Research Alert: UC San Diego study tracks shifting US smoking norms over 30 years

University of California - San Diego

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A recent study from researchers at the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego developed and validated a new way to measure changing social norms around cigarette smoking and secondhand smoke exposure in the United States over the last three decades. Using data from 1.5 million respondents in the Tobacco Use Supplement to the Current Population Survey, researchers created a “Willingness to Restrict Smoking” (WTRS) scale that captures how strongly people believe smoking should be restricted in public settings. The results offer tobacco control programs a new way to evaluate their success and solve a decades-long challenge for researchers: how to effectively measure social norms around tobacco.

In the early 1990s, the National Cancer Institute (NCI) helped transform the public health approach to  tobacco control by shifting the focus from individual behavior change to changing social norms around smoking, particularly around where smoking should and should not be permitted. The California Tobacco Control Program (CTCP) became a leading example of this strategy, paving the way for California to successfully implement the world’s first smoke-free bar law in the late 1990s. This achievement was made possible by prior CTCP efforts to reshape attitudes toward smoking in bars through mass media campaigns featuring bar workers’ testimonials and targeted outreach to bar owners and employees. Since then, researchers and public health officials alike have sought a clear and reliable way to measure social norms around tobacco use.

The new study analyzed survey responses collected between 1992 and 2022 across all 50 states. Participants were asked whether smoking should be allowed in locations such as hospitals, workplaces, restaurants, shopping malls, bars, playgrounds and casinos. Researchers found that support for smoke-free environments increased steadily over time, particularly in indoor public spaces. Hospitals and playgrounds consistently received the strongest support for smoking restrictions.

The researchers say the findings support the long-standing public health strategy of reducing smoking by shifting social norms around secondhand smoke exposure. They also found that the scale remained stable and reliable across survey years despite changes in survey questions and settings over time. According to the study, the WTRS scale may offer tobacco control programs a new way to quantitatively evaluate whether campaigns and policies are successfully changing public attitudes toward smoking restrictions.

The study [“Social norms and the decline in US cigarette smoking: Evidence from 30 years of US representative surveys”], led by David Strong, PhD, professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, published on June 17, 2026 in BMJ Public Health.

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Journal

BMJ Public Health

 

Fathers’ smoking habits influence teen vaping, new research shows

University of Nebraska-Lincoln

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A new study from the University of Nebraska–Lincoln sheds light on how parental smoking shapes adolescents’ attitudes and use of both traditional cigarettes and e‑cigarettes, finding that fathers’ behaviors may play a more influential role than those of mothers. 

Led by Alex Mason, a professor in the Department of Child, Youth and Family Studies, the research tracked 230 children from preschool through adolescence, examining how repeated exposure to smoking behaviors within the home affects later smoking and vaping behaviors by teens. The study collected self-reports on parental smoking habits during early childhood, including retrospective accounts of smoking during pregnancy, and later assessing teens’ attitudes toward and use of cigarettes and vaping devices.

The findings show that cumulative exposure to parental smoking over time significantly increases the likelihood that adolescents will both view smoking and vaping more favorably and engage in those behaviors themselves.

“With repeated exposure, as we suggest here, adolescents develop attitudes that are favorable to the substance, and then that results in smoking and vaping behaviors,” Mason said.

Most surprisingly, the researchers also found that a father’s smoking habits were more significantly linked to adolescent attitudes and use of cigarettes and e-cigarettes.

“I think our initial hunch would have been that mothers, more likely in the caregiving role and with prenatal exposure, would have more effect,” Mason said. “The father's role appears to be more salient — they're observing their father's smoking and being influenced by their father's attitudes.”

Mason pointed out that research into teen alcohol use follows a similar pattern, with paternal drinking exerting a stronger influence on future use. 

The research comes at a time when youth vaping use is trending upward. Data from the Nebraska High School Youth Tobacco Survey show that while cigarette use among high school students has dropped significantly, e‑cigarette use has climbed — from 19% reporting ever using e‑cigarettes in 2015 to 30% in 2022.

The 2024 National Youth Tobacco Survey found that 19% of students reported having used a tobacco product at some point, and about one in 10 high school students identified as current users. Vaping products are the most used product.

