Fact Sheet: Arguments against "Youth Epidemic" Claims

From my GFN presentation in a panel titled "Debunking the Science Used to Support Prohibition"

Artwork by Pawel Bugucki

The following is a written version of one of my presentations at the annual Global Forum on Nicotine (GFN) 2026. The theme of this conference was prohibition and this session was titled “Debunking the Science Used to Support Prohibition.” Ian Fearon organized the session and asked the 4 speakers (Ian, Konstantinos Farsalinos, and Libby Clarke) to debunk 2 claims each which are used to justify restrictive policies and provide a useable list of facts and references.

My two claims were “youth epidemic” (the subject of this post) and “gateway to smoking / addiction” (which I’ll link to once that’s up).

The Claim

The “youth epidemic” claims are about making youth use of e-cigarettes and nicotine pouches seem like, well, an epidemic. These claims often involve the following types of spin:

• Presenting numbers without context (e.g. worrying about 5.2% of youth vaping but ignoring that youth smoking used to be much higher);

• Switching between percentages and total numbers (e.g., “2 million youth who vape”), whichever sounds worse; and/or

• In the US, continuing to cite the 2019 data point (20% of youth vaped in the past month according to NYTS) without acknowledging the >70% decline since then.

Here are some notable examples of what I’m talking about (all drawn from the THR Community Notes account on Twitter/X which flags misinformation about nicotine products):

Next, I will cover 5 rebuttal arguments.

1. Youth vaping has declined in some countries after an initial peak and is accompanied by a decline in smoking.

I will focus mainly on the US because that’s where a big part of the “youth vaping” concerns originated (and then spread globally). Youth vaping was common in 2019, peaking at 20% of middle and high school students who vaped in the past month (Wang et al., 2019) according to the CDC/FDA survey, the National Youth Tobacco Survey (NYTS).

Source: Altria’s analysis of NYTS 2011-2025 data.

But following the 2019 peak, youth vaping declined by >70%, to 5.2% who vaped in the past month in 2025 (Park-Lee et al., 2026). Youth vaping is now about as low as youth smoking was when public health seemed to stop caring about it (5-6% in 2015) to focus on vaping instead.

Youth use of any nicotine product shows similar trends: it peaked in 2019 (because of the peak in e-cigarette use) and has declined by about two-thirds since then.

Of course, the category of “any nicotine product” is not especially informative because it groups together products with very different risk profiles. The biggest change with respect to long-term health risks is that youth uptake of e-cigarettes was accompanied by large declines in cigarette smoking, the most lethal form of nicotine. Youth cigarette smoking is now 1.4% in the US.

Similar trends have occurred in other countries, including Canada and New Zealand: youth e-cigarette use increased up to a point, sometimes causing a temporary peak in the use of any nicotine product, but then declined. There are also exceptions, however; most notably, the UK where the increase in vaping is currently larger than the decline in smoking among youth. In almost all cases, however, the uptake of vaping was accompanied by a concomitant decline in cigarette smoking.

Overall, claims of a “vaping epidemic” are based on looking at the rise in vaping in isolation, without acknowledging either the concomitant declines in smoking or the declines in vaping after an initial peak.

2. Youth vaping is similar or less common to what youth smoking was 20-30 years ago.

The above point is about ignoring more recent declines (e.g., after 2019 in the US, which I still see in academic papers in 2026). This point is about ignoring older data points, especially from before e-cigarettes were invented.

Here are the long-term trends of youth cigarette smoking prevalence from the nationally-representative youth survey Monitoring the Future, going back to 1975:

Source: Monitoring the Future tables and figures. Colors show different grades: brown = 12th grade; green = 10th grade; blue = 8th grade.

Youth past-month cigarette smoking peaked around 1997 at 28.3% overall (average over 8th, 10th, and 12th grades). Just after the Master Settlement Agreement, this was 22.6% overall in 2000 and declined to 12.8% in 2010, just before the rise in e-cigarette use. This shows that tobacco control policies, including educating people about the harms of smoking (or maybe this was the only effect; see Carl V Phillips, PhD and Red Is Not A Colour’s 2022 paper), were having an effect on reducing youth smoking; however, these traditional policies have diminishing returns over time (see Fagerström et al. 2025) so this decline was flattening out leading up to 2010.

