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How the pandemic has changed vaping habits among teens and young adults

Experts have worked to understand how COVID-19 has changed e-cigarette use by teens and young adults. But the shift has not been what Brian Jenssen, a researcher and pediatrician at CHOP, expected.

A man exhaling smoke from an electronic cigarette.
A man exhaling smoke from an electronic cigarette.Read moreEva Hambach / AFP/Getty Images

When the University of Pennsylvania closed its campus last March, Brandon Orzolek realized that COVID-19 was becoming a serious issue. And he knew his vaping habit put him at greater risk of severe illness from the virus.

“People are dying, and there’s no way that inhaling some foreign substance into your lungs could be a good thing if you get a respiratory virus,” said Orzolek, a 24-year-old graduate student studying chemistry. “I was already in a panic about getting sick, and I was like, ‘Well, if I do get sick, I want the best chance at not having serious complications.’”

So after nearly three years, he quit. He experienced unpleasant nicotine withdrawal symptoms for the first few days, but is overall happy with the decision he made more than a year ago. He also picked up running to keep himself occupied during quarantine.

“It was super, super challenging,” Orzolek said of withdrawal. “You feel physically ill for probably about three days before your body is like, ‘OK, well, that’s not going to be happening for a while anymore.’ And then the cravings are really bad for the first couple of weeks, but then it progressively gets better and better.”

Although vaping among teens and young people was a major health issue before the pandemic, conversation about e-cigarettes and its impact on lung health has come to a pause in the last year. Despite a 2019 national outbreak of e-cigarette or vaping product use-associated lung injury (EVALI), which caused more than 2,000 hospitalizations, the Centers for Disease Control and Prevention (CDC) web page that tracks cases has not been updated since February 2020.

As a result, many public health experts and pediatricians have had to rely on their own data collection, as well as anecdotal evidence, to understand how COVID-19 has changed e-cigarette use by teens and young adults, said Brian Jenssen, a researcher and primary care pediatrician specializing in tobacco use at the Children’s Hospital of Philadelphia. But the shift has not been what he expected, Jenssen said.

When schools closed, Jenssen thought e-cigarette use would decrease because “students can’t hide their use as easily,” he said. “But we haven’t seen that. Anecdotally, my colleagues are seeing cases where teens come in [with COVID-19 symptoms], test negative for COVID, and we realize they have a textbook case of EVALI.”

This trend tracks with a May study published in JAMA Pediatrics that found teens in Northern California did not change their e-cigarette use significantly during the stay-at-home order.

However, other studies have found that adolescents and young adults have decreased their e-cigarette use during the pandemic. A study published in May in the American Journal of Public Health found that e-cigarette use was down among people ages 15 to 20 from last March to June because the stay-at-home orders made accessing e-cigarette products more difficult. Another study, published by JAMA Network in December, found a similar trend — out of the 2,167 teens and young adults researchers surveyed, 810 reported reducing or quitting e-cigarette use. Respondents who had used e-cigarettes more than 10 times or were nicotine dependent were less likely to quit, the same study found.

A study published by the CDC last December also found that tobacco use among middle school and high school students was down 25% in 2020 from 2019, although there is not enough information to determine whether that decrease is directly attributable to the pandemic.

“Some data suggests that teens and young adults are using at the same levels they were pre-pandemic, and some suggests that they are using at lower rates,” said Jenssen. “Whatever is happening, it’s affected by the fact that teens can’t access these products as easily from stores, so they’re getting a lot of products online.”

Because decreased access has impacted teens’ e-cigarette use, “that shows that we need to do a better job ... making it difficult to purchase these products and punishing the stores who sell illegally,” Jenssen said. “We also need to look at restricting online sales.”

During the pandemic, Bonnie Halpern-Felsher, a professor of pediatrics who specializes in adolescent medicine at Stanford University, co-authored studies about how vaping elevated five-fold the risk of contracting COVID-19 for young people ages 13 to 24 and about changes in how teens are accessing vaping products.

“When you’re not with friends, not at parties, you’re less likely to pick up a vape and use it, unless you’re addicted,” Halpern-Felsher said. “If you’re not addicted, it’s a good time to quit. What we weren’t sure was why this was. … Are teens quitting because of concerns about lung health, concerns about COVID, or a decrease to access? Or maybe because teens finally got the message about EVALI?”

Stay-at-home orders were a huge factor for changes in e-cigarette use by young people, she said. Although some teens accessed vape shops online, sneaking products around their parents became “a little bit harder,” Halpern-Felsher said.

“A lot of teens get products from their friends, so when they’re not with them, they can’t get them as easily,” she said.

But as schools across the county reopened in the spring, Halpern-Felsher said, she heard from educators that students were vaping again. That’s why it is so important to continue public health messaging about tobacco usage and lung health, even as COVID-19 cases continue to drop, Halpern-Felsher pointed out.

Texting campaigns are an effective strategy, said Amanda Graham, chief of innovations at Washington-based Truth Initiative, a nonprofit public health organization focused on preventing tobacco addiction among teens and young adults. A recent study Graham coauthored found that participants who received messages from the program were one-third more likely to quit after seven months, compared with those who did not.

Graham said it is impossible to know how much social distancing and lockdowns affected vaping habits.

“The evidence goes both ways,” she said. “Some people found that COVID was a reason to stop using tobacco. … The fear of inhaling something into your lungs during a pandemic that is primarily respiratory was kind of a motivator. On the other side of the coin, people were socially isolated and stressed, and they turned to tobacco as stress mitigation.”

Staying away from nicotine during the pandemic has not been easy for Orzolek, but he is determined to keep up his new healthy habits.

“There was a while where I was pretty down in the dumps,” he said. “It was the hardest year for a lot of people, but [quitting vaping] definitely didn’t help it, and all the times that I started to feel really bad for myself, like sad and depressed and stuff like that, I was like, ‘OK, well, maybe if I start vaping again.’ But I never did, and I’m feeling a lot better.”