Adolescent Perceptions and Use of E-Cigarettes as Smoking Cessation Tools and for Pleasure: Data Analysis from National Youth Tobacco Survey (NYTS), 2011, 2015, 2019, and 2023
School of Human Sciences, College of Health and Human Sciences, Southern Illinois University, Carbondale, IL 62901, USA
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Author to whom correspondence should be addressed.
Societies 2025, 15(7), 201; https://doi.org/10.3390/soc15070201
Submission received: 24 April 2025
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Revised: 8 July 2025
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Accepted: 10 July 2025
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Published: 17 July 2025
Abstract
Once marketed as smoking cessation tools, e-cigarettes are used by adolescents mainly for entertainment, driven by aggressive marketing, appealing flavors, and safer alternatives to smoking. This study analyzes data from the National Youth Tobacco Survey (NYTS) to explore trends in adolescent perceptions and usage patterns of e-cigarettes from 2011 to 2023, focusing on their dual roles as cessation aids and recreational products. Cross-sectional data from the NYTS over four years (2011: N = 18,866; 2015: N = 17,711; 2019: N = 19,018; 2023: N = 22,069) formed the foundation of this study. This study investigated demographic trends, usage frequency, initial and future use patterns, and quitting behavior. Descriptive statistics and latent class analysis (LCA) were employed to examine adolescent e-cigarette use patterns, with statistical significance determined at p < 0.05. The reasons for using e-cigarettes have changed significantly over the years because of family or friends. In all years (2015–2023), use for smoking cessation dropped significantly (2.33% in 2023 vs. 6.95% in 2015). In 2023, 38% wanted to quit using e-cigarettes within 30 days, and 25% attempted to quit at least 10 times. Flavored e-cigarette users were more than twice as likely to consider quitting compared to those not interested in flavors (OR = 2.64). Our findings highlight a significant decrease in the use of e-cigarettes for cessation, with a corresponding increase in recreational use over time. These trends emphasize the urgency of implementing interventions to mitigate nicotine addiction and its associated health risks among adolescents. Adolescent e-cigarette use has transitioned from being primarily driven by cessation efforts to recreational purposes, largely influenced by appealing flavors and social factors such as peer influence, showing the need for stricter marketing regulations and targeted educational campaigns.
1. Introduction
The use of electronic cigarettes (e-cigarettes or electronic nicotine delivery systems [ENDS]) among adolescents has become a significant public health concern in recent years. Initially marketed as tools for smoking cessation, e-cigarettes have rapidly gained popularity, particularly among adolescents for recreational use [1,2,3]. These devices, which vaporize a liquid to produce inhalable aerosols, were introduced to the United States in 2007 and have since evolved in both public perception and usage patterns [3,4,5,6]. While early marketing efforts emphasized their potential as a safer alternative to traditional cigarettes, subsequent shifts in both perception and usage trends have raised new concerns [1,2,3,4,7,8].
People who use e-cigarettes in adolescence have increased significantly over the past decade. Between 2011 and 2018, the prevalence of e-cigarette use among middle and high school students in the U.S. rose sharply, from 1.5% to 20.8% [3,4,5,6]. This growth is partly driven by the appeal of flavored e-cigarettes, which have become a primary factor in attracting younger people who use e-cigarettes [3,6,9,10,11]. These people often perceive e-cigarettes as less harmful than traditional cigarettes and are influenced by social factors such as peer pressure and exposure to online advertising [3,6,9]. These trends highlight the need for updated public health interventions to address the misconceptions surrounding e-cigarette safety and their potential risks [12].
1.1. Significance of the Study
The increased use of e-cigarettes poses risks to the brain development of adolescents who use e-cigarettes and may lead to long-term health consequences, such as nicotine addiction [9,13,14]. The purpose of this study is to address the evolving patterns of e-cigarette use among adolescents and the misconceptions that may drive this behavior. Specifically, it seeks to fill a gap in understanding how adolescents’ perception of e-cigarettes has evolved over time, from smoking cessation tools to recreational products. Analyzing data from the National Youth Tobacco Survey (NYTS), this study aims to identify these trends and inform targeted public health strategies.
1.2. Objectives of the Study
This study examines the long-term patterns of e-cigarette use among adolescents from 2011 to 2023 using data from the NYTS. It aims to explore changes in how adolescents who use e-cigarettes perceive them, their evolving use as cessation aids and recreational tools, and the strategies adolescents who use e-cigarettes employ to quit e-cigarette use. The research questions guiding this study include.
- How have the perceptions and behaviors of adolescents who use e-cigarettes for smoking cessation changed from 2011 to 2023?
- What shifts have occurred in the recreational use patterns of adolescents who use e-cigarettes for pleasure-seeking and experimentation from 2011 to 2023?
- What strategies have adolescents who use e-cigarettes reported using in attempts to quit between 2011 and 2023?
2. Materials and Methods
The data used for this study were from the NYTS accessed through the US Centers for Disease Control and Prevention (CDC) website in January 2025. The NYTS is a crucial data collection tool used to monitor tobacco use among middle and high school students in the United States [15]. The data were obtained from four cross-sectional surveys conducted in 2011, 2015, 2019, and 2023. Related questions on e-cigarette use emerged in 2011 and continued to appear through 2023. While age and sex were considered in the stratification of the sample, no formal statistical adjustments were made in the analysis. This limitation is acknowledged in the discussion section.
This survey provides essential data to inform tobacco prevention and control programs. The NYTS has periodically facilitated tracking changes in tobacco use patterns over time. The survey is conducted annually, starting in the fall of 1999, with the latest data released in 2023. Information regarding the survey method and materials was obtained via the CDC website.
The NYTS sampled all U.S. middle and high school students to provide subgroup estimates with ±5% precision at 95% confidence. A multi-stage sampling design selected public and private schools by level and size, with all students in sampled classes invited. Stratification was based on school characteristics, minority composition, and geography to ensure subgroup representation. Post-stratification weights aligned the sample with national demographics using the Common Core of Data since 2015. Students completed a standardized, self-administered, classroom-based questionnaire. Trained data collectors implemented a uniform, one-week protocol without collecting personal identifiers. Data were analyzed using SUDAAN and SAS Version 8, applying Taylor series linearization to estimate variance and design effects [15].
