Media coverage and campaigns drove decline in youth vaping

Researchers from the University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science have found that both anti-vaping advertising and widespread news coverage of a lung-injury outbreak tied to vaping - known as e-cigarette or vaping product use-associated lung injury (EVALI) - were critical in making 2019 a turning point in youth vaping prevalence in the United States.

The study published in BMC Public Health, offers key insight into why the 2019 public health messaging coincided with more teens attempting to quit vaping and a decline in interest among teens who had never vaped. 

What we saw in California between 2017–18 and 2019–20 was a rare, dramatic population-level shift in adolescent vaping behavior. A convergence of media forces - aggressive public health campaigns and frightening news reports about people being hospitalized with severe lung injuries - appears to have shaken adolescents out of complacency and motivated many of them to quit."

Shu-Hong Zhu, PhD, senior author of the study, Herbert Wertheim School of Public Health professor

Youth vaping in the United States surged from 8.1% in 2017 to a peak of 20% in 2019 before beginning a sustained decline, reaching 5.9% by 2024. Understanding what triggered that reversal is critical for ongoing tobacco prevention efforts. By 2019, two major media forces converged: aggressive anti-vaping advertising from the Food and Drug Administration (FDA), the Truth Initiative and state-led campaigns like California's Tobacco Control Program; and extensive news coverage of the EVALI outbreak. EVALI was linked to more than 2,800 hospitalizations - many among young people - and 68 deaths. News organizations covered the crisis heavily, with nearly 20,000 EVALI-related news articles appearing online between July 2019 and March 2020.

The study analyzed data from two cycles of the California Student Tobacco Survey, a large, population-representative biennial survey of students in grades 8, 10 and 12. The 2017–18 cycle, which included more than 117,000 students, was conducted before national anti-vaping campaigns had launched; the 2019–20 cycle, with more than 143,000 students, was conducted after the campaigns had been running for over a year and during peak EVALI news coverage. Researchers compared quit attempts and quitting intentions among current vapers, and susceptibility to future vaping among students who had never vaped, across the two periods.

The differences were striking. Among current vapers, the proportion who had attempted to quit in the past year nearly doubled, rising from 28.8% in 2017–18 to 53.2% in 2019–20. Intentions to quit also climbed sharply, from 56.9% to 79.1%. Among teens who had never vaped, susceptibility to trying vaping in the future dropped from 30.3% to 25.7%. The research confirmed that both anti-vaping advertising exposure and EVALI awareness independently predicted higher odds of quit attempts and quitting intentions, even after controlling for demographics and other tobacco-related behaviors.

EVALI awareness was significantly associated with lower susceptibility to future vaping among never-vapers - an effect not found with anti-vaping advertising. This is remarkable because the two major national ad campaigns had combined annual expenditures exceeding $100 million, while EVALI awareness emerged primarily through news coverage generated at no direct advertising cost.

EVALI coverage was pervasive in part because the outbreak's cause was not initially identified, leading reports to frame the crisis around vaping broadly. Though the outbreak was eventually linked to black market THC vape products, most teens who became aware of EVALI incorrectly believed nicotine was responsible. Future research should examine whether those perceptions persisted as the real cause became clearer, and whether the misinformation itself played a role in the behavioral changes observed.

The researchers note that a similar reversal has not been observed in countries such as England, where youth vaping has continued to rise. Cross-national comparisons of media environments and policy contexts could offer valuable insights for designing the next generation of tobacco control strategies.

"Quit attempt rates on a population level almost never change this dramatically from one period to the next," said first author Jijiang Wang, PhD, a postdoctoral researcher at the Herbert Wertheim School of Public Health, whose doctoral dissertation as a student in the Joint Doctoral Program in Public Health focused on this topic. "When they do, it tells us something important about what is possible when the media environment shifts."

Additional co-authors on the study include: Anthony C. Gamst and Yue-Lin Zhuang from UC San Diego. 

The study was funded by the California Department of Public Health (contract #CDPH-16-10109).