“Cigarette smoking plummeted to historic lows in terms of prevalence,” Mason said. “But of course, they quickly replaced that behavior with something else. Of the substances we’ve measured in our research — and we’ve assessed many others — by a long shot, vaping was the most prevalent, and we were seeing pretty high levels of vaping in kids at a young age.”

So what can parents do? 

Mason said this new research shows that early family intervention is needed to prevent children from becoming consumers of nicotine and tobacco products. He suggested, based on additional research literature, that parents who smoke or vape should avoid doing so in the presence of children and should have clear household rules and expectations that substance use is illegal and harmful. 

Mason is developing a new proposal for research into the effects of vaping on teens’ brain development. He noted that if children start vaping in their middle school or early teen years, by the time they graduate high school, they will have consumed the products for six or seven years. 

“We have very little understanding of what the consequences of that is for brain development,” he said. “It’s kind of an absurd experiment with our children’s health.”

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Journal

Drug and Alcohol Dependence

DOI

10.1016/j.drugalcdep.2026.113132 

Method of Research

Survey

Subject of Research

People

Article Title

Associations of parental smoking throughout childhood with adolescent smoking and vaping: Mediation via adolescent substance use attitudes

Article Publication Date

21-Jun-2026

 

TikTok content supports “illicit vape subculture” among teens

University of East Anglia

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image: 

Eleanor Bray, Research Associate at the University of East Angla

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Credit: University of East Anglia

TikTok content normalises illegal vaping among young people – according to research from the University of East Anglia (UEA). 

A new study shows that young people are far more likely to encounter illicit vaping content portrayed as normal, humorous and harmless on TikTok. 

Meanwhile evidence-based health advice on official health and education websites may fail to cut through the digital noise. 

That gap may be putting young audiences at risk, just weeks after The Tobacco and Vapes Act 2026 received royal assent, the team say. 

Dr Emma Ward, from UEA’s Norwich Medical School, said: “Our research shows that young people encounter very different messages about illicit vapes depending on where they look online.  

“While health and education websites tend to provide accurate, well-intentioned information about vaping in general, there is comparatively less information available about illicit vaping.  

“In contrast, TikTok content is far less regulated and often presents illegal vaping as conventional or even desirable. 

“These TikTok videos attract significant attention and can feed into an emerging illicit vape subculture, where young people exchange tips, experiences, and ways to bypass age restrictions.” 

The research found that some sellers actively glamorise illicit devices by marketing them as part of cosmetic or confectionery‑style ‘bundles’, a tactic the researchers say is designed to evade age verification. 

Dr Ward said: “This fragmented online environment is concerning. When accurate information is hard to find or feels unappealing, young people may turn instead to content that is more engaging but also more misleading, particularly on fast-growing video platforms like TikTok.”                 

How was the study carried out?  

To reflect what young people may encounter online, the researchers conducted systematic searches across both Google and TikTok. 

Educational and health websites were identified by reviewing the first six pages of Google search results, while TikTok content was analysed using popular hashtags linked to illicit vaping, including #noIDvape and #puffbundles. 

Research Associate, Eleanor Bray, from UEA’s School of Psychology, said: “By analysing both Google search results and TikTok content, we were able to compare formal health messaging with the informal content young people are most likely to consume day‑to‑day. 

“What stood out was how inconsistently illicit vaping is addressed across platforms. On TikTok, illegal products were sometimes actively glamorised, with vendors marketing devices through ‘bundle’ deals designed to evade age verification.” 

A Patient and Public Involvement and Engagement Representative (PPIE) with lived experience of vaping helped by looking over the findings and ensuring they accurately reflect youth experiences and relevance. 

Why does the research matter?  

The findings highlight an uneven online information landscape where accurate health advice struggles to compete with highly engaging social media content that can normalise or glamorise illegal vaping.  

Dr Ward said: “With the introduction of the Tobacco and Vapes Bill, our findings arrive at a critical moment. The research suggests that legislation alone will not be enough if video based platforms continue to expose young audiences to unregulated and misleading content.” 

