Daily vaping and failed quit attempts rise sharply among U.S. youth

Since 2019, overall rates of nicotine vaping have declined among U.S. youth, but those who continue to vape are showing signs of worsening addiction, according to new USC research. Between 2020 and 2024, the share of current users who vaped every day increased from 15.4% to 28.8%. Over the same period, the share of daily users who tried to quit but were unable to rose from 28.2% to 53%. The study, funded in part by the National Institutes of Health, was just published in JAMA Network Open.

Public health advocates raised the alarm when youth vaping rates surged between 2014 and 2019. Data collected during the COVID-19 pandemic suggested that those who continued to vape were becoming heavy users, with a growing number reporting vaping within five minutes of waking up and on an increasing number of days per month.

To follow up on those trends, a team of researchers from the USC Institute for Addiction Science and the Tobacco Center of Regulatory Science analyzed data from surveys completed by 115,191 teens in the 8^th, 10^th and 12^th grade across the United States. They aimed to find out whether young vapers are "hardening," a term borrowed from tobacco research that describes when, as overall use declines, the remaining users become more addicted and have a harder time quitting.

What we found is highly concerning for clinicians, public health advocates and policymakers. The rise in daily vaping and growing number of youth trying to quit implies that these youth are experiencing a severe level of nicotine addiction. This means we need to improve treatment and prevention efforts for this population."

Abbey Masonbrink, MD, MPH, study's first author, clinical associate professor of pediatrics, Keck School of Medicine of USC and research director of the Division of Hospital Medicine, Children's Hospital Los Angeles

The findings can help policymakers and regulators determine how best to protect young people. For example, new generations of vapes can deliver higher concentrations and volumes of nicotine than earlier versions. Limits on nicotine content could potentially help reduce the risk of severe addiction among U.S. youth.

"The nicotine industry is constantly evolving-changing the size, concentration and size of products-and youth may not be aware of the high quantities of nicotine they're consuming," said Masonbrink, who is also a member of the USC Institute for Addiction Science. "We're concerned that these products pose a high risk of addiction for youth who continue to vape." 

Growth in daily use

The researchers analyzed the past five years of data from Monitoring the Future, an annual in-school survey that asks 8^th, 10^th and 12^th graders across the country about their substance use. 

Among youth who reported vaping at least once in the past 30 days, the percentage who vaped daily increased from 15.4% in 2020 to 28.8% in 2024. Of those reporting daily use, the percentage who tried unsuccessfully to quit rose from 28.2% to 53%.

Over the study period, the demographics of youth vapers also changed. By 2024, more vapers were female, non-Hispanic Black or from a rural area. More youth vapers also reported using other substances, including alcohol and cannabis.

Helping youth quit

Among youth in rural communities, daily vaping jumped dramatically-from 16.4% in 2020 to 41.8% in 2024, a spike that has prompted the study team to examine further. Masonbrink is now planning a follow-up study with youth in urban, suburban and rural areas to explore their experiences with nicotine product marketing and product access, as well as prevention and public health messaging.

National surveys have shown that while many young people want to quit vaping, most attempt to do so without formal support or treatment.

"Youth who only vape occasionally may be able to stop on their own, but those who are vaping daily will have a much harder time quitting without treatment and support," said Masonbrink, who leads research to improve care for adolescents with severe nicotine dependence at CHLA.

New research shows that medications for nicotine addiction, such as varenicline, are effective in helping young people quit. Educating youth about these treatments and expanding access for those with severe nicotine addiction should be a top priority going forward, Masonbrink said.

About this research

In addition to Masonbrink, the study's other authors are Dayoung Bae, Junhan Cho, Alyssa F. Harlow, Steve Sussman, Louisiana M. Sanchez, Abigail Adjei, Leah R. Meza, Ming Li and Adam M. Leventhal from the Keck School of Medicine of USC and the Institute for Addiction Science, University of Southern California; Richard A. Miech from the Institute for Social Research, University of Michigan, Ann Arbor; Hongying D. Dai from the College of Public Health, University of Nebraska; and Dae-Hee Han from Emory University.

This work was supported by the National Institute on Drug Abuse of the National Institutes of Health [K23DA055736, K99DA058241 and K24048160]; and the National Cancer Institute and U.S. Food and Drug Administration [U54180905].