Descriptive analyses were conducted to summarize patterns in e-cigarette use behavior and intention to use e-cigarettes for all four years. Ordinal logistic regression was employed to examine factors associated with quitting e-cigarette use only for 2023 since relevant variable (Are you seriously thinking about quitting e-cigarettes?) was available only for that year, given the ordinal nature of the outcome variable. To identify distinct subgroups based on motivations for e-cigarette use, latent class analysis (LCA) was performed using responses to six motivation-related indicators for only the 2019 and 2023 years due to the availability of standard variables across years. For continuous outcomes compared across latent classes, one-way ANOVA was used, and assumptions of normality were assessed through visual inspection and formal testing. All analyses were conducted using R [16], with significance levels set at p < 0.05.
3. Results
The average age of participants remained relatively consistent across the survey years, ranging from 14.04 to 15.49 years. Adolescents who had used e-cigarettes were generally older than those who had not, highlighting a pattern of increasing use with age. Gender differences were also observed, with a higher percentage of e-cigarette users being male across all years, except for 2011 and 2023, where a slight shift occurred.
In terms of ethnicity, the proportion of Hispanic or Latino participants who had used e-cigarettes declined slightly over time, while White adolescents consistently made up the majority of users, in line with their representation in the general population. Notably, there was an increasing representation of American Indian or Alaska Native and multiracial adolescents in later years among e-cigarette users (Table 1).
Furthermore, strategies for quitting e-cigarette use evolved over time. Reported methods such as seeking support from peers or adults, switching to alternative cessation tools, and gradually reducing use were most frequently cited in the more recent survey waves, particularly post-2019. This trend suggests a growing awareness among adolescents about the need to quit, accompanied by a more proactive approach to cessation in recent years.
Table 2 presents the analysis of adolescents’ responses to questions about their potential future use of e-cigarettes revealed statistically significant trends across the 2015, 2019, and 2023 survey years, with all chi-square tests yielding p < 0.001. Across these years, a consistent majority of participants expressed strong resistance to e-cigarette use. Specifically, about 65.1% of respondents reported that they were “Definitely not” curious about using an e-cigarette. Similarly, 74.7% indicated they would “Definitely not” try one soon, and 73.7% stated they would “Definitely not” accept an e-cigarette from a close friend.
However, a notable shift occurred in 2019, when the proportions of adolescents expressing curiosity (“Probably yes” or “Definitely yes”) peaked at 22.7%. Additionally, willingness to try an e-cigarette if offered by a friend reached 8.7%, suggesting a heightened susceptibility to peer influence during that year. These findings highlight the persistence of resistance to e-cigarette use, while also illustrating the fluctuating levels of vulnerability to peer influence and experimentation over time.
The outcome variable was based on the question: “Are you seriously thinking about quitting e-cigarettes?”, with five ordered response categories: (1) Yes, within 30 days; (2) Yes, within 6 months; (3) Yes, within 12 months; (4) Yes, but not within 12 months; (5) No. Higher values indicate lower intention to quit. The analysis includes only adolescents who responded to this question in the 2023 NYTS.
The results revealed several key findings related to adolescent e-cigarette use and quitting intentions. Firstly, a significant relationship was observed between the age at which an adolescent first used an e-cigarette and their likelihood of seriously considering quitting. Specifically, for each one-year increase in age at first use, the odds of contemplating quitting e-cigarettes decreased by 11% (OR = 0.89). This suggests that younger adolescents who begin using e-cigarettes are less likely to consider quitting, which is consistent with patterns of nicotine dependence observed in earlier studies (Table 3).
In addition, Table 3 results show that the length of time an individual had used e-cigarettes in their lifetime was significantly associated with their likelihood of thinking about quitting. Adolescents who had used e-cigarettes for only 1 day or between 2 to 10 days were less likely to consider quitting (OR = 0.54, CI: 0.34–0.86 and OR = 0.53, CI: 0.35–0.79, respectively), compared to those who had used them for over 100 days. However, adolescents who had used e-cigarettes for 11 to 20 days or 21 to 50 days exhibited higher odds of considering quitting (OR = 1.14, CI: 0.74–1.76 and OR = 1.02, CI: 0.68–1.53), though these results were not as statistically significant. This suggests that moderate use is linked to a greater likelihood of quitting, whereas both minimal and extensive use may lead to lower quitting intentions.
Furthermore, a trend was observed in the past 30 days: each additional day of e-cigarette use increased the odds of seriously thinking about quitting by 2% (OR = 1.02, CI: 1.01–1.03), indicating that more frequent use over a short period may trigger a desire to quit.
In terms of quit attempts, the data showed that adolescents who attempted to stop using e-cigarettes for one day or longer in the past 12 months were less likely to seriously consider quitting compared to those who did not attempt to stop. The odds of quitting decreased as the number of quit attempts increased. Specifically, those who had stopped once, twice, or 3 to 5 times had lower odds of considering quitting (OR = 0.28, OR = 0.31, OR = 0.27, respectively), with even further reductions in the odds for adolescents who had attempted to quit 6 to 9 times (OR = 0.26) and 10 or more times (OR = 0.18). This finding highlights the diminishing returns of repeated quit attempts, suggesting a complex relationship between past efforts to quit and future intentions.
The role of flavors in e-cigarette use was also a significant factor. Adolescents who used e-cigarettes because they were available in appealing flavors such as menthol, mint, candy, fruit, or chocolate were significantly more likely to seriously consider quitting, with odds 2.64 times higher compared to those who did not cite flavors as a reason for use (OR = 2.64, CI: 1.91–3.66). This finding underscores the influence of flavored products on adolescents’ e-cigarette use patterns and their quitting intentions.