What this means to me is that, even with fairly strong tobacco control policies and good education, ~10-15% of adolescents continued to smoke cigarettes. It may have continued to decline somewhat if the status quo continued, but a lower bound might be 10% of youth smoking cigarettes despite most of the reasonable precautions having already been in place for many years. Youth vaping is now half of that. Youth smoking is much lower, too, but only after there was another nicotine product they could use.

If critics acknowledge the decline in smoking at all, they often frame vaping as opposing that progress or undermining those declines in smoking. However, this is flawed because treating a 1 percentage point increase in vaping as offsetting a 1 percentage point decline in smoking ignores the vastly different health risks.

Claims of a “vaping epidemic” ignore that youth nicotine/tobacco use used to be both much more prevalent and in a much more harmful form.

3. Youth smoking has declined far more than we ever thought possible 15 years ago.

Related to the above, if the decline in youth smoking is acknowledged at all, it is presented as something that was already happening that is now being undermined by the rise in vaping. However, as Joe Gitchell #PickOnGitch has pointed out, there is some proof that the decline in youth smoking was unprecedented and unexpected.

You just have to look at the “residue” from the CDC Initiative, Healthy People 2020. What is “residue”? I’m repurposing this term from kooky online discussions of people who believe that Mandela Effects are not just false memories experienced en masse, but actual shifts in timelines or reality. “Residue” refers to evidence that the other timeline was real.

Kooky origins aside, “residue” is a really useful way to frame this point because Healthy people 2020 is a now-denied relic of the way public health was thinking about youth smoking before the “vaping epidemic” concerns. The Healthy People initiative involves setting goals and targets for behavioral health indicators (the relevant ones here are youth tobacco use) 10 years ahead of time. That means Healthy People 2020 targets were set in 2010 based on (a) what youth tobacco use trends looked like up to that point and (b) the best-case achievable progress over the next decade.

I’ve put the Healthy People 2020 baseline and target numbers (which are based on the Youth Risk Behavior Surveillance (YRBS) Survey) into the table below, along with what actually happened:

*By the way, the current Healthy People official website contains information only about 2030 and, as far as I can tell, they have removed all references to the 2020 initiative. So the “residue” is being wiped away and getting harder to find. I’ve downloaded the only copy that I could find and put it on my Google drive here.

Looking at the first two columns, the 2020 target was modestly lower for each “indicator” (any tobacco use, cigarettes, smokeless, and cigars) than the 2009 baseline. Meaning, for example, that in 2009 YRBS showed 19.5% of youth smoked cigarettes in the past month and while they hoped for and expected a decline, the best they could reasonably hope to achieve was 16.0% after 10 years.

What actually happened? Youth cigarette smoking plummeted to 6.0% in 2019 and 3.5% in 2023, far below what was ever thought possible in 2010. While there was admittedly an increase in “any product use” in 2019, this was due to the peak in youth vaping and then declined well below the 2020 target by 2023.

The kicker is that Healthy People 2020 states that the 2020 targets were chosen by retaining the 2010 targets — which had obviously not been achieved over the prior decade! So youth cigarette smoking (and youth tobacco use in general) was stubbornly high for several decades, such that 16% of youth smoking in the past month was the most optimistic possible scenario.

Then, suddenly, once youth had another nicotine product to use instead (more on this diversion idea in the next fact sheet on “gateway”), cigarette smoking plummeted. “Youth epidemic” claims are not credible when youth cigarette smoking specifically and tobacco products in general have declined far below the best-case scenario in 2010.

4. The majority of youth e-cigarette use is transient and experimental.

Youth e-cigarette use is usually measured as “any use in the past 30 days” which can include everything from trying a friend’s e-cigarette on one day for the first time, to vaping daily in the past month. This umbrella definition, also referred to as “current use,” obscures the range of vaping behavior.

Most of the surveillance studies (e.g., NYTS, MTF, YRBS) are repeated cross-sectional surveys, which survey a different random sample of youth every year instead of following the same ones over time. That limitation prevents being able to determine with certainty what proportion of youth e-cigarette use ends with experimentation versus persists or escalates.

