily from 4.9 percent in 2021 to 7.8 percent in 2024, approaching the peak seen during the 2018-2019 surge, while 4.6 percent of boys the same age were regular users in 2024.

Against those vaping trends, the decade of data also reveals a genuine public health triumph: traditional cigarette smoking among adolescents has collapsed. By the final wave of data, fewer than half of 1 percent of both boys and girls were established smokers. Toll described the decline as a massive public health win, and Sanford suggested that the changing patterns indicate vaping may be displacing at least some cigarette smoking among young people.

E-cigarettes do expose users to fewer known toxicants and carcinogens than combustible cigarettes, which is part of why they may help adults who smoke transition away from cigarettes. That does not make them harmless, particularly for adolescents who otherwise might never use nicotine. Because e-cigarettes are relatively new, their long-term health effects remain unknown, and for teenagers, regular vaping can establish nicotine addiction while the brain is still developing.

The devices also make patterns of use harder to measure. Unlike cigarettes, which have a natural stopping point, a single cartridge can deliver hundreds or thousands of puffs, allowing users to vape repeatedly throughout the day, and the devices are easy to conceal. Sanford described seeing that challenge firsthand with his patients: when asked how much they vape, many struggle to answer clearly because they cannot track individual sessions or how long a device lasts.

What the study cannot yet say is why girls are now vaping more. Because the analysis is observational, Brownstein emphasized that the researchers can only point to associations, not conclude that any single factor caused the increased use among girls. Still, she called the patterns fascinating and said there is far more work to delve into.

Sanford agreed that understanding what drives use is one of the most important next questions, asking whether there have been shifts in motivation, marketing, social influences or perceptions. Answering those questions could ultimately help researchers develop more targeted prevention messages and cessation programs tailored to the factors influencing use among girls and among young people more generally. The findings carry implications well beyond the research community.

Toll warned that some complacency has set in since the height of the JUUL crisis, and urged pediatricians, parents, coaches and others who regularly interact with teenagers to stay alert to youth vaping, especially among female patients. Sanford said the changing trends point to where attention and resources should go, in terms of prevention efforts, treatment development and public health policy. The message from the research team is clear: the youth vaping problem has not gone away, it has simply changed shape, and the alarm bells now ring loudest for girls without falling silent for boys.

Subject of Research: Gender trends in adolescent vaping and cigarette smoking in the United States

Article Title: Girls vaping at higher rates than boys, national study finds

Article References: Girls vaping at higher rates than boys, national study finds. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

DOI: Not provided

Keywords: youth vaping, adolescents, nicotine, e-cigarettes, JUUL, gender differences, JAMA Pediatrics, public health, MUSC Hollings Cancer Center, PATH Study, Girls, vaping