Adolescent Perceptions and Use of E-Cigarettes as Smoking Cessation Tools and for Pleasure: Data Analysis from National Youth Tobacco Survey (NYTS), 2011, 2015, 2019, and 2023

Once marketed as smoking cessation tools, e-cigarettes are used by adolescents mainly for entertainment, driven by aggressive marketing, appealing flavors, and safer alternatives to smoking. This study analyzes data from the National Youth Tobacco Survey (NYTS) to explore trends in adolescent perceptions and usage patterns of e-cigarettes from 2011 to 2023, focusing on their dual roles as cessation aids and recreational products. Cross-sectional data from the NYTS over four years (2011: N = 18,866; 2015: N = 17,711; 2019: N = 19,018; 2023: N = 22,069) formed the foundation of this study. This study investigated demographic trends, usage frequency, initial and future use patterns, and quitting behavior. Descriptive statistics and latent class analysis (LCA) were employed to examine adolescent e-cigarette use patterns, with statistical significance determined at p < 0.05. The reasons for using e-cigarettes have changed significantly over the years because of family or friends. In all years (2015–2023), use for smoking cessation dropped significantly (2.33% in 2023 vs. 6.95% in 2015). In 2023, 38% wanted to quit using e-cigarettes within 30 days, and 25% attempted to quit at least 10 times. Flavored e-cigarette users were more than twice as likely to consider quitting compared to those not interested in flavors (OR = 2.64). Our findings highlight a significant decrease in the use of e-cigarettes for cessation, with a corresponding increase in recreational use over time. These trends emphasize the urgency of implementing interventions to mitigate nicotine addiction and its associated health risks among adolescents. Adolescent e-cigarette use has transitioned from being primarily driven by cessation efforts to recreational purposes, largely influenced by appealing flavors and social factors such as peer influence, showing the need for stricter marketing regulations and targeted educational campaigns.