Changes in U.S. Adolescent Nicotine Vaping Prevalence from 2022 to 2023: The Role of Reduced Initiation Three Years Earlier during the Onset of the Pandemic.

INTRODUCTION: The prevalence of adolescent nicotine vaping declined substantially after the COVID-19 pandemic onset in the U.S. during the Spring of 2020. This study examines whether the decline continued from 2022 to 2023, and the extent to which any decline reflects the lasting influence of lowered levels of initiation three years earlier, at the onset of the pandemic.

METHODS: Data for this study come from nationally-representative, cross-sectional surveys of U.S. 12th grade (n=9,854) and 10th grade (n=14,663) students administered in the Spring of 2022 and 2023. The main outcomes are past 12-month nicotine vaping and grade first ever vaped nicotine.

RESULTS: From 2022 to 2023 prevalence of past 12-month nicotine vaping declined a relative 20% for 12th grade students, from 24.3% to 19.1%, and for 10th grade students by a relative 16%, from 17.8% to 15.1%. Among 12th grade students who vaped nicotine in the past 12 months, a significant decline in prevalence took place only among those who first ever vaped nicotine in 9th grade, and not among those who first ever vaped nicotine in any other grade. Among 10th grade students who vaped nicotine in the past 12 months, a significant decline in prevalence took place only among those who first ever vaped nicotine in 7th grade, and not among those who first ever vaped nicotine in any other grade.

CONCLUSION: These results contribute national-level evidence that forestalled initiation of nicotine use for one year may have a lasting effect that continues to lower adolescents' levels of use many years afterwards.

IMPLICATIONS: These findings caution against looking to contemporaneous policy for explanations of the large, one-year decline in nicotine vaping from 2022 to 2023. It can be tempting to interpret the decline as a victory for current efforts to restrict adolescent access to vaping products, or current education/media campaigns that warn adolescents of the dangers of vaping. The findings of this study suggest, instead, that the one-year vaping declines primarily result from declines in initiation that were set into place three years ago during the pandemic onset, more so than the immediate result of contemporaneous policy.