Furthermore, Table 4 presents adolescents’ demographics by latent class categories. LCA revealed three distinct subgroups based on motivations for e-cigarette use, which were selected based on model fit and interpretability (Appendix A.1). The first group, labeled “Motivated” (users who are motivated), demonstrated high probabilities of endorsing all six reasons for e-cigarette use, including social influence, cost, perceived health benefits, and availability of flavors, suggesting a broadly motivated subgroup. The second group, “Irrational” (users without a rational reason), showed consistently low probabilities across all indicators, reflecting individuals with little to no endorsement of common motivations for e-cigarette use. The third group, “Rational” (users with a rational reason), endorsed select reasons at moderate levels, particularly perceived harm reduction and flavors, indicating a group with more targeted motivations. These class profiles reflect meaningful differences in how adolescents perceive and engage with e-cigarette use (Appendix A.2 and Appendix A.3).
Significant differences were found across the three latent classes in age, grade level, and past 30-day e-cigarette use. The Motivated class users were significantly older (M = 15.5, SD = 1.85) than the Irrational class users group (M = 15.2, SD = 1.84, p < 0.001), while the Rational class users (M = 15.2, SD = 2.64) did not differ significantly in age from either group. In terms of grade level, the Irrational class users group (M = 9.54, SD = 1.78) reported significantly lower grades than both the Rational class users (M = 10.0, SD = 1.90, p = 0.007) and the Motivated class users (M = 9.78, SD = 1.76, p < 0.001). However, the difference between the latter two was not statistically significant. For the past 30-day e-cigarette use, the Rational class users reported the highest frequency (M = 23.8 days, SD = 10.1), followed by the Motivated class users (M = 12.9, SD = 12.6) and the Irrational class users group (M = 3.63, SD = 7.52), with all pairwise differences statistically significant (p < 0.001). Chi-square tests revealed significant associations between latent class membership and participants’ sex, Hispanic ethnicity, and survey year (all p < 0.001), with the Motivated class users more likely to be male and from the 2019 survey, while the Rational class users were predominantly from 2019 and showed slightly higher representation among non-Hispanic individuals.
4. Discussion
This study aimed to examine adolescents’ perceptions of e-cigarettes, their evolution, and their understanding of these products as both smoking cessation aids and recreational tools. In doing so, we need to address the research question of what changes have occurred in adolescents’ views and behaviors toward using e-cigarettes to quit smoking between 2011 and 2023. While this study provides valuable insights, it is important to acknowledge that the use of cross-sectional data limits our ability to draw causal inferences regarding adolescent e-cigarette use and cessation behaviors. Longitudinal studies would be necessary to track these behaviors over time and to establish a clearer understanding of cause-and-effect relationships.
4.1. Historical Context
In 2003, China became the pioneer in the development of e-cigarettes [17,18]. These devices entered the United States market four years later, in 2007, and swiftly gained traction, particularly in nations with robust tobacco control initiatives [18]. By 2014, the e-cigarette market had expanded to include 466 brands that offered 7764 unique flavors [19]. The number of brands and flavors has continued to increase, reflecting the industry’s rapid growth and diversification [19].
E-cigarette design and technological advancements have reached significant milestones over time [3,5]. The initial e-cigarette models were called cigarlikes because they looked like standard cigarettes. Refillable tank-equipped eGos and mods offering extensive customization options gained widespread popularity [6,18]. The emergence of pod mod devices like JUUL represented a significant advancement in 2015 [3,13]. The sleek design and user-friendly operation of JUUL allowed it to become popular among young people [2,3]. By 2018, the e-cigarette market share owned by JUUL reached 75% [13].
Marketers promote e-cigarettes as healthier smoke substitutes and as solutions for quitting smoking [7]. The marketing approach of the e-cigarette industry mirrors traditional tobacco companies through television and radio campaigns in places where tobacco advertising is prohibited [8,20]. The early e-cigarette brands emphasized their superiority when compared to traditional cigarettes, which newer manufacturers followed with a strategy based on offering a range of flavors and product options [5,19].
4.2. Adolescent Use of E-Cigarettes
The swift surge in e-cigarette consumption among adolescents has become a significant public health concern [3,8,9]. The increasing exposure to nicotine in adolescents presents serious concerns because it harms brain development [9,14,21]. Data shows that e-cigarette usage among young people has grown drastically over multiple years [3,5,22]. Between 2011 and 2018, e-cigarette use among United States middle and high school students rose from 1.5% to 20.8% [3,5].
The National Youth Tobacco Survey (NYTS) data collected between 2015 and 2019 revealed that smoking rates dropped by 1.85 percentage points while e-cigarette use rates rose by 9.03 percentage points [22]. The rise in e-cigarette use rates has been documented across multiple countries, but the growth rate does not match that of the United States [9]. Adolescents choose to use e-cigarettes because they believe these products are less damaging and less habit-forming compared to regular cigarettes [23].
The availability of a variety of flavors, such as candy, fruit, and menthol, makes e-cigarettes attractive to adolescents [3,9]. Often, adolescents use e-cigarettes because they want to fit in with their peers and follow social norms [3,9,23]. Adolescents who encounter online e-cigarette advertising develop reduced perceptions of e-cigarette dangers and stronger intentions to use them [9]. The use of e-cigarettes among some adolescents stems from their desire to explore new products and satisfy their curiosity [3,24].
4.3. Change in Perception: Harm Reduction to Recreational Use
People first believed e-cigarettes could reduce smoking-related harm for smokers [5,18]. Several people believed e-cigarettes presented a reduced risk compared to traditional cigarettes while providing a potential quitting aid for smokers [1,5,9,18]. Research findings about potential risks combined with changing marketing tactics targeting young non-smokers caused a shift in perceptions about e-cigarettes [9,18]. However, this view has evolved as research revealed potential risks and marketing strategies shifted to appeal to younger, non-smoking populations [7,9].
Research suggests that e-cigarettes present fewer health risks compared to traditional tobacco cigarettes [5,18]. The concept that smokers could eliminate many dangerous compounds formed during tobacco combustion by using e-cigarettes instead of traditional cigarettes led to the development of this new approach [5,7]. Some healthcare professionals view e-cigarettes as an effective tool to assist patients in quitting smoking [5,7]. However, e-cigarettes now serve recreational purposes primarily among adolescents [3,9].