Rather than turning away from social media, the researchers argue it should be embraced as part of the solution. 

Eleanor Bray said: “Public health messaging is more likely to be effective when it works with young people and the platforms they already use. To protect young audiences, we need online information that is not only accurate, but also accessible, engaging and relevant to their everyday lives.” 

This research was led by UEA’s Norwich Medical School.  

‘#NoIDVape: A content analysis of illicit vape messaging in young people’s information sources’ is published in Addiction Journal.  

ENDS 

NOTES TO EDITORS 

1/ For more information or to request an interview, please contact the UEA Communications office by emailing communications@uea.ac.uk. 

2/ A copy of the paper is available via the following Dropbox link: https://www.dropbox.com/scl/fo/6iaovpez9d50arp5r2uie/AOqmF39bXP1Wdv8sgTDwJns?rlkey=ugb6b56083nr1ngrharbb5pio&st=gxo8kpzg&dl=0

3/ The University of East Anglia (UEA) is a UK Top 25 university for research quality (Times Higher Education Rankings 2026) and UK 26th in the Complete University Guide. It also ranks in the World Top 60 (QS World Rankings for Sustainability 2025) and the World Top 20 for reduced inequalities and World Top 200 (Times Higher Education Impact Rankings 2025). Known for its world-leading research and good student experience, its 360-acre campus has won nine Green Flag awards in a row for its high environmental standards. The University is a leading member of Norwich Research Park, one of Europe’s biggest concentrations of researchers in the fields of environment, health and plant science. www.uea.ac.uk.    

 

 

 

 

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Journal

Addiction

DOI

10.1111/add.70476 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

‘#NoIDVape: A content analysis of illicit vape messaging in young people’s information sources’

Article Publication Date

1-Jun-2026

‘Open, Shameless Grift’: Right Before FDA Ruling on Vapes, Big Tobacco Company Gave $5 Million to a Trump Super PAC

“In the Trump administration, money beats MAHA every time.”


A young teenager vapes near the Boardwalk in Ocean City, Maryland on June 16, 2021.
(Photo by Shuran Huang for The Washington Post via Getty Images)

Stephen Prager
May 21, 2026
COMMON DREAMS

It was already known that President Donald Trump pressured top health officials to allow flavored vapes to hit the market after being leaned on by Big Tobacco executives earlier this month.

But The New York Times has revealed that the decision came just over a week after a massive super political action committee (PAC) donation from one of the cigarette companies looking to have the regulations lifted.


Report Details How Trump Did Big Tobacco’s Bidding on Flavored Vapes Despite Risk to Kids

Kenneth Vogel and Christina Jewett reported for the Times that on April 30, a subsidiary of the tobacco company Reynolds Americans—which owns Camel and Lucky Strike cigarettes—donated $5 million to the Trump-backed super PAC MAGA Inc., according to a financial report filed on Wednesday. It brought the total amount donated to the PAC up to $8 million.

The donation came just two days before tobacco industry executives held their sit-down with Trump at his golf club in Jupiter, Florida, where they told the president they were displeased with the FDA’s ban on flavored vapes, which was enacted in light of evidence that they were driving an epidemic of youth vaping.

According to a youth survey by the Centers for Disease Control and Prevention (CDC), the vast majority of middle- and high school-aged e-cigarette users prefer fruit and candy-flavored vapes.

The Times reported earlier this month that immediately after receiving an earful from executives at Reynolds and Philip Morris owner Altria, Trump rang Secretary of Health and Human Services Robert F. Kennedy, Jr., and Centers for Medicare and Medicaid Services head Mehmet Oz to complain about the FDA’s ban on e-cigarettes.

In the days that followed the meeting, Trump reportedly berated then-FDA Commissioner Marty Makary, who hesitated to reverse the policy due to the potential impact on children. Makary ultimately resigned less than a week later, along with RFK Jr.'s chief spokesperson, Rich Danker, citing disagreement about the e-cigarette policy change as the ultimate reason.

Within a week of the meeting with executives, the FDA announced it was dropping the ban on fruit-flavored vapes and authorizing the sale of mango and blueberry flavors by the Los Angeles-based company Glas Inc., which could pave the way for major cigarette makers to launch their own products on store shelves. It also allowed companies to add greater amounts of nicotine to pouches, which smokers often use in order to quit the habit.

