Brad Davidson, PhD

A RECENT UPDATE from the National Youth Tobacco Survey shows that youth e-cigarette use, including among middle and high school students, dropped to a new low in 2024. Only 5.9% of youths now report using e-cigarettes, down from 7.7% in 2023 and extending a steady decline from a peak of nearly 20% in 2019. This year’s drop is due primarily to a decrease in e-cigarette use by high school students, from 10% in 2023 to 7.8% in 2024.

This momentum is years in the making, with the American Association for Cancer Research (AACR) being a steadfast leader in the fight against e-cigarette use in young people. In 2015 and 2022, the AACR and the American Society of Clinical Oncology (ASCO) worked in partnership to publish policy statements outlining clear proposals that could be enacted by federal and state governments to curb the youth e-cigarette epidemic. These actionable recommendations have served as a framework for steps taken to stem the proliferation of e-cigarettes and other electronic nicotine delivery systems.

Increasing taxes on traditional combustible cigarettes has been a highly effective tobacco control strategy, and the first AACR-ASCO statement on youth and e-cigarettes recommended taxing e-cigarettes as well. To date, 32 states, the District of Columbia and multiple U.S. territories have enacted these policies. E-cigarette use was once allowed in indoor public spaces in all 50 states; 19 states now ban their use in locations where cigarette smoking is outlawed. Other AACR-ASCO proposed initiatives include flavored tobacco bans passed by various cities and states. This is especially critical because nearly 90% of youth e-cigarette users report using flavored products.

Looking to the future, a Food and Drug Administration (FDA) and Department of Justice-led task force was created in June 2024 to prevent the sale of illegal e-cigarettes that have not been authorized by the FDA. To date, only 34 e-cigarette products have been authorized, rendering the current sale of thousands of e-cigarette products illegal. The FDA recently intensified efforts to discourage the sale of these illegal products by issuing warning letters to online and brick-and-mortar retailers, litigating against manufacturers, and seizing unauthorized products. In September 2024, the FDA also released a final rule to prohibit the placement of tobacco product vending machines in areas where people under 21 years of age may be present. Both developments are key steps toward implementing policies endorsed by the AACR and ASCO that will drive down e-cigarette use.

Unfortunately, barring further actions, signs remain that the e-cigarette epidemic will persist. Of middle and high schoolers who currently use e-cigarettes, nearly 40% report frequent use—a strong indicator of addiction. In addition, youths who started using e-cigarettes during the boom in popularity in the late 2010s have continued to vape. According to data from the FDA/National Institutes of Health Population Assessment of Tobacco and Health Study, daily vape usage and established usage among young adults ages 18 to 24 steadily increased between 2013 and 2021, peaking at over 8% for daily usage and 14% for established usage, with subsequent data points yet to be released.

Sustained pressure is needed to continue the push for lower use of e-cigarettes and other tobacco products across all age groups. The AACR will continue to advocate for cutting-edge tobacco research and evidence-based tobacco control policies to reduce tobacco-related cancers and deaths. Important areas for future action include sweeping bans on all flavored tobacco products, more widespread taxes on all e-cigarette products, stronger warning labels and greater enforcement against illegally sold products. To read the most recent AACR-ASCO e-cigarette policy statement, please visit AACR.org/ENDS.

BRAD DAVIDSON, PhD, is a regulatory science and policy analyst for the American Association for Cancer Research (AACR).