This shift occurred potentially because adolescents find e-cigarettes appealing due to manufacturing strategies that offer a wide range of popular flavors, including candy, fruit, and menthol [3,9]. Social media marketing campaigns have targeted young people with messages that portray e-cigarettes as a stylish lifestyle choice rather than an instrument for quitting smoking [3,9]. The perception among adolescents that e-cigarettes present zero risk stems from prevalent safety misconceptions [3,9].
Likewise, many e-cigarette users, including adolescents, continue to smoke traditional combustible cigarettes alongside their e-cigarette usage [7,20]. Among some special populations, such as cancer survivors, e-cigarette use had an even stronger positive association with combustible cigarette smoking [25]. The pattern diminishes the possible advantages of harm reduction because users remain at risk from harmful elements found in traditional cigarettes [9,24,26].
4.4. Duality in Perception: Smoking Cessation vs. Recreational Use
E-cigarettes, initially marketed as cessation tools, are now mainly used by adolescents for recreational purposes, driven by appealing flavors and social influences [3,9,23]. Research shows that e-cigarettes provide more successful outcomes compared to nicotine replacement therapy (NRT) when helping individuals stop smoking [27,28,29]. The available evidence does not provide a clear conclusion, and numerous health professionals express skepticism because this effect has been observed solely in a limited number of controlled clinical trials [7,23].
Adolescent recreational use of e-cigarettes creates concerns about the gateway effect because it may lead to traditional cigarette usage as well as other drug consumption [3,9,21]. Studies indicate that adolescents using e-cigarettes tend to transition to smoking traditional cigarettes as an initial step leading toward smoking behavior [1,3,23].
The adolescent population displays varied opinions about the health effects of using e-cigarettes [9,30]. There are differing opinions about e-cigarettes; some think they cause adverse health effects, but others either see no impact or remain uncertain [1,9,31]. Individuals who use both e-cigarettes and conventional cigarettes show more positive opinions about e-cigarettes [1,9].
4.5. Changes in Adolescent Views and Behaviors Using E-Cigarettes for Quitting Smoking
Our study reveals that the use of e-cigarettes among adolescents has evolved over time. As shown in the Results, the average age of participants remained relatively consistent over the years, ranging from 14.04 to 15.49 years. Adolescents who had used e-cigarettes were generally older than those who had not, suggesting that older adolescents may be more likely to experiment with or continue using e-cigarettes. In addition, our findings provide insight into why adolescents who use e-cigarettes first began using them, including whether they were to quit smoking or use other tobacco products. The percentage of adolescents who first used e-cigarettes to try to quit smoking other tobacco products such as cigarettes has consistently remained low and has decreased over time. However, the data focus on the initial reasons for use and not necessarily the ongoing views and behaviors related to quitting smoking with e-cigarettes.
Adolescent views and behaviors toward using e-cigarettes to quit smoking have become more nuanced, as research has revealed potential risks [5,18]. This shift was also influenced by changing marketing tactics that increasingly targeted young, nonsmoking populations [5,7,9,18]. Data from the National Youth Tobacco Survey (NYTS) between 2015 and 2019 indicated that while smoking rates dropped, e-cigarette use rates significantly increased [9,22,23], suggesting a potential displacement, but not necessarily a direct link, to smoking cessation among adolescents [27].
Research findings demonstrate that current adolescent smokers have higher rates of e-cigarette usage [1,5,18,32], possibly in an attempt to quit smoking or to use them in places where smoking is prohibited [33,34]. A 2015 survey of Chinese adolescents found that people who use e-cigarettes had higher odds of having tried to quit smoking conventional cigarettes and a notable percentage reported using e-cigarettes to help them stop smoking [35,36]. However, the success rate among those who used e-cigarettes for cessation is low [35].
In contrast, other research, such as an analysis of the North Carolina Youth Tobacco Survey (NCYTS) data from 2011 and 2013, indicated that US adolescents who used e-cigarettes demonstrated reduced chances of remaining abstinent from cigarette smoking [37]. The use of e-cigarettes correlated with intentions to quit smoking but had no connection to current usage [37]. Moreover, attempts to quit smoking have not consistently been linked to e-cigarette use [37]. This aligns with findings from a study of EU member states (2012–2014), which showed an increase in experimentation with e-cigarettes as a cessation aid. However, approximately half of those who attempted to report that e-cigarettes did not help reduce smoking or even led to increased smoking [38].
Adolescents cited cessation far less frequently as their reason for using e-cigarettes than adults, according to the 2013 NCYTS data [37]. Adolescent smokers who had quit attempts or cessation intentions during the previous year showed reduced e-cigarette usage. The reasons why adolescents who use e-cigarettes try them remain unclear, as they might experiment to quit smoking or out of curiosity, or to find a healthier alternative. The varied reasons for using e-cigarettes (cessation-motivated vs. experimentation) can make the association between cessation intentions and e-cigarette use patterns non-significant [37].
E-cigarette use as a method to quit smoking did not serve as the main reason adolescents who use e-cigarettes began using them during the survey period. The decreasing trend for this reason for first use might indicate a declining perception or practice of using e-cigarettes for smoking cessation among adolescents initiating e-cigarette use. Notably, there is no comparable data available for 2011 regarding the specific reasons for its first use.
4.6. Changes in Adolescent Perceptions and Recreational Use of E-Cigarettes for Pleasure-Seeking and Experimentation
The data from the Results section indicated that e-cigarette use has largely shifted toward recreational use, particularly for pleasure-seeking and experimentation [33]. The proportion of adolescents who reported using e-cigarettes for reasons other than cessation increased over time, especially among those who were older. This was consistent with the findings showing a gradual increase in the number of older adolescents engaging in e-cigarette use, potentially driven by peer influence and the appeal of flavors, as shown in the results [33,37].
