Earlier this week, the FDA released the data from its 2025 National Youth Tobacco Survey. This is a public use dataset so it is freely available to all. My own analysis of these data revealed some important findings that I want to share. To the best of my knowledge, the questions I investigated in my analysis are questions that no health agency or anti-nicotine organization has ever examined. When you see the results, you will understand why.
First, I want to put forth the conceptual thinking that led me to ask these particular questions. It is based on adolescent risk-taking theory, which posits that adolescent risk-taking is not necessarily a sign of brain dysfunction, but rather a normal, necessary, and adaptive part of development. According to the UCLA Center for the Developing Adolescent: "It’s not only normal for adolescents to take risks and try new things, it’s an essential part of learning during these years. Being able and willing to take risks is a part of our natural tendency to explore new things in adolescence—in ways that help us discover who we are, expand our skills, and ultimately leave the safe nest of home."
Moreover, independence and rebellion are the core values of adolescence. Risk-taking is a way of expressing autonomy and rebelling against adult authority. It is also a way of coping with the stresses of adolescent life. Given what is going on in the world today, it is not surprising that youth are facing unprecedented challenges to their mental health. Most are going to engage in some form of risky behavior in order to cope. The problem with authoritarian thinking in the tobacco control movement is that we have committed ourselves to the goal of eliminating all nicotine-related risk among youth rather than attempting to employ a harm reduction approach and ensure that the risks youth do take are relatively safe, at least in comparison what they could otherwise be doing.
The general theory in the tobacco control movement is that youth vape because Big Tobacco is evil and has tricked them into thinking that vapes are safer than cigarettes, has enticed them with gummy bear and cotton candy flavors, and used targeting marketing in an attempt to addict a new generation to a behavior that is a gateway to smoking and most likely, a lifetime of tobacco use. This argument is flawed for many reasons -- not the least of which is that it is untruthful -- but beyond that there is strong evidence that vaping went viral largely because of social media influencers combined with the addictive nature of nicotine. Remember that even without an addictive component, "six-seven" took off in 2025 and fidget spinners became a viral toy craze in 2017.
The bottom line is that adolescents engage in risk-taking behavior and that youth who take one type of risk are also more likely to take other risks. For example, we know that youth who use marijuana are also more likely to smoke. So the question I posed is: Could it be that youth who use e-cigarettes are also more likely to smoke or to vape other even more risky substances, like THC, CBD, or synthetic marijuana like K2 or spice?
The Rest of the Story
Based on my analysis of the 2025 National Youth Tobacco Survey, the prevalence of current e-cigarette use (defined as use within the past 30 days) among middle and high school students was 5.2%, drastically down from a peak of 20.0% in 2019. Among these youth current e-cigarette users, about half (51.0%) also were current smokers and/or current users of THC, CBD, or synthetic marijuana vapes. Among heavy e-cigarette users (defined as use on at least 20 of the past 30 days), a large majority (63.5%) also were current smokers and/or current users of THC, CBD, or synthetic marijuana vapes.
What this means is that for nearly two-thirds of youth heavy e-cigarette users, the biggest risk they face is not the e-cigarettes but either smoking or using black market marijuana vapes.
The reason tobacco control groups don't want you to know this is that it exposes their culpability in the EVALI outbreak, which resulted in nearly 3,000 hospitalizations and 68 deaths. These groups were insistent upon blaming the outbreak on e-cigarettes. They promoted bans on e-cigarettes and continually insisted that the problem was e-cigarettes but failed to tell youth the truth: black market THC products tainted with vitamin E acetate are the cause and you need to stop using these product today!
The failure to warn youth about the dangers of black market THC products was very much responsible for many hospitalizations and perhaps deaths. The health groups did such a poor job of communicating this essential fact that only 11% of youth knew that EVALI was caused by marijuana vaping.
These data paint a very different picture of the youth vaping "epidemic." The large majority of youth who use e-cigarettes regularly are engaging in multiple risk taking behaviors, including ones that are far more dangerous than nicotine vaping. The use of black market THC vapes or synthetic marijuana vapes could literally be life-threatening or at least pose a significant risk of immediate health harm severe enough to require hospitalization. Even though vitamin E acetate is no longer a common component of THC vapes, the use of any black market vaping product carries the risk of tainting with synthetic cannabinoids or other drugs, a risk that is not present with the use of nicotine-containing e-cigarettes that originated in a retail store. These drugs can cause heart attacks, strokes, and seizures. Black market THC vape pens may also contain synthetic opioids whose use could be fatal.
Based on my analysis, an alarming 15.2% of youth daily e-cigarette users are also vaping synthetic marijuana. While anti-vaping groups are trying to ban e-cigarettes, most are not even informing youth about this risk and seem to be more concerned about a youth ripping a cherry vape than having hallucinations, seizures, or being hospitalized because of black market drug use.
Yes, youth e-cigarette use is a public health problem. However, our insistence on a prohibition-based approach rather than focusing on harm reduction is putting youth at great risk, not less.
