Reasons for Vaping Among US Adolescents

Adolescent use of electronic nicotine delivery systems or e-cigarettes—known as vaping—is prevalent1 and of critical public health importance because of dependence risk2 and respiratory, neurologic, and cardiovascular problems.3 Vaping is marketed as a less harmful alternative to smoking combustible cigarettes. However, a large population of nicotine-naïve consumers, including adolescents, vape.4 In 2015, US adolescents in eighth, 10th, and 12th grades most frequently endorsed experimentation, taste, and boredom as reasons for vaping.4 Adolescents rarely endorsed cigarette cessation as a reason to vape.4 In the past decade, adolescent nicotine vaping has become a primary concern.1 Understanding why adolescents vape nicotine, specifically, is important for informing prevention and intervention. This study examined reasons for vaping nicotine among eighth-, 10th-, and 12th-grade US students, focusing on differences by vaping frequency and grade.Monitoring the Future data were collected from 2021 to 2023 using in-school web surveys,1 based on annual nationally representative samples of US eighth-, 10th-, and 12th- grade students. A University of Michigan institutional review board approved the study.Questions were asked of a randomly selected one-third of respondents (N = 28 522; average response rate 79%); 1890 (0.7%) were excluded because of missing data on vaping. Students were asked if they vaped nicotine in the past 12 months (yes/no) and how many days they vaped nicotine in the past 30 days (recoded as any/none, and near-daily 20+ occasions/not). Those who vaped (N = 5082) were asked about their most important reasons for vaping nicotine (selecting all that apply from a list of 13). Analysis weights accounted for Monitoring the Future’s complex sample design in prevalence and mean estimates and χ2 comparisons of group differences.Prevalence levels for near-daily vaping in the past 30 days were 1.7%, 4.2%, and 7.8% for eighth-, 10th-, and 12th-grade students, respectively (Table 1). Near-daily analyses were limited to 12th graders (N = 637) because of low prevalence in younger grades.Vaping nicotine to “relax” was the most commonly cited reason (Table 2), reported by 48.7% of those vaping in the past 12 months and 71.1% vaping near-daily. Second and third most commonly cited were “experiment” and “boredom” among those vaping in the past 12 months or 30 days; among those vaping near-daily, respective reasons were “boredom” and “hooked.” Across groups, “taste” was fourth. Among adolescents who vaped near-daily, roughly one-third endorsed “feel good” and “more convenient than cigarettes”; 8.9% endorsed “help quit cigarettes.” Mean number of reasons endorsed was higher (non-overlapping confidence intervals) for those reporting near-daily vaping (Supplemental Table 3).Eighth graders endorsed “boredom” and “feel good” significantly more than 10th or 12th graders and “taste,” “good time,” and “control weight” more than 12th graders (Supplemental Table 4). Twelfth graders endorsed “more convenient than cigarettes,” “hooked,” and “help quit cigarettes” more than eighth or 10th graders. Tenth graders endorsed “to avoid getting caught smoking” more than 12th graders.US adolescents who vaped nicotine endorsed a wide range of reasons for the behavior. Vaping to relax was the most commonly cited reason among all frequency groups; boredom was in the top 3 reasons for all use categories. Nearly half of adolescents who vaped nicotine in the past year or month (and >70% who vaped near-daily) reported doing so to relax or relieve tension. Screening for nicotine vaping alongside stress and anxiety may be an important tool for early intervention efforts because using to relax is associated with increased risk of future dependence.7This represents a shift in adolescent vaping reasons over the past decade. In 2015, relaxation was the fifth-most common reason (reported by 22% of adolescents who vaped, behind experimentation, taste, boredom, and fun with friends).4 However, available data in 2015 differed in that the prompt was vaping in general (not just nicotine) and the surveys included only 10 reasons (compared with 13 in the current analysis). Data limitations include using a nationally representative school-based sample; future research among those not in school is needed because dropout is associated with substance use.6Among adolescents who vaped near-daily, other reasons reported by more than 40% included boredom, being hooked, and taste. Vaping for smoking cessation was rare.8 Additional research is needed regarding vaping among adolescents for weight management,5 which was reported by nearly one-fifth of adolescents who vaped near-daily.The authors thank Shanna Elaine Rogan, MS, for analytic assistance.