Our study also revealed significant changes in the use of e-cigarettes among adolescents, which can be linked to experimentation and potential pleasure seeking. The prevalence of ever having used e-cigarettes showed a dramatic increase before decreasing. This peak in “ever use” in 2019 suggests a period of increased experimentation. Looking at the reasons for first use, several factors pointed toward recreational use and experimentation: “A friend or family member used them”. The top reasons cited in both 2015 and 2019 demonstrated a substantial social influence during the first experiment. This proportion is expected to decrease significantly by 2023. They are available in flavors such as menthol, mint, candy, fruit, and chocolate [8,36].
Flavors were a major driver for initial use in 2015 and 2019, suggesting pleasure-seeking or curiosity about different tastes as motivators. This indicates a substantial decrease in 2023. The recreational use of e-cigarettes among adolescents is driven by several factors, including pleasure seeking, curiosity, and desire to try new products [33]. The appeal of flavors such as menthol, candy, and fruit are significant motivators, particularly for high school students [33,34,37,39], and may contribute to the perception of lower harm [39]. Adolescents who use e-cigarettes also report using them because they are perceived as “cool” and a “healthier/better alternative” to cigarettes [33]. Furthermore, peer and family influences play a substantial role in initiating e-cigarette usage (Kong et al. 2014). The convenience of hiding e-cigarettes together with their availability encourages people to use them for recreational purposes [33,34].
“I use them for some other reason” was also a notable percentage in all three years, 2015, 2019, and 2023, respectively, which could encompass various motivations, including experimentation or perceived enjoyment not captured in the other categories. Many adolescents choose to use e-cigarettes because they believe that these products are less damaging and less habit-forming than regular cigarettes [9,22,23,40]. However, this perception exists alongside recognition of the potential for nicotine addiction [21,35,37].
Our findings on curiosity and willingness to try among adolescents who do not use e-cigarettes also reflect the trends in potential experimentation. The percentage of non-users who had ever been curious about using e-cigarettes increased from definitely yes and probably yes in 2015 to 2019, before decreasing in 2023. Similarly, the percentage of non-users who thought they would try an e-cigarette soon followed a similar pattern, increasing from definitely yes to probably yes in 2015 and 2019, and then decreasing in 2023. Even though recreational e-cigarette use among adolescents has increased, most adolescents express negative attitudes toward their peers who use e-cigarettes [41]. This suggests a complex social dynamic surrounding e-cigarette use. Moreover, perceptions can differ based on the type of electronic nicotine delivery system (ENDS) used. The public may view people who use e-hookahs as youthful trendsetters, while seeing people who use e-cigarettes as older individuals struggling with addiction [34].
Curiosity and appealing flavors remain the main reasons for trying e-cigarettes. Some adolescents also believe that e-cigarettes can be used anywhere [33]. The lack of regulations surrounding e-cigarettes can lead to different interpretations, with some viewing them as a sign of safety and others as an indication of risk [34]. These trends suggest an increase in experimentation and potentially pleasure-seeking behaviors related to e-cigarettes among adolescents between 2011 and 2019, followed by a decrease in these behaviors and perceptions by 2023. The role of social influence and flavors as initial motivators appears to have diminished by 2023.
4.7. Methods Used by Adolescents Who First Used or Formerly Used E-Cigarettes to Stop Quitting
The only metric that provided data specifically for the quitting intentions and past quit attempts of adolescents who use e-cigarettes was the 2023 dataset. A significant proportion of the respondents considered quitting e-cigarettes. A high proportion of participants thought about quitting within 30 days, a moderate proportion thought about quitting within 6 and 12 months, and a low proportion thought about quitting, but not within 12 months. Only the average proportion did not consider quitting.
Many had made quit attempts in the past 12 months; a low proportion had stopped using e-cigarettes for one day or longer, a low proportion stopped two times, a moderate proportion stopped three to five times, a small proportion stopped six to nine times, and a moderate proportion stopped 10 or more times. Only an average proportion of the participants reported that they had not tried to stop in the past 12 months. Data from 2023 indicates that a substantial number of adolescents who used e-cigarettes were motivated to quit smoking and made efforts to do so.
According to the 2021 NYTS data, a significant majority of adolescents who use e-cigarettes and made a past year quit attempt reported unassisted quitting, indicating that they did not use any resources [42]. For those who sought assistance, the top methods included peer support, help on the Internet, mobile apps, text messaging, and parental support [43]. The less frequently used methods were help or advice from a teacher or coach, telephone helpline or Quitline, and treatment from medical facilities (Dai et al., 2023). The demographic variations were observed using these methods. For example, female vapers are less likely to seek parental support, whereas Hispanic vapers are more likely to seek support from friends and parents (Dai et al. 2023). Adolescents who use e-cigarettes and view e-cigarette use as harmful avoided seeking advice from friends but turned to mobile apps or text messaging programs [42]. Adolescents who use both e-cigarettes and other tobacco products seek assistance from teachers/coaches and healthcare providers and visit medical facilities more often than those who use only e-cigarettes [42].
The 2013 NCYTS data showed that most adolescent smokers who tried to stop smoking used the “cold turkey” method or made no attempt to quit smoking during the previous year [37]. Adolescents who turned to cessation aids showed lower rates of present-day e-cigarette use, but those who tried to quit without assistance had a previous e-cigarette experience [37]. The purpose of e-cigarette use during attempts to quit (curiosity, cessation aid, or healthier alternatives) remains unclear [37]. The category “Something else” was also reported as a cessation method by a notable portion of adolescents, suggesting other uncaptured strategies are being employed [42]. The findings suggest that using e-cigarettes as a tool to quit smoking is not a primary or increasing motivation for adolescents between 2015 and 2023. Recreational use and experimentation, potentially driven by social influences and flavors, saw a rise and decline during this period [30]. By 2023, a significant proportion of adolescent e-cigarette users were considering quitting and attempting to do so, although the specific methods employed were not detailed for any of the surveyed years.
In line with Dai et al. (2023), our study reveals that a significant majority of adolescent who use e-cigarettes, made a past year quit attempt reported unassisted quitting, indicating that they did not use any resources. For those who sought assistance, the top methods included peer support, help on the Internet, mobile apps, text messaging, and parental support. The less frequently used methods were help or advice from a teacher or coach, telephone helpline or Quit line, and treatment from medical facilities (Dai et al., 2023).
