Study warns teen girls now vape more than teen boys

By Stephen Beech

Girls are vaping more than boys, reveals a new study.

But researchers found that cigarette use among both school-age boys and girls has plummeted with less than one in 200 today "established" cigarette smokers.

The findings reveal a reversal of long-standing gender trends with boys and men having been more likely than their female peers to use nicotine for several decades.

The new study of adolescents shows that the long-term pattern has reversed amid "alarmingly high rates" of vaping.

Girls have been vaping at higher rates than boys since 2021 - with the gap becoming particularly pronounced among older teenagers, according to the American study.

The findings, published in JAMA Pediatrics, are the first analysis of how smoking and vaping patterns have changed by age and gender across a full decade since the rapid rise of e-cigarettes in the late 2010s.

Researchers say the figures should serve as a warning that the youth vaping problem has not gone away.

Benjamin Toll, director of the Medical University of South Carolina (MUSC) health tobacco treatment program, said: "We have to understand why, and we need to mobilize our public health efforts.

"We need both prevention and intervention for these young people who are vaping at alarmingly high rates."

The study is the first to examine smoking and vaping trends by age and gender across a full decade, from 2014 to 2024.

The wider view allowed researchers to follow the evolution of youth vaping – from historically higher rates among boys, through the dramatic surge in use in 2018 and 2019 to the more recent emergence of higher rates among girls.

MUSC researchers analyzed data from the Population Assessment of Tobacco and Health Study (PATH), a nationally representative study of tobacco use in the US.

The analysis included adolescents ages 12 to 17 and the 2014 to 2024 data.

The study focused on "current established" smoking and vaping – meaning they were not adolescents who had simply tried a cigarette or e-cigarette at some point.

Participants had to report having used the product regularly and within the past 30 days.

Study lead author Brandon Sanford said: "That makes this a pretty conservative estimate of use.

"These aren't youth who simply tried vaping once or twice.

"We're talking about adolescents who are regularly using e-cigarettes now."

Historically, nicotine use has been more common among men.

The research team found that pattern had held for vaping from 2014 to 2018.

Vaping was also consistently more common among older teens ages 15 to 17 than 12- to 14-year-olds.

A dramatic surge in youth vaping came in 2018 and 2019, when rates climbed sharply among both boys and girls, and the longstanding gender gap largely disappeared.

Researchers say the surge coincided with the growing popularity of a new generation of e-cigarettes, including products such as JUUL, which used nicotine salts and came in small, pod-based devices that made vaping more appealing, easier to use and more discreet.

More from this section

Can you really be addicted to food? Researchers are uncovering convincing similarities to drug addiction

The science and politics behind the panic over ultraprocessed foods

Study warns teen girls now vape more than teen boys

Sanford said rates then dropped by 2021 – but what came next differed by age and gender.

Among younger adolescents ages 12 to 14, vaping rates remained relatively low and fluctuated from year to year.

Girls generally had higher rates than boys after 2021, although vaping among girls declined in the latest data.

Study co-first author Naomi Brownstein, a biostatistician at MUSC, cautioned against viewing the recent decline as evidence that the problem has disappeared.

She said: "Even though the rate dropped from 2023 to 2024, it's still high.

"There are still a lot of middle school girls vaping."

Among older teens ages 15 to 17, Brownstein said the shift was much more pronounced.

Regular vaping among girls consistently climbed from 4.9% in 2021 to 7.8% in 2024, approaching the peak seen during the 2018-2019 youth vaping surge.

By comparison, 4.6% of boys the same age were regular users in 2024.

The researchers stressed that vaping among boys remains a public health concern as well.

Toll said: "We have to sound the alarm bells for girls.

"But we also need to make sure that we're addressing the boys, too."

The decade-long data also revealed traditional cigarette smoking among adolescents has fallen dramatically.

Fewer than 0.5% of both boys and girls were established smokers by the final wave of data.

Toll described the decline in cigarette smoking as a "massive public health win."

Sanford added that the changing patterns suggest that vaping may be displacing at least some cigarette smoking among young people.

He said e-cigarettes expose users to fewer known toxicants and carcinogens than combustible cigarettes, which is part of why they may play a role in helping adults who smoke to transition away from cigarettes.

But that doesn't make them harmless, particularly for young people who otherwise might not use nicotine.

Because e-cigarettes are relatively new, researchers don't yet know their long-term health effects.

Sanford said, for adolescents, regular vaping can lead to nicotine addiction at a time when the brain is still developing.

When asked how much they vape, he says many teens struggle to give a clear answer because they can't keep track of individual vaping sessions or how long a device lasts.

Because the study was observational, Brownstein emphasized that the researchers can only point to associations - not conclude that any one factor caused the increase among girls.

She said: "There are certainly factors associated with these rates we're seeing that are quite fascinating.

"There's a lot more work that we could delve into."

Sanford added: "I think it says a lot about where we ought to be putting our resources in terms of prevention efforts, treatment development and public health policy."