Kush Desai, a spokesperson for the White House, told the Times that Reynolds’ $5 million donation to the MAGA Inc. PAC had nothing to do with the administration’s sudden shift in policy surrounding flavored vapes. He said “the only guiding factor behind the Trump administration’s health policymaking is gold standard science,” as well as “recent evidence that has found [vapes] can help adults quit smoking.”

A spokesperson for MAGA Inc. said his organization “is pleased to accept legal contributions from those who agree with President Trump’s America First agenda and his goal to make America great again.”

The $5 million donation is far from the only contribution Big Tobacco has made to Trump. As Common Dreams reported earlier this month:
Trump, who ran in 2024 on a pledge to “save vaping” as part of an effort to appeal to young voters, has raked in huge sums of money from the tobacco industry. According to data from OpenSecrets, his inaugural committee took over $3 million from vaping special interests, including $1.25 million from the Vapor Technology Association, and $1 million apiece from Altria and Breeze Smoke.

Altria, which owns Marlboro maker Philip Morris, and Reynolds American, which owns Lucky Strike and Camel, have also offered donations to Trump’s $400 million White House ballroom project. Reynolds, the biggest producer of menthol cigarettes, also gave $10 million to the super PAC backing Trump in 2024.

The Times also reported on Wednesday that a Reynolds executive was invited to a dinner hosted by Trump at the White House in October for donors who gave $2.5 million or more.



Critics described the $5 million donation as effectively a legal “bribe” to Trump and the latest example of the White House’s “open, shameless grift.”

It comes amid what seem to be endless reports of blatant self-dealing by Trump allies, most recently exemplified by the Trump-controlled Department of Justice’s settlement of a lawsuit from Trump against the Internal Revenue Service, which handed the president $1.8 billion in taxpayer funds that he plans to disperse to his allies as part of a so-called “weaponization fund,” which critics have dubbed a “slush fund.”

It’s also the latest example of Trump appearing to take actions in direct service of rich corporate donors—particularly in the fossil fuel, artificial intelligence, and cryptocurrency industries—or members of his family or personal inner circle.

Rep. Seth Magaziner (D-RI) also described the FDA’s policy change on vaping as a betrayal by the administration’s overseer, Kennedy. Though the HHS secretary has built his brand on pledges to “Make America Healthy Again” by decoupling corporate interests from health policy, he has been accused of bending to industry pressure on everything from food regulation to cancer-causing pesticides.

“In the Trump administration,” Magaziner said, “money beats MAHA every time.”

 

Avoidable inequalities remain in cardiovascular disease burden and care

European Society of Cardiology

Key takeaways

• The latest cardiovascular disease (CVD) statistics from the ESC Atlas of Cardiology have been published in the European Heart Journal.

• CVD continues to be a leading health challenge − the report highlights that CVD is responsible for more than 3 million deaths and 68 million healthy years of life lost annually across ESC member countries.

• Great steps forward in cardiovascular medicine are at risk of being offset by the high prevalence of risk factors such as hypertension, dyslipidaemia and obesity. · Middle-income countries continue to experience roughly double the incidence of CVD mortality of high-income nations, underscoring the need for stronger health system investment and more equitable service provision.

Sophia Antipolis, France – 19 May 2026: Cardiovascular disease (CVD) remains one of Europe’s biggest health challenges, according to new data from the European Society of Cardiology (ESC) Atlas of Cardiology, published in the European Heart Journal.1

The ESC Atlas of Cardiology celebrates its 10-year anniversary with the fifth edition of the ESC Atlas report. The publication again demonstrates that CVD is the most common cause of death in more than 50 ESC member countries studied. “The new report shows that CVD was responsible for more than 3 million deaths and 68 million healthy life-years lost annually. These are not abstract statistics − they represent lives lost too early, people living with long-term illness and health systems under growing pressure,” said Professor Adam Timmis, co-first author of the publication.