4.8. Policy and Public Health Implications
The NYTS data revealed several public health and policy implications through its findings on usage trends and reasons. The sharp rise in e-cigarette usage from 2011 to 2019 demonstrates the necessity for specialized interventions to stop adolescent initiation. Public education initiatives must focus on the dangers of nicotine addiction and long-term health risks associated with e-cigarette use. The decline in the perception of reduced harm as a motivation for starting e-cigarette use indicates that previous anti-e-cigarette use campaigns have achieved some positive results. Sustained interventions remain essential, because curiosity rates vary significantly. The role of flavors in attracting adolescents who use e-cigarettes for the first time diminished in 2023 but indicates that new regulations on flavored e-cigarette products might alter adolescents’ decisions to start using them. Implementing age restrictions and point-of-sale regulations to control access to these products is essential. Prevention initiatives need to address social norms and peer influences, because friends and family play a key role in the initiation of e-cigarette use. The large number of adolescents who use e-cigarettes and expressed a desire to quit and attempted quitting over the last few years presents an opportunity to develop cessation programs for adolescent users.
5. Conclusions
Adolescents have come to view e-cigarettes as both recreational products and smoking cessation tools because their usage patterns among teens have evolved throughout recent years. Social influences through friends or family using e-cigarettes along with flavored options emerged as the leading reasons for usage, but these influences are diminishing. The percentage of adolescents who started using e-cigarettes to stop smoking other tobacco products remained low and reduced over time. The reduction in the use of e-cigarettes among adolescents likely results from both intervention efforts and increased public awareness. The rise of concurrent e-cigarette and traditional cigarette use shows a correlation with multiple efforts to quit smoking. Our study results suggest that implementing stricter marketing controls alongside flavor bans and educational campaigns can help correct safety misconceptions. These actions will strengthen efforts to address critical health issues that aim to diminish nicotine addiction and its harmful effects on young people.
6. Limitations
It is difficult to establish causal relationships between e-cigarette use and smoking cessation outcomes using cross-sectional data for 2011, 2015, 2019, and 2023. Of the four-year reviews, only 2023 asked questions related to quitting intentions. Temporal changes in the NYTS methodology across the years surveyed may have affected the comparability of the data over the past years. Using self-reported data on e-cigarette use and cessation attempts may be subject to social desirability biases, and longitudinal research is needed to track these behaviors over time.
Author Contributions
Conceptualization, O.I., C.K. and W.J.; methodology, O.I.; software, C.K. and O.I.; validation, O.I., C.K. and W.J.; formal analysis, O.I.; investigation, O.I.; resources, O.I. and C.K.; data curation, C.K.; writing—original draft preparation, O.I.; writing—review and editing, O.I., C.K. and W.J.; visualization, C.K.; supervision, W.J.; project administration, O.I.; funding acquisition, W.J. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
This study utilizes publicly accessible, de-identified secondary data, making it exempt from institutional review board (IRB) approval per ethical standards for research involving human subjects.
Informed Consent Statement
Not applicable.
Data Availability Statement
The data presented in this study are available in [Historical NYTS Data and Documentation] at [https://www.cdc.gov/tobacco/about-data/surveys/historical-nyts-data-and-documentation.html] (accessed on 23 April 2025).
Conflicts of Interest
The authors declare no conflict of interest.
Abbreviations
The following abbreviations are used in this manuscript:
| CDC | Centers for Disease Control and Prevention |
| LCA | Latent Class Analysis |
| NYTS | National Youth Tobacco Survey |
| NCYTS | North Carolina Youth Tobacco Survey |
Appendix A
Appendix A.1
Table A1.
Model Fit Indicators across Latent Class Models (N = 8944).
| Classes | LL | AIC | BIC | G2 | df |
|---|---|---|---|---|---|
| 1 | −17,812 | 35,635 | 35,678 | 3181 | 57 |
| 2 | −16,530 | 33,087 | 33,180 | 618 | 50 |
| 3 | −16,372 | 32,784 | 32,928 | 301 | 43 |
| 4 | −16,272 | 32,597 | 32,792 | 101 | 36 |
| 5 | −16,251 | 32,570 | 32,815 | 60 | 29 |
| 6 | −16,239 | 32,561 | 32,855 | 36 | 22 |
LL = Log Likelihood; AIC = Akaike Information Criterion; BIC = Bayesian Information Criterion; G2 = G-Squared; df = Degrees of Freedom.
Appendix A.2
Table A2.
Latent Class definition by reasons for e-cigarette use.
| Class | Q10_1 | Q10_2 | Q10_3 | Q10_4 | Q10_5 | Q10_6 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Motivated | 0.64 | 0.36 | 0.71 | 0.29 | 1.00 | 0.00 | 0.54 | 0.46 | 0.87 | 0.13 | 0.83 | 0.17 |
| Rational | 0.19 | 0.81 | 0.00 | 1.00 | 0.00 | 1.00 | 0.00 | 1.00 | 0.00 | 1.00 | 0.00 | 1.00 |
| Irrational | 0.36 | 0.64 | 0.08 | 0.92 | 0.05 | 0.95 | 0.07 | 0.93 | 0.28 | 0.72 | 0.41 | 0.59 |
Q10_1 = A friend or family member used them; Q10_2 = To try to quit using other tobacco products, such as cigarettes; Q10_3 = They cost less than other tobacco products, such as cigarettes; Q10_4 = I have seen people on TV, online, or in movies use them;Q10_5 = They are less harmful than other forms of tobacco, such as cigarettes; Q10_6 = They are available in flavors, such as menthol, mint, candy, fruit, or chocolate.
Appendix A.3
Figure A1.
Latent Class probabilities by reasons for e-cigarette use. Q10_1 = A friend or family member used them; Q10_2 = To try to quit using other tobacco products, such as cigarettes; Q10_3 = They cost less than other tobacco products, such as cigarettes; Q10_4 = I have seen people on TV, online, or in movies use them;Q10_5 = They are less harmful than other forms of tobacco, such as cigarettes; Q10_6 = They are available in flavors, such as menthol, mint, candy, fruit, or chocolate.
