New Review Misleads on Youth Vaping and Public Health

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Key Points:

• Alarmist Review: New Cureus paper revives the “youth vaping epidemic” narrative despite data showing sharp declines since 2019.

• Data Misuse: Authors conflate e-cigarette use with “any tobacco product” and ignore that youth vaping dropped 61.5 percent from 2019 to 2024.

• Key Omission: Most youth vape for stress or anxiety (43.4 percent), not flavors (13.2 percent), per CDC survey.

• Flawed Science: Relies on cherry-picked, cross-sectional studies that can’t prove causation and overlooks confounding factors.

• Evidence Ignored: Large reviews and RCTs show e-cigs are more effective than nicotine replacement therapy and improve health outcomes versus smoking.

• Policy Risk: Misleading claims could justify unnecessary restrictions and undermine harm reduction for 20M U.S. adult vapers.

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Another alarmist article is once again pushing the long-debunked “youth vaping epidemic” narrative. Published in Cureus (part of Springer Nature) on August 5, the authors’ bias is evident from the title alone: “Electronic Cigarette Use (Vaping) Among Adolescents: A Narrative Review of an Emerging Public Health Epidemic.”

The paper claims to be a narrative review examining the “rising” public health concerns related to youth vaping, including its prevalence, health risks, and regulatory responses. In reality, this so-called “review” is a smorgasbord of debunked falsehoods about tobacco harm reduction products.

The authors begin by summarizing the history of vaping, then shift to a discussion of the “epidemiology of vaping,” claiming that 10 percent of U.S. high school students used any tobacco product in 2024. They follow this with an overview of FDA regulations, briefly touching on milestones such as the 2016 Deeming Rule and recent U.S. Supreme Court decisions on e-cigarette regulation. From there, the authors return to the motivations behind youth vaping, asserting that adolescents use e-cigarettes for the same reasons previous generations smoked cigarettes – primarily social factors. They go on to list other reasons, including curiosity, appealing flavors and aromas, perceived health benefits, attempts to quit traditional smoking, and the influence of family members who vape. Cost, availability, and discreet design are also cited as contributing factors.

The paper then delves into the toxicology of e-cigarettes, warning of potential effects on respiratory, cardiovascular, and neurological health. The authors claim there is insufficient data on the short- or long-term effects of the more than 7,000 unique e-liquid flavors available. They also reference the 2019 outbreak of vaping-related lung injuries, despite the now well-established fact that those cases were linked to illicit THC products, not regulated nicotine vapes. The authors further assert that there is “well-documented” evidence of nicotine’s impact on the developing brain.

They go on to claim that nicotine in e-cigarettes, particularly disposable products, is more addictive than combustible cigarettes, and that vaping is strongly associated with other substance use. While the paper does briefly acknowledge that e-cigarettes have been considered as tools for smoking cessation, the authors selectively cite one study claiming no difference in quit rates between vaping and traditional nicotine replacement therapy.

The conclusion of the paper reiterates that youth e-cigarette use has been on the rise for two decades and argues that the lack of regulation justifies more aggressive FDA intervention. Predictably, the authors end with a call to "learn from the history of the tobacco industry," a trope that conveniently ignores the millions of adult smokers who have successfully quit with the help of vaping.

Policymakers should be skeptical. This is yet another attempt to revive a discredited narrative, ignoring meaningful regulatory progress and scientific nuance. Contrary to the authors’ claims, youth vaping is not increasing. It has, in fact, declined dramatically since its peak in 2019. That year, 20 percent of high schoolers reported current e-cigarette use. By 2024, that figure had fallen to just 5.9 percent – a 61.5 percent decrease in five years. Moreover, conflating e-cigarette use with “any tobacco product” misrepresents the data and exaggerates youth risk. In 2023, 7.7 percent of adults used e-cigarettes, a higher rate than among high school students. Even the FDA’s own Brian King, former director of the Center for Tobacco Products, stated in 2023 that the agency had stopped using the word “epidemic,” noting that “the science has shown a decline in the number of youth users.”

The paper also fails to address the real reasons young people vape. According to the 2021 National Youth Tobacco Survey, the most common reason cited by current youth vapers was stress, anxiety, or depression, reported by 43.4 percent of respondents. Only 13.2 percent cited flavors. If the goal is to reduce youth vaping, public health officials would do well to focus on mental health, not misleading narratives.

The review’s toxicological discussion is vague at best. The authors rely heavily on cherry-picked, cross-sectional, self-reported surveys that fail to account for confounding variables such as dual or former smoking. These types of studies are incapable of establishing causation and offer little useful insight.

More rigorous research contradicts the alarmism. In 2018, the National Academies of Sciences, Engineering, and Medicine found “no available evidence” linking e-cigarette use to clinical cardiovascular outcomes. A 2019 study in Internal and Emergency Medicine found that cardiovascular events were significantly lower among vapers than among cigarette smokers. Most people who switch from smoking to vaping report better health outcomes.

The paper also completely ignores a substantial body of peer-reviewed evidence showing that e-cigarettes are more effective than traditional NRT in helping smokers quit. A 2019 randomized controlled trial found that e-cigarettes were twice as effective as NRT. A 2024 Cochrane Review concluded there is “high-certainty evidence” that nicotine-containing e-cigarettes increase quit rates by 60 percent compared to NRT.

Policymakers should be wary of reviews that claim to identify a youth vaping epidemic. Papers like this one not only mislead regulators and institutions, they also dismiss the lived experience of over 20 million American adults who were using e-cigarettes in 2023 – many of them successfully staying off cigarettes. If public health is truly the goal, fearmongering narratives like this one must be replaced with honest, evidence-based discussion.

Nothing in this analysis is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101.