In line with previous ESC Atlas editions, a central message is the persistent and avoidable inequalities in cardiovascular risk, outcomes and access to care. Middle-income countries continue to experience roughly double the mortality of high-income nations. Professor Steffen Petersen, co-first author, noted: “Europe does not have one cardiovascular reality – ESC Atlas data show that the CVD burden is uneven across ESC countries. While there has been real progress in some countries, in many there are important gaps related to access to advanced diagnostics, procedures and specialist workforce.”

New ESC Atlas data emphasise the growing importance of wider determinants of cardiovascular health, with air pollution levels twice as high in middle-income countries as in high-income countries. In addition, the prevalence of vaping, particularly in young people, underscores the lack of evidence supporting e-cigarettes as an effective smoking cessation tool. The use of e-cigarettes increases the likelihood of later cigarette smoking among minors,2 strengthening the need for clearer regulation and youth-focused prevention policies.

The high prevalence of clinical risk factors such as hypertension, dyslipidaemia, obesity and diabetes remains a concern. Professor Timmis noted: “The progress that has been made in reducing the CVD burden across some ESC member countries is at risk of being offset by the epidemic of obesity and diabetes. The scale of the healthy life-years lost due to modifiable risk factors supports urgent efforts to improve prevention across a person’s life and aid early detection and guideline implementation. The medical and economic costs of inaction are huge.”

Female disadvantage is evident across many of the variables studied, including lower access to key cardiac procedures. While the ESC Atlas report highlighted that 40% of cardiologists are women, only 11.5% of interventional cardiologists are women, with even fewer women in cardiac surgery (8.8%).

“A major strength of the ESC Atlas is the contributions of the ESC National Cardiac Societies, which provide not only a picture of disease burden, but also a practical representation of how cardiovascular care is delivered, to whom and by whom in different countries,” explained Professor Petersen, who concluded: “The ESC Atlas is not just about describing the problem. Mapping these gaps is the first step towards closing them with targeted policy action, guiding investment and supporting national cardiovascular strategies that reduce inequalities.”

In addition to the fifth published edition, interactive data dashboards showing inequalities in CVD across more than 50 countries are freely available at eAtlas.

Previous editions of ESC Atlas data were presented to EU health ministers as part of discussions that led to the recent launch of the Safe Hearts Plan, which aims to anchor CVD at the centre of Europe’s public health agenda.

ENDS


References:

[1] Timmis A, Petersen SE, et al. European Society of Cardiology: Cardiovascular Disease Statistics 2025. Eur Heart J. 2026. https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehag345

[2] Hammond D, Reid JL, Cole AG, et al. Electronic cigarette use and smoking initiation among youth: a longitudinal cohort study. CMAJ. 2017;189:E1328−E1336.

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Journal

European Heart Journal

DOI

10.1093/eurheartj/ehag345 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

European Society of Cardiology: cardiovascular disease statistics 2025

Article Publication Date

19-May-2026

Report Details How Trump Did Big Tobacco’s Bidding on Flavored Vapes Despite Risk to Kids

“Trump could not care less about the health consequences and costs of giving teenagers access to addictive flavored poison if it means his tobacco industry donors can make record profits,” said one public health advocate.


Fruit flavor vape refills for e-cigarettes on shelves of a vaping shop, England, UK on December 15, 2025.
(Photo by Alex Segre/UCG/Universal Images Group via Getty Images)

Stephen Prager
May 13, 2026
COMMON DREAMS

The resignation of a pair of top health officials in the Trump administration this week has brought to light efforts by the president to help Big Tobacco executives and lobbyists sell addictive flavored e-cigarettes that could be marketed to children.

On Friday, the Food and Drug Administration (FDA) issued new guidance allowing cigarette makers to begin marketing and selling fruit- and candy-flavored vape products on store shelves, which were banned under previous administrations due to evidence that they were driving youth vaping.

The policy was enacted despite the strong opposition of then-FDA Commissioner Marty Makary, who resigned on Tuesday, reportedly because he could not in good conscience support it.

Makary’s resignation was followed by the departure of Rich Danker, the chief spokesperson for Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., who similarly warned that the policy “would appeal to children and expose them to nicotine addiction, lung damage, and higher risk of cancer” in a letter addressed to Trump on Wednesday.

