Monitoring the Future Survey Results Show Alarming Rise in Teen Vaping

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For four and a half decades, the NIDA-funded Monitoring the Future (MTF) survey has provided researchers and policymakers with an invaluable window into the drug use and attitudes of America’s 12th-graders, with 8th and 10th graders added to the survey in 1991. The results of the 2018 MTF survey, released today (December 17), contain a mix of encouraging news and warning signals. Notably, the survey this year contained a major shock: a stunning rise in use of nicotine in vaping devices since 2017. Although there have been few significant changes over the past few years in teen marijuana use, use of most other illicit drugs by middle and high schoolers is at historic lows—this includes use of opioids, at a time when the opioid crisis is ravaging older sectors of the population.

Between January 2017 and January 2018, the percentage of 12th graders who reported vaping nicotine (not flavoring or other substances) during the past 30 days nearly doubled, from 11 percent to nearly 21 percent; among 10th graders, the increase was almost as great, from 8.2 percent to 16.1 percent. These are—by far—the biggest one-year increases ever seen for any substance in the history of the MTF survey. Previously, the largest increase for any substance in 12th grade was seen between 1975 and 1976, when past-month marijuana use jumped from 27.1 to 32.2 percent. Teens report they are vaping “flavoring only” in higher numbers as well, although it is likely that many young users do not know what is in the liquid they are vaping.

For reasons I’ve discussed before on this blog, any increase in nicotine use among adolescents is an alarming development. There is a perception, promoted by the manufacturers of vaping devices, that vaping is harmless because it does not involve the burning of tobacco—the source of carcinogenic tar in traditional cigarette smoke. However, there is mounting evidence that vaping can be harmful to the respiratory system, potentially contributing to long-term respiratory problems as observed with tobacco cigarettes.  Even more importantly, nicotine, which stimulates the firing of dopamine neurons and thus enhances the saliency of rewarding stimuli, might render the brain more sensitive to the reinforcing effects of drugs, increasing the risk for addiction. Scientific findings and epidemiological data suggest that nicotine can act as a “gateway” to other substances. Considering that the younger a person engages in repeated administration of any addictive drug, the greater the risk of them becoming addicted, preventing nicotine exposure among adolescents whether by vaping or by smoking traditional tobacco cigarettes must be a high priority.  

Not only are teen users of popular vaping devices like Juul re-glamorizing a smoking-like behavior that years of prevention campaigns had effectively stigmatized, they might be paving the way for a transition to conventional cigarettes as well as other substances. (Although vaping devices are touted by marketers as smoking cessation aids, very few clinical trials have been reported that evaluate their efficacy). It would be tragic to undo those historic declines in cigarette use because a new generation rediscovered cigarettes after being hooked on popular vaping devices. The recent decision by the Food and Drug Administration (FDA) to require manufacturers of vaping devices to have plans for keeping their products out of the hands of children and teens is thus an important step; only time will tell whether the increases in teen vaping can be reversed through such measures.

Rates of marijuana use by teens have been of great interest to researchers over the past decade, given major social and legislative shifts around the drug; it is now legal for adult recreational use in 10 states plus the District of Columbia, and it is available medicinally in many more. Fortunately, even as teens’ attitudes toward marijuana’s harms continue to relax, they are not showing corresponding increases in marijuana use. This year, a little over a third of high school seniors (35.9 percent) and a little over a quarter of sophomores (27.5 percent) reported using marijuana in the past year. However, for the past two decades, between 5.0 and 6.6 percent of seniors have reported using marijuana on a daily basis, and that has not changed; this year it was 5.8 percent, meaning that a significant portion of students is performing below their potential in school and thus adversely affecting their life prospects at a critical juncture. More teenagers are also reporting marijuana vaping, which for 12th graders increased from 9.5 percent for past-year use in 2017 to 13.1 percent in 2018. It is unclear if the teens who vape marijuana are also smoking it, or if they are a growing cohort of young people being exposed to marijuana for the first time through vaping.

On the brighter side, teens are using other illicit drugs at very low rates. Seniors’ use of illicit drugs other than marijuana (12.4 percent in the past year; 6 percent in the past month) was the lowest in 2018 that it has been since the start of the survey. The continued declines in misuse of prescription opioids like Vicodin are particularly reassuring (only 1.7 percent of seniors used Vicodin during the previous year, down from 10.5% in 2003), as is the fact that heroin use, now resurgent among adults and young adults, remains negligible in teens. Alcohol and cigarette use are also at all-time lows. These findings point to the success of prevention efforts, such as measures aimed at protecting young people from the effects of tobacco company advertising.

Compared to other national surveys, the MTF data are analyzed and released remarkably quickly: Funded by a NIDA grant, the research team at the University of Michigan that conducts the survey of 8th, 10th, and 12th graders every January analyzes the results and reports on them by the end of the year, giving us a real-time picture of drug trends among America’s youth. It is important to remember, however, that the MTF only captures drug use among those in school. Illicit drug use, drinking, smoking, and vaping are all likely to be higher in adolescents who have dropped out of high school.

Readers who want to learn more about this year’s MTF results can find many more details on this site. And for those wanting more information on the vaping findings, Richard Miech, one of the principle co-investigators at the University of Michigan, today published a letter on these alarming data in the New England Journal of Medicine