The Switch: Cigarettes to E-Cigarettes

Cigarette smoking has declined in the United States, but nicotine use among young people has not disappeared. Instead, it has shifted into newer forms, especially through vaping and e-cigarette products. This shift is concerning because vaping is often perceived as a lower-risk alternative to smoking, despite the presence of nicotine in many products and growing evidence of possible health consequences.

The NYC Department of Health has reported that vaping is over three times more common than cigarette smoking among public high school students, with rates of 14% compared to 4%. Among young adults, vaping is over seven times more common than cigarette smoking, with rates of 15% compared to 2%. These findings show how common vaping has become among young New Yorkers and why youth access to e-cigarette products remains an important public health concern.

The data also show that vaping rates are significantly higher than cigarette smoking rates, which highlights the importance of addressing the accessibility of vapes. Public health efforts have attempted to address this issue by limiting access to illegal nicotine products. In New York City, "Operation Padlock to Protect" targeted illegal nicotine shops selling these products and resulted in the closure of approximately 1,400 illegal businesses. Enforcement efforts such as these reduce accessibility and availability; however, enforcement alone cannot fully address the issue. Prevention also requires education that helps young people understand the risks associated with nicotine use.

Accessibility remains a major concern. Although cigarette use has declined in the United States, e-cigarette usage has increased significantly despite laws prohibiting the sale of tobacco products to individuals under the age of 21. A biennial, school-based, self-administered survey of NYC high school students compared data from 2014 and 2018 and found an approximate 15% increase in e-cigarette use among middle school students, with similar increases among high school students.

Additionally, the results showed that willingness to try e-cigarettes among students who had never used them was twice as high in 2018 compared to 2014. The study concluded that e-cigarette usage increased dramatically over the four-year period and that tobacco products remained accessible despite laws such as Tobacco 21. Together, these findings suggest that additional prevention programs and stronger enforcement measures are needed to reduce youth access to e-cigarette products.

As concerns about vaping have increased, so have concerns regarding the advertising strategies used to promote e-cigarette products. Since young adults are often the target audience, companies use marketing strategies such as attractive packaging, a wide variety of flavors, and visually appealing product designs. Examples include fruit ice, mint, menthol, and other sweet flavors.

It is easy to see why these products appeal to younger audiences. While vapes and e-cigarettes are often marketed toward young adults, steps can still be taken to limit exposure. Individuals can educate themselves about these products, maintain vape-free environments at home, and engage in open conversations with young people. Education for both youth and adults is critical to ensure a full understanding of the risks and health consequences associated with vaping and e-cigarette use.

Beyond concerns about nicotine addiction and lung health, vaping may also be associated with cardiovascular effects, including heart rhythm abnormalities. According to a study published in The Journal of Pediatrics, adolescents and young adults who vaped had an 82% higher likelihood of being diagnosed with heart rhythm abnormalities compared to those who did not vape.

The study utilized data from the TriNetX network and compared two matched groups of adolescents and young adults: one group that vaped and one that did not. Each group contained 57,202 individuals, resulting in a total sample size of 114,404 participants. Due to the large sample size, the study was valuable for identifying broader trends and potential generalizations. The findings suggest that e-cigarette use may be associated with an increased risk of heart rhythm abnormalities among adolescents and young adults, though additional research is needed to understand the long-term effects.

Reducing youth vaping requires more than simply telling young people not to use e-cigarettes. While vaping may appear less harmful than traditional cigarette smoking, the rise in usage among adolescents demonstrates that nicotine addiction remains a serious public health concern—just in a newer form.

The flavors, packaging, and accessibility of these products make them easier to try and more difficult to view as dangerous, especially for younger audiences. Even with laws such as Tobacco 21 in place, the continued prevalence of youth vaping suggests that enforcement, education, and community awareness must work together.

Understanding the potential health risks—including nicotine addiction and cardiovascular effects—can help young people make informed decisions before vaping becomes normalized. Protecting youth is a community-wide effort that depends on educating the public about the risks of e-cigarette use and advocating for stronger measures that limit youth access to tobacco and nicotine products.

References

1. NYC Department of Health. New NYC Health Department Data Show Vaping Persists Among Young New Yorkers. 2025.

2. Debchoudhury, Indira, et al. E-Cigarette Use Among Middle and High School Students in New York City Before and After Passage of Tobacco 21. Tobacco Use Insights, Vol. 15, 2022.

3. Tsalatsanis, Athanasios, et al. Increased Risk of Heart Rhythm Abnormalities in Adolescents and Young Adults Who Vape. The Journal of Pediatrics, June 1, 2026.