Danker did not blame Trump for the policy in his letter; instead, he attributed it to “senior HHS officials in the immediate office of the secretary.”



This is despite the fact that The Wall Street Journal reported last week that Trump had personally berated Makary over his hesitation to enact the policy and had signed off on a plan to fire him.

A New York Times report on Wednesday confirms the extent of Trump’s direct involvement in strong-arming the FDA into enacting the policy. It found that he pressured higher-ups in HHS to move the policy forward amid a tongue-lashing from tobacco industry lobbyists and executives angry that they could not get in on the highly profitable sale of fruit- and candy-flavored vapes. Despite being illegal and mostly imported to the US from China, these vapes make up about 60% of the total e-cigarette market.

Trump, who ran in 2024 on a pledge to “save vaping” as part of an effort to appeal to young voters, has raked in huge sums of money from the tobacco industry. According to data from OpenSecrets, his inaugural committee took over $3 million from vaping special interests, including $1.25 million from the Vapor Technology Association, and $1 million apiece from Altria and Breeze Smoke.

Altria, which owns Marlboro maker Philip Morris, and Reynolds American, which owns Lucky Strike and Camel, have also offered donations to Trump’s $400 million White House ballroom project. Reynolds, the biggest producer of menthol cigarettes, also gave $10 million to the super PAC backing Trump in 2024.

According to The New York Times, executives for Altria and Reynolds were turning the screws on Trump over lunch at his golf club in Jupiter, Florida, in early May because they were “unhappy with the way the Food and Drug Administration was regulating their industry.”

Trump interrupted the conversation to call up RFK Jr. and Mehmet Oz, the head of the Centers for Medicare and Medicaid Services (CMS), and complained to them about the FDA’s regulation of e-cigarettes.

Within a week, the new policy had been enacted, and its leading opponent, Makary, was gone. He has since been replaced by Kyle Diamantas, whom the healthcare advocacy group Protect Our Care described as “a 30-something lawyer whose qualifications for such a critical public health role seem to begin and end at being Donald Trump Jr.'s ‘hunting buddy.’”

“Donald Trump’s fury at FDA head Makary was motivated by gross political opportunism and fat checks from the big vape industry,” said Jeremy Funk, the deputy director of Protect Our Care’s Public Health Watch team. “Trump could not care less about the health consequences and costs of giving teenagers access to addictive flavored poison if it means his tobacco industry donors can make record profits.”

While youth vaping is at a 10-year low, about 1.6 million middle and high school students were estimated to use vape products in the Centers for Disease Control and Prevention’s 2024 National Youth Tobacco Survey. Nearly 90% of them said they used fruit and candy-flavored vapes.

Dr. Jerome Adams, a physician and professor at Purdue University, said in a post on social media that the rise of vaping has fueled a rebound in nicotine usage among college-aged adults.

“Youth combustible cigarette smoking was already at an all-time low and consistently dropping before vaping came on the scene. There is literally no reason to believe that the majority of young people who are now vaping would have otherwise been smoking combustible cigarettes,” he said. “Amongst college-age and young adults, nicotine use is going back up to incredibly high rates—largely due to vaping.”



The new policy enacted by the FDA has so far only authorized the sale of flavored products by one company, the Los Angeles-based Glas Inc., which will be allowed to sell vapes in flavors like mango and blueberry under names like “Gold” and “Sapphire.”

The FDA sought to assuage fears of underage use by pointing to the Glas’ digital age-verification system, which requires the product to be connected to the Bluetooth of a phone owned by a person over the age of 21. However, it is expected that, especially amid industry pressure, more companies will have their products approved soon.

Kayla Hancock, director of Protect Our Care’s Public Health Project, said that while Makary had a “terrible record” as FDA commissioner, having taken actions that slowed vaccine development and launched dubious, politically charged “reviews” of abortion pills long found to be safe, “apparently, it wasn’t terrible enough for Donald Trump.”

