Trends in Daily Nicotine Vaping and Unsuccessful Quit Attempts in Youths

Importance: US youths who vape nicotine may be hardening into a more nicotine-dependent, treatment-resistant population over time, as evidenced by shifts toward daily vaping and difficulty quitting, which may vary by behavioral health and demographic factors. Objective: To assess prevalence trends from 2020 to 2024 in (1) current (past 30 days) nicotine vaping, (2) daily vaping among youths who currently vape nicotine, and (3) unsuccessful quit attempts among youths who vape nicotine daily and to examine variation in these trends by behavioral health and demographic factors. Design, Setting, and Participants: This cross-sectional study used data from Monitoring the Future (MTF), a nationally representative annual cross-sectional survey of 8th, 10th, and 12th grade respondents in US middle and high schools, from survey years 2020 to 2024. Exposures: Survey year; grade in school; population density of school location; and self-reported sex, race and ethnicity, depressive symptoms, conduct problems, and past-30-day use of nicotine vaping, other tobacco products, cannabis, and alcohol. Main Outcomes and Measures: Prevalence of (1) past-30-day nicotine vaping (≥1 vs 0 days) among all respondents, (2) past-30-day daily vaping among currently vaping youths (vaped all 30 vs 1-29 days), and (3) unsuccessful attempts to quit vaping (yes, no) among youths vaping daily, with weights applied to generate nationally representative estimates. Results: In the pooled sample of 115 191 MTF respondents (50.8% 95% CI, 50.0%-51.6% male), prevalence of past-30-day nicotine vaping declined from 2020 to 2024 (risk ratio RR, 0.88; 95% CI, 0.86-0.89). Among youths who currently vaped (n = 15 226), prevalence of daily vaping rose from 15.4% (95% CI, 13.1%-18.0%) in 2020 to 28.8% (95% CI, 26.6%-31.0%) in 2024 (RR, 1.14; 95% CI, 1.11-1.18). Among daily vapers (n = 3512), prevalence of unsuccessful quit attempts increased from 28.2% (95% CI, 19.5%-38.8%) in 2020 to 53.0% (95% CI, 45.9%-60.0%) in 2024 (RR, 1.08; 95% CI, 1.02-1.15). For female, non-Hispanic Black, cannabis-using, and tobacco-using youths, past-30-day nicotine vaping prevalence either remained stable or reduced more slowly during 2020 to 2024 compared with the overall study population (eg, from 10.4% 95% CI, 8.6%-12.5% to 4.1% 95% CI, 3.5%-4.8% in those without vs 58.1% 95% CI, 51.9%-64.1% to 57.3% 95% CI, 54.0%-60.5% in those with past-30-day cannabis use). Among current vapers, daily vaping increased more rapidly in rural youths (from 16.4% 95% CI, 11.5%-22.9% to 41.8% 95% CI, 35.3%-48.5%) than in urban youths (15.9% 95% CI, 12.7%-19.6% to 18.1% 95% CI, 14.8%-21.9%). Conclusions and Relevance: The findings of this cross-sectional study of US youths suggest that although the prevalence of current nicotine vaping declined during 2020 to 2024, the youth vaping population may have hardened over this period, evidenced by increasing daily use, more unsuccessful quit attempts, and shifting demographic profiles. Clinicians and policy makers should be mindful that youths with frequent vaping increasingly face unique challenges that may impact treatment and prevention efforts.