Figure A1.
Latent Class probabilities by reasons for e-cigarette use. Q10_1 = A friend or family member used them; Q10_2 = To try to quit using other tobacco products, such as cigarettes; Q10_3 = They cost less than other tobacco products, such as cigarettes; Q10_4 = I have seen people on TV, online, or in movies use them;Q10_5 = They are less harmful than other forms of tobacco, such as cigarettes; Q10_6 = They are available in flavors, such as menthol, mint, candy, fruit, or chocolate.
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Table 1.
Descriptive analysis by ever used e-cigarette even once or twice for four years.
| Variable | 2011 (N = 18,600) | 2015 (N = 17,400) | 2019 (N = 18,972) | 2023 (N = 21,885) | ||||
|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | Yes | No | |
| Age 1 | 15.61 (1.86) | 14.50 (2.07) | 15.49 (1.82) | 14.17 (1.99) | 15.35 (1.85) | 14.04 (2.04) | 15.12 (1.90) | 14.16 (1.93) |
| Grade 1 | 10.00 (1.76) | 8.82 (1.99) | 9.80 (1.74) | 8.50 (1.92) | 9.66 (1.79) | 8.41 (1.94) | 9.43 (1.80) | 8.43 (1.89) |
| Gender 2 | ||||||||
| Male | 227 (41%) | 9088 (50%) | 2570 (55%) | 6191 (49%) | 3426 (54%) | 6346 (51%) | 1538 (46%) | 9512 (52%) |
| Female | 330 (59%) | 8954 (50%) | 2075 (45%) | 6452 (51%) | 2958 (46%) | 6132 (49%) | 1836 (54%) | 8869 (48%) |
| Hispanic or Latino or other 2 | ||||||||
| No | 381 (69%) | 11,877 (67%) | 3019 (67%) | 9035 (74%) | 4432 (70%) | 8663 (70%) | 2184 (65%) | 13,026 (72%) |
| Yes | 168 (31%) | 5893 (33%) | 1488 (33%) | 3159 (26%) | 1902 (30%) | 3651 (30%) | 1151 (35%) | 5061 (28%) |
| Race 2 | ||||||||
| American Indian or Alaska Native | 29 (5.9%) | 840 (5.5%) | 199 (4.8%) | 444 (3.9%) | 295 (4.8%) | 617 (5.3%) | 350 (11%) | 1287 (7.5%) |
| Asian | 18 (3.7%) | 642 (4.2%) | 110 (2.7%) | 594 (5.2%) | 218 (3.6%) | 779 (6.6%) | 152 (4.8%) | 2042 (12%) |
| Black or African American | 50 (10%) | 3748 (25%) | 652 (16%) | 2230 (20%) | 820 (13%) | 2140 (18%) | 449 (14%) | 2900 (17%) |
| Native Hawaiian or Other Pacific Islander | 8 (1.6%) | 286 (1.9%) | 117 (2.8%) | 192 (1.7%) | 143 (2.3%) | 241 (2.1%) | 69 (2.2%) | 308 (1.8%) |
| White | 338 (69%) | 8355 (55%) | 2666 (65%) | 7241 (63%) | 4060 (67%) | 7065 (60%) | 1733 (55%) | 9178 (53%) |
| More than 1 Race | 50 (10%) | 1328 (8.7%) | 365 (8.9%) | 725 (6.3%) | 559 (9.2%) | 883 (7.5%) | 395 (13%) | 1469 (8.5%) |
1 A continuous variable and values are mean (sd) within the table. 2 A categorical variable and values are n (%) within the table. The total sample size for 2011, 2015, 2019, and 2023 was 18,600, 17,400, 18,972, and 21,885, respectively.
Table 2.
Possible future use of e-cigarettes among adolescents who have never tried an e-cigarette.
| Variable | 2015 (N = 12,727) | 2019 (N = 12,563) | 2023 (N = 18,494) | Total (N = 43,784) |
|---|---|---|---|---|
| Curiosity about e-cigarette use | ||||
| Definitely yes | 547 (4.3%) | 807 (6.4%) | 666 (3.6%) | 2020 (4.6%) |
| Probably yes | 1473 (11.6%) | 2043 (16.3%) | 2391 (13%) | 5907 (13.5%) |
| Probably not | 1648 (13%) | 2077 (16.6%) | 3570 (19.4%) | 7295 (16.7%) |
| Definitely not | 9031 (71.1%) | 7596 (60.7%) | 11,770 (64%) | 28,397 (65.1%) |
| Likelihood of trying an e-cigarette soon | ||||
| Definitely yes | 083 (0.7%) | 109 (0.9%) | 080 (0.4%) | 272 (0.6%) |
| Probably yes | 537 (4.2%) | 673 (5.4%) | 508 (2.8%) | 1718 (3.9%) |
| Probably not | 2315 (18.2%) | 2676 (21.4%) | 4043 (22%) | 9034 (20.8%) |
| Definitely not | 9752 (76.9%) | 9037 (72.3%) | 13,713 (74.8%) | 32,502 (74.7%) |
| Willingness to use an e-cigarette if offered by a friend | ||||
| Definitely yes | 159 (1.3%) | 152 (1.2%) | 113 (0.6%) | 424 (1%) |
| Probably yes | 747 (5.9%) | 937 (7.5%) | 607 (3.3%) | 2291 (5.3%) |
| Probably not | 2182 (17.2%) | 2571 (20.6%) | 3997 (21.8%) | 8750 (20.1%) |
| Definitely not | 9611 (75.7%) | 8817 (70.7%) | 13,626 (74.3%) | 32,054 (73.7%) |
For each year of data, the sample used in this analysis included adolescents who had never tried an e-cigarette.
Table 3.
Factors Associated with Intention to Quit E-Cigarette Use Among Adolescents (N = 1403), using Ordinal Logistic Regression.
Table 3.