“Hesitating to approve flavored vapes and not put American teens on a fast-track to lifelong addiction to harmful nicotine products is the bare minimum anyone could hope for from the Trump FDA,” she said. “But that was a bridge too far for Donald Trump, who sees young people as disposable political pawns that he can appeal to with poison while lining the pockets of his big vape donors.”

She said the ouster of Makary and his replacement with Diamantas “all but guarantees an FDA further consumed by chaos and driven by the wish lists of special interests that want profits put before public health.”

 

Does vaping help people quit smoking? Maybe.

Oxford University Press USA

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A new review paper in Nicotine and Tobacco Research, published by Oxford University Press, finds that while research has previously found that vaping is associated with subsequently quitting smoking, that may not always be true. In fact, it appears studies limited to people who actually want to quit smoking are less likely to find this relationship.

Tobacco smoking, in particular cigarette smoking, remains prevalent and is the leading cause of preventable death in the world. Most cigarette smokers express a desire to quit, but quitting is difficult. In the U.S., Food and Drug Administration-approved smoking cessation medications with demonstrated efficacy are available (mostly nicotine replacement therapy drugs such as varenicline and bupropion), but their use remains low. Although smoking prevalence in the U.S. has been declining, among the 28.8 million US adults who smoked cigarettes in 2022, approximately 67.7% were interested in quitting, 53.3% attempted to quit in the past year, 36.3% used medication to quit smoking, but only 8.8% were successful.

Nicotine Vape Products (also known as e-cigarettes) may help smokers quit smoking. Vaping has been increasing notably since 2010, with adult prevalence of current use estimated to be approximately 6% in 2022. Most users of vaping devices are current or former cigarette smokers, and there is higher use among younger smokers compared to older smokers. This finding may suggest that smokers turn to vaping as an alternative to traditional cigarettes, potentially using them as a tool to reduce or stop smoking.

Controversy remains regarding whether vape products are effective at helping people quit smoking. This is because reviews have largely overlooked studies using the same data source. To address this gap, investigators here conducted a narrative review to examine the differences in the reported association of studies that used data from the same source, the Population Assessment of Tobacco and Health (PATH) Study, a national longitudinal long-term study of tobacco and nicotine use in the United States. The researchers here extracted and summarized key study characteristics, including inclusion criteria, participant characteristics, study duration, and definitions of vaping exposure and smoking outcomes.

There are four key findings from the 38 reviewed studies. First, 63.2% of studies reported that vape product use was associated with increased odds of cigarettes cessation within one to three years, while the remaining studies did not find evidence of a positive association. Second, the absence of a positive association does not necessarily indicate that NVPs are ineffective. In several studies, vaping was compared with FDA-approved treatments (like varenicline or bupropion); in these contexts, vaping may not have appeared beneficial because it was not significantly better than established medical aids. Third, daily vape use was a stronger predictor of successful cessation than intermittent, occasional, or no use. Finally, study findings varied by sample selection: studies that included participants regardless of quit intention were more likely to report positive association than those restricted to smokers actively reported an intention to quit. Specifically, positive association were observed in 85% of studies without such restrictions, compared with 35.3% of studies limited to individuals attempting to quit using vape products.

“Regarding the association between vape products  and smoking cessation, researchers are advised against making broad claims based on any single study in general, and to be vigilant when multiple research teams analyze the same data,” said the paper’s lead author, Shu Xu. “Multiple studies using the same data source must be carefully examined in order to synthesize evidence and assess consistency of the findings.

The paper, “Effectiveness of Nicotine Vape Products (E-cigarettes) as a Smoking Cessation Aid for US Adults - A Narrative Review of Findings from the Population Assessment of Tobacco and Health Study,” is available (at midnight on April 30th) at https://doi.org/10.1093/ntr/ntag068.

To request a copy of the study, please contact:
Daniel Luzer 
daniel.luzer@oup.com

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Journal

Nicotine & Tobacco Research

DOI

10.1093/ntr/ntag068 

Method of Research

Literature review

Subject of Research

People

Article Title

Effectiveness of Nicotine Vape Products (E-cigarettes) as a Smoking Cessation Aid for US Adults - A Narrative Review of Findings from the Population Assessment of Tobacco and Health Study

Article Publication Date

30-Apr-2026