Daily vaping among youth has soared in recent years, increasing from 15.4% in 2020 to 28.8% in 2024, according to a new study. Over the same period, the share of daily users who have tried to quit but failed rose from 28.2% to 53%, revealing a growing trend in nicotine dependence.
Researchers from the USC Keck School of Medicine and the USC Institute for Addiction Science, along with the Tobacco Center of Regulatory Science, conducted a study that set out to tackle the pressing health issues of vaping among teens from 8th to 12th grade.
The study’s lead author, Abbey Masonbrink, a research director at the Children’s Hospital Los Angeles (CHLA), says what the study found is highly concerning for clinicians, public health advocates and policymakers alike.
Masonbrink said that the research’s purpose was to find out if young vapers are “hardening,” which describes when overall use of nicotine in the population declines, but the remaining users become more addicted and find it harder to quit.
“Overall rates of nicotine vaping in youth have declined since 2019, which is really reassuring news,” said Masonbrink. “But my colleagues and I were concerned about youth who continue to vape nicotine. We had concerns that they were experiencing increased addiction and increased…intensity or frequency of use.”
“We focused the study on youth who reported past 30-day nicotine vaping, [and] the numbers were increasing each year and nearly doubled over the last five years,” said Masonbrink.
Intending to improve treatment and prevention efforts for middle and high-school-age groups, Masonbrink hopes the research can help policymakers and regulators determine how best to protect young people.
“One of the markers of nicotine dependence is the inability to quit. Around 60-65% either intended to quit or have tried to quit in the last year,” said Masonbrink. “Most commonly, kids who want to quit vaping do so without any treatment at all. They might have some peer support or family support, and maybe rely on some social media…There needs to be more awareness for clinicians to screen for nicotine vaping, and have resources available to link kids who want to quit to help them quit successfully.”
The study shows increasing daily nicotine may be associated with more adverse cardiovascular, respiratory, addiction, and mental health outcomes compared with less frequent vaping.
“I started during my anorexic era…Though I have quit many times, I have been vaping for 3.5 years now, which disgusts me—but it is genuinely impossible to quit,” said a sophomore who requested anonymity, explaining, “My parents don’t know I vape and would literally murder me.”
In the last few years, nicotine products have increasingly developed to meet the changing consumer market. Newer generations of e-cigarettes can deliver higher concentrations and volumes of nicotine.
“Older products used to use a form of nicotine called free base nicotine, which was very harsh. It’s very bitter [and] it’s very unappealing to the user,” said Alyssa F. Harlow, an assistant professor of clinical population and public health sciences who worked on the study.
“If you were to have free base nicotine that’s as highly concentrated as what we’re seeing now, it would be completely unusable by a person, because it would just be so disgusting,” said Harlow. “But now what we see is products are using nicotine salts…where it reduces the harshness and allows these manufacturers to make their products to include very high concentrations of nicotine while still making it be sort of like an appealing experience for the user.”
At the start of 2025, California prohibited retailers from selling flavored tobacco products. As part of the USC Institute for Addiction Science, Harlow saw a gap in the retail environment failing to uphold regulations for points of access.
“I think if we can really effectively reduce the availability of flavored e-cigarettes, that it could also help to reduce the addictive potential of these products,” said Harlow.
As flavored nicotine products continue to roll out, regulations can’t seem to keep up.
“There really is a lack of regulation around these products,” said Masonbrink. “Youth are continuing to use them, becoming more addicted, while the tobacco industry continues to increase nicotine exposure, and have flavored products despite bans.”
In December 2019, President Donald Trump signed legislation amending the Federal Food, Drug, and Cosmetic Act, which raised the federal minimum age for sale of tobacco products from 18 to 21 years, known as “Tobacco 21” or “T21,” which became effective immediately.
Since then, it has been illegal for a retailer to sell any tobacco product—including e-cigarettes—to anyone under 21. In August 2024, the FDA issued the final rule “Prohibition of Sale of Tobacco Products to Persons Younger than 21 Years of Age."
Current regulation states that a photo ID is required to verify the age of anyone under the age of 30 trying to purchase cigarettes, smokeless tobacco and covered tobacco products.
Despite this, much of the issue is related to accessibility.
Research shows that minors are primarily obtaining vapes through social sources, like peers or dealers, with a substantial portion purchasing directly from retail vape shops. More and more youth are tuning in to places to buy a vape without presenting ID.
“Young people have always sort of been able to get access to substances that are illegal for them,” said Harlow. “Our lab has done a lot of research on cutting down the marketing of these products…because even if the young people aren’t buying them directly from the vape shops, you may have product diversion, or people buying vapes from these products, and then they are giving it or selling it to minors.”
This easy access feeds into a culture of nicotine use on college campuses as well.
“There is a lot of nicotine addiction across USC’s frat row, and the environment is often mutually encouraging,” said a freshman at USC who requested anonymity out of protection for his fraternity. “People don’t really quit because it’s so hard, and if they do, it’s difficult to stay committed when constantly surrounded by it.”
As the nicotine industry is constantly evolving—changing the sizes, concentrations and compositions of products—youth may not be aware of the high quantities of nicotine they’re consuming, said Masonbrink.
Originally, e-cigarettes were used to help adult cigarette smokers quit by providing nicotine delivery through a vapor, which could satisfy users’ physical dependence without the combustion and other toxic chemicals found in cigarettes. Using these devices, users would reduce their nicotine intake over time.
However, the FDA has not approved the use of e-cigarettes as a safe product.
Now, most youth start using nicotine through e-cigarettes instead of traditional tobacco, said Masonbrink. This early exposure puts them at a higher risk for using other substances, including cigarettes, other nicotine products, as well as alcohol and other illicit substances.
“Use of e-cigarettes to help adult tobacco cigarette smokers quit is a helpful tool, but I think that there are a lot of limits…There are a lot of reasons not to apply that information to youth,” Masonbrink said.
While prevention remains the most effective approach against youth addiction, new treatments like varenicline—a prescription medication that targets nicotine receptors in the brain, reducing cravings and withdrawal symptoms—have shown promising results in helping young people quit nicotine, according to a randomized trial done by the Department of Psychiatry at the Massachusetts General Hospital.