Smoking among US high schoolers has “basically disappeared” despite a recent surge in vaping, proving that fears about safter alternatives acting as a nicotine gateway to cigarettes among young people are overblown and unfounded.

Researchers examined more than ten years of data from the US National Youth Tobacco Survey (NYTS) and the National Health Interview Survey (NHIS).

The aim was to compare data from the US Centers for Disease Control and Prevention (CDC) on smoking and vaping rates to shed light on whether e-cigarettes help reduce combustible cigarette consumption, or whether they open a nicotine gateway to youth smoking.

Significant drop in smoking prevalence

Putting the data together for the first time, the study — published in Harm Reduction Journal — reveals that cigarette smoking among high school students decreased significantly from 15.7 percent in 2011 to just 2 percent in 2022. 

Similarly, smoking among emerging young adults (ages 18-20) dropped by 86 percent over the same period.

Meanwhile, vaping prevalence surged over the same period. Among high school students, vaping climbed from less than one percent in 2011 to a peak of 22 percent in 2019, before stabilizing around 10 percent in recent years. 

Emerging young adults experienced a steady increase in exclusive vaping, reaching 9.4 percent by 2022.

Quit ratios rise sharply

The study also examined the prevalence of dual-use (smoking and vaping simultaneously) and found it to be relatively low, peaking at 5.7 percent among high school students in 2018. By 2022, dual-use rates had dropped to 1.5 percent. 

Notably, quit ratios—the proportion of former smokers relative to ever-smokers—increased sharply, particularly among emerging young adults, rising from 15 percent in 2011 to 52 percent in 2022.

The data show that smoking rates have declined significantly from 2011 to 2022 across every age cohort examined in the study. At the same time, rates of dual-use, while more volatile among high schoolers, also stabilized at low levels (0.8 to 3.5 percent).

Overall drop in nicotine consumption

And while the rapid increase in vaping among high schoolers did result in an overall increase in nicotine product consumption from 2014-2020 compared to the 2011 baseline, vaping rates stabilized by 2022.

Thus, overall rates of nicotine product consumption ultimately fell for all cohorts between 2011 and 2022, indicating that e-cigarettes have largely displaced combustible cigarettes without resulting in an increase in smoking or an overall increase in nicotine product use.

“Smoking among high schoolers has basically disappeared,” one of the authors, Brad Rodu, wrote in a blog post presenting the research.

“While the high school vaping rate was very volatile with sharp increases and declines, vaping in young adults age 18-20 was much more stable. But the smoking rate went down and stayed there, suggesting that these general trends are likely to continue. Which means that in 25 to 30 years, smoking-related diseases will disappear too.”

Vapes, pouches not a nicotine gateway to smoking

The results counter claims often made by anti-nicotine activists that less harmful nicotine products like e-cigarettes or nicotine pouches, are a gateway to smoking and result in increased overall consumption of nicotine products by young people.

“Overblown fears about nicotine risk overshadowing the big picture when it comes to alternative nicotine products: they help reduce smoking,” says Patrik Strömer, Secretary General of the Association of Swedish Snus Manufacturers.

“The numbers here don’t lie. Vaping and pouches don’t open a nicotine gateway to cigarettes. If they were, we wouldn’t see such dramatic drops in smoking and such low levels of dual use.”

Strömer admits he was “troubled” by the explosive growth in vaping among young people in the US. In Sweden, nicotine pouches, rather than vapes, have seen the greatest increase in popularity among young people, which he also believes is cause for concern.

“People under 18 shouldn’t be using nicotine products of any kind, period,” he says.

“However, it’s important that these concerns don’t detract from continued efforts to reduce smoking – which is by far the greatest nicotine-related public health hazard for young and old alike.”

‘A huge victory for public health’

Strömer hopes policymakers and researchers in Sweden take notice of the new findings about US vaping rates and smoking rates as they consider different approaches to regulating nicotine pouches.

“As we find ourselves on the other end of the hype cycle for these new products and see how usage has stabilized, we need to look closely at the impact on smoking rates and overall nicotine consumption,” he explains.

“That smoking rates remain low among young adults in the US – who a few years ago were high school students when vaping rates were at their highest – is convincing evidence that a spike in youthful experimentation didn’t result in creating a new generation of nicotine addicts as many anti-nicotine activists claim. Rather, these products help keep people away from cigarettes for good. And that is a huge victory for public health.”