Is the COVID-19 Pandemic Slowing Down the Teen Vaping Epidemic?

Prior to the COVID-19 pandemic, Monitoring the Future (MTF), a national survey of teen substance use, reported that rates of electronic cigarette (e-cig) use among adolescents were steadily increasing (Miech et al., 2019; Willet et al., 2019). However, with the onset of the pandemic, rates of e-cig use seem to be stalling out. As of May 2020, over a third of underage e-cig users reported desisting use, while another third reported reducing the frequency of their use (Gaiha et al., 2020). Although mostly speculation, some emerging literature points to the COVID-19 as being an unintentional catalyst for this decrease in e-cig use among teens (Dumas et al., 2020; Gaiha et al., 2020)

Remote schooling and work have potentially blocked adolescent access to e-cigs, while simultaneously decreasing time spent unsupervised. Additionally, the nature of COVID-19 itself, as a respiratory virus, may have encouraged abstinence from smoking (Dumas et al., 2020; Gaiha et al., 2020). Compared to combustible cigarettes, e-cigs provide a relatively unobtrusive way to access nicotine and hide use from parents and teachers. As is the case with most forms of adolescent delinquency, unsupervised time during and after school may provide the greatest opportunity for e-cig use (Osgood et al., 1996; Osgood et al., 2004).

The design and look e-cigs allow them to be easily hidden from parents and teachers, while the presence of peers may encourage use (Osgood et al., 2004). Indeed, teens report frequent exposure to e-cigs during school hours and on school property, with nearly a third of middle schooler and half of high schoolers reporting exposure on school grounds and a third of high schoolers reporting exposure in school bathrooms or locker rooms (Alexander et al., 2021). Unsupervised time during and after school might then best opportunity to for teen e-cig use, both of which were greatly restricted once COVID-19 guidelines were put in place.

Strategies and guidelines meant to reduce the transmission of COVID-19, such as remote schooling and work, may have unintentionally altered adolescents’ e-cig use, primarily by constructing barriers to access.

Among youth who reported decreased or quitting use of e-cigs, approximately two-thirds reported that this change was due to either their parents being home and/or inability to get e-cig products (Gaiha et al., 2020). Adolescents who maintained their usual use also acknowledged the increased pandemic-related difficulties of accessing devices and pods (Gaiha et al., 2020).

Alongside barriers to access, COVID-19-related health concerns have led to decreased use of e-cigs (Gaiha et al., 2020). Prior to COVID-19, few e-cig users were aware of the harms of nicotine and e-cig use, with less than half of regular teen users aware of the presence of nicotine in their e-cig devices (Willet et al., 2019). However, during the pandemic, the most common reason for discontinuing use of e-cigs among adolescents was the concern that e-cigs “may weaken the lungs” (Gaiha et al., 2020), suggesting that the nature of COVID-19 and its effects on the respiratory system acted as a deterrent for continued e-cig use.

On the contrary, the COVID-19 pandemic may have increased the frequency of e-cig use for some adolescents, as was the case for alcohol and cannabis use (Dumas et al., 2020). Among underage e-cig users, slightly less than one-fifth of youth reported either increasing e-cig use or transitioning to other forms of nicotine delivery (Gaiha et al., 2020), primarily to ease boredom and/or self-medicate to mitigate stress. In a similar vein, other studies mirror this idea that adolescent users are particularly attentive to the rewarding aspects of e-cig use, especially the psychopharmacological effects of nicotine (Al-Hamdani et al. 2021).

Prior literature has already established that adolescent e-cig use has been linked to later use of other substances, including combustible cigarettes (Miech et al. 2019; Nicksic & Barnes, 2019). In conjunction with increased barriers to access e-cigs, adolescents may transition faster to other, more easily accessible, forms of nicotine delivery and other substance use.

While more research is needed to further understand the impact of the COVID-19 pandemic on adolescent substance use, as vaccinations increase, social restrictions decrease, and schools develop reopening plans, we question how reconnecting with peers will affect rates of adolescent e-cigarette use.

It is likely that any decreases in e-cig use that have occurred during the pandemic may be counteracted by increases once teens again have access to e-cigs, their substance using peers, and less adult supervision. However, it is also possible that increased health concerns will mitigate anticipated increases in use. Regardless, this current period, with limited social interaction and peer influence may be an opportune time for parents and health professionals to intervene and potentially reverse the pre-COVID increases in e-cig use over the past several years.

Blog Author:

Jessica Mongilio is a PhD candidate at Penn State University's Department of Sociology & Criminology. Her primary research interests include adolescent risk-taking, decision-making, and delinquency.





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