Nevertheless, there are still ways to estimate this even with cross-sectional “snapshot” surveys. One way of doing this is to compare the ratio of “ever use” (i.e. at least once in your lifetime, regardless of when) to “current use.” This will give a rough approximation of how many youth who ever experimented even once continue to vape at the time of the survey. Of course it’s not perfect because it will still capture some experimentation that happened only recently, but if anything this means the “true” rate of experimentation would be even lower.

The table below shows the lifetime prevalence, current prevalence, and their ratio from NYTS 2024 (Jamal et al., 2024; Park-Lee et al., 2024). (Yes, NYTS 2025 is out now, but the various publications on it so far do not have all the information I need for the table below. I don’t expect the numbers to be very different, though.)

The ratio varies quite a bit by product, but it shows pretty consistently that at least half of all lifetime use appears to end with experimentation. That is, of all youth who ever tried a nicotine or tobacco product, only between a quarter and a half of them (across products) are still using at the time of the survey.

Half might still sound like a lot, but “current use” is still a broad category, as I mentioned above. If we further look at “frequent use” (usually defined as using on 20+ of the past 30 days), for e-cigarettes it’s 38.8% (of the 8.1% of youth who currently vape) and for pouches it’s 29% (of the 1.8% who currently used pouches) (Park-Lee et al., 2024).

Not much longitudinal work has been done to see what proportion of youth vapers persist or escalate vs. stop with experimentation, so Sooyong Kim (my Pinney colleague) and I looked at this ourselves in PATH. We took all the adolescents who first initiated e-cigarette use around the 2019 peak of youth vaping and followed them to see how their vaping behavior changed (or not) ~2 years later. About 60% had reduced their vaping frequency, including about 50% who completely stopped vaping (i.e., not in the past full year at the 2-year follow-up) (Kim & Selya, 2025):

Claims of an “epidemic” are not justified when the majority of youth use is transient and experimental, since this has negligible health and addiction risks in and of itself.

5. Dynamics resemble other cases of a population shift from one product to another

Taking the full context into account — not just the rise in vaping in isolation but the concomitant decline in smoking — the dynamics start to look like the population shifting from one product to another, while maintaining an overall steady or slightly declining prevalence of any nicotine use. That is, there is a similar or slightly declining demand for nicotine at the population level, but consumption is shifting to a different product.

“No population has dispensed with one form of tobacco without replacing it by another” - Michael Russell

This shift has happened many times before. Norway and Sweden are illustrative examples because it happened in living memory but long ago enough that the dynamics have more fully played out and can put the hysteria to rest. Both countries switched from smoked tobacco to snus use; snus gradually displaced smoking (first among men and then among women), without any obvious “recruitment” of new users who otherwise wouldn’t have smoked. From Lund & Vedøy 2021, here’s what the shift looked like in Norwegian men:

These shifts were larger among younger age groups (Lund & McNeill 2013).

Remarkably similar patterns are occurring in the US, with overall nicotine product use slightly declining over time, and (within this) a massive shift away from cigarettes and towards e-cigarettes, especially in younger age groups. See my other recent Substack post, “The population is shifting to a less harmful form of nicotine,” covering a recent article of mine, with the key figure below below:

My previous post also reviews other examples in different countries. In all cases, the rise in vaping among younger age groups initially looks alarming if presented in complete isolation from larger historical trends. But the rise in vaping combined with unprecedented declines in smoking, especially among younger age groups, is more consistent with a population shift away from cigarettes rather than vaping opposing gains in smoking that (are claimed) would have happened anyway.

Summary

“Youth vaping epidemic” claims are misleading and do not stand up to wider evidence. Looking at population trends over time, the countries with the highest rates of youth e-cigarettes often (though not always) have the largest unprecedented and unexpected (see Healthy People 2020 “residue”) declines in smoking.

If vaping is offsetting those gains, it’s still a net reduction in population harms due to the difference in risk between cigarettes and e-cigarettes. In an ideal world, youth would not use nicotine, but a mitigating factor is that most use is experimental and transient.

Instead, however, it’s possible (and IMO very likely) that vaping is causing those gains, by substituting for cigarettes in people who would have otherwise smoked. The same dynamics have occurred in other countries as populations shifted from one product to another while maintaining (or even slightly decreasing) total nicotine demand.

I also created a downloadable fact sheet based on this GFN presentation; feel free to make use of it.