Factors Associated with Intention to Quit E-Cigarette Use Among Adolescents (N = 1403), using Ordinal Logistic Regression.
| Variables | OR | CI-2.50% | CI-97.50% |
|---|---|---|---|
| Age | 1.06 | 0.95 | 1.18 |
| Grade | 0.95 | 0.85 | 1.06 |
| Age at first e-cigarette use | 0.89 | 0.84 | 0.95 |
| Past 30-day e-cigarette use | 1.02 | 1.01 | 1.03 |
| Gender (Ref = Male) | |||
| Female | 0.91 | 0.74 | 1.14 |
| Hispanic or Latino or other (Ref = No) | |||
| Yes | 1.12 | 0.88 | 1.43 |
| Race (Ref = White) | |||
| American Indian or Alaska Native | 0.91 | 0.64 | 1.28 |
| Asian | 0.73 | 0.42 | 1.24 |
| Black or African American | 1.07 | 0.77 | 1.49 |
| Native Hawaiian or Other Pacific Islander | 1.23 | 0.54 | 2.79 |
| More than 1 | 0.93 | 0.67 | 1.30 |
| Lifetime e-cigarette use (Ref = Over 100 days) | |||
| 1 day | 0.54 | 0.34 | 0.86 |
| 2 to 10 days | 0.53 | 0.35 | 0.79 |
| 11 to 20 days | 1.14 | 0.74 | 1.76 |
| 21 to 50 days | 1.02 | 0.68 | 1.53 |
| 51 to 100 days | 0.94 | 0.64 | 1.38 |
| Quit attempts in the past 12 months (Ref = did not try, past 12 months) | |||
| 1 time | 0.28 | 0.19 | 0.41 |
| 2 times | 0.31 | 0.22 | 0.45 |
| 3 to 5 times | 0.27 | 0.19 | 0.37 |
| 6 to 9 times | 0.26 | 0.17 | 0.40 |
| 10 or more times | 0.18 | 0.13 | 0.25 |
| Reasons for current e-cigarette use (Ref = Not this reason) | |||
| A friend or family member used them | 0.87 | 0.69 | 1.11 |
| To try to quit using other tobacco products, such as cigarettes | 0.78 | 0.44 | 1.38 |
| They cost less than other tobacco products, such as cigarettes | 1.25 | 0.73 | 2.15 |
| I have seen people on TV, online, or in movies use them | 0.98 | 0.50 | 1.89 |
| They are less harmful than other forms of tobacco, such as cigarettes | 1.19 | 0.79 | 1.79 |
| They are available in flavors such as menthol, mint, candy, fruit, or chocolate | 2.64 | 1.91 | 3.66 |
| I use them for some other reason | 0.96 | 0.70 | 1.31 |
Table 4.
Adolescent’s demographics by Latent class categories (N = 8944).
| Variable | Motivated | Irrational | Rational | Total | p-Value |
|---|---|---|---|---|---|
| Age 1 | 15.17 (2.64) | 15.23 (1.84) | 15.51 (1.85) | 15.31 (1.86) | <0.001 |
| Grade 1 | 10.03 (1.90) | 9.54 (1.78) | 9.78 (1.76) | 9.62 (1.78) | <0.001 |
| Past 30-day e-cigarette use 1 | 23.82 (10.10) | 3.63 (7.52) | 12.95 (12.59) | 6.63 (10.44) | <0.001 |
| Gender 2 | <0.001 | ||||
| Male | 93 (75.6 %) | 3146 (50.7%) | 1350 (51.6%) | 4589 (51.3%) | |
| Female | 30 (24.4%) | 3061 (49.3%) | 1264 (48.4%) | 4355 (48.7%) | |
| Hispanic/Latino ethnicity 2 | 0.031 | ||||
| No | 86 (69.9%) | 4425 (71.3%) | 1934 (74%) | 6445 (72.1%) | |
| Yes | 37 (30.1%) | 1782 (28.7%) | 680 (26%) | 2499 (27.9%) | |
| Survey year 2 | <0.001 | ||||
| 2023 | 52 (42.3%) | 2668 (43%) | 271 (10.4%) | 2991 (33.4%) | |
| 2019 | 71 (57.7%) | 3539 (57%) | 2343 (89.6%) | 5953 (66.6%) | |
1 A continuous variable and values are mean (sd) within the table. P-values were related to the ANOVA test. Post-hoc pairwise comparisons were conducted using the Tukey Honestly Significant Difference (HSD) test. 2 A categorical variable and values are n (%) within the table. p-values were related to the Chi-square test.
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Ibukun, O.; Kumbalatara, C.; Jayawardene, W. Adolescent Perceptions and Use of E-Cigarettes as Smoking Cessation Tools and for Pleasure: Data Analysis from National Youth Tobacco Survey (NYTS), 2011, 2015, 2019, and 2023. Societies 2025, 15, 201. https://doi.org/10.3390/soc15070201
AMA Style
Ibukun O, Kumbalatara C, Jayawardene W. Adolescent Perceptions and Use of E-Cigarettes as Smoking Cessation Tools and for Pleasure: Data Analysis from National Youth Tobacco Survey (NYTS), 2011, 2015, 2019, and 2023. Societies. 2025; 15(7):201. https://doi.org/10.3390/soc15070201
Chicago/Turabian StyleIbukun, Olusoji, Chesmi Kumbalatara, and Wasantha Jayawardene. 2025. "Adolescent Perceptions and Use of E-Cigarettes as Smoking Cessation Tools and for Pleasure: Data Analysis from National Youth Tobacco Survey (NYTS), 2011, 2015, 2019, and 2023" Societies 15, no. 7: 201. https://doi.org/10.3390/soc15070201
APA StyleIbukun, O., Kumbalatara, C., & Jayawardene, W. (2025). Adolescent Perceptions and Use of E-Cigarettes as Smoking Cessation Tools and for Pleasure: Data Analysis from National Youth Tobacco Survey (NYTS), 2011, 2015, 2019, and 2023. Societies, 15(7), 201. https://doi.org/10.3390/soc15070201
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