Teen use of electronic cigarettes fell sharply in 2021, the second consecutive year of big declines, according to the government’s annual National Youth Tobacco Survey.
This year, 11.3 percent of high school students reported that they currently vape — down from 19.6 percent in 2020 and strikingly lower than the 27.5 percent reported in 2019, according to a report of the survey issued Thursday by the Centers for Disease Control and Prevention.
Even with the drop, the survey found that more than 2 million high school and middle school students were currently using e-cigarettes. And because the declines came during the pandemic, some public health experts questioned whether the data really signaled a change in youth vaping trends over the long term.
E-cigarettes came on the market in the United States in the early 2000s, devices designed to give smokers the nicotine fix they craved without the carcinogens that come from burning cigarettes. But they began to catch on with teenagers who had never smoked, and in 2018, the Food and Drug Administration warned of an epidemic of vaping among teenagers who were becoming addicted to nicotine through e-cigarettes.
In a statement, Mitch Zeller, the director of the F.D.A.’s Center for Tobacco Products, said that the new data remained concerning, particularly the popularity of flavored e-cigarettes, which were banned by the Trump administration but remain on the market in certain forms through a regulatory loophole. According to the report, nearly 85 percent of youth e-cigarette users said they used flavored products. The most common flavors were fruit flavors, but also included candy, mint and menthol — consistent with prior years.
“We are equally disturbed by the quarter of high school students who use e-cigarettes and say they vape every single day,” Mr. Zeller said, pointing to the data that shows 27 percent of regular users are daily users.
The American Heart Association expressed concern as well.
“The results show that the crisis of e-cigarette use among youth remained very much alive even with kids spending large amounts of time at home during the pandemic,” the heart association said in a published statement. “With millions of children having returned to school this fall, immediate action is needed to prevent the sale of flavored e-cigarettes and other tobacco products, including menthol products.”
Robin Koval, president and chief executive of Truth Initiative, a nonprofit organization focused on ending nicotine addiction, emphasized that the sharp drop in youth vaping may be attributable to a temporary factor, the pandemic restrictions that kept young people at home. “Kids were not in school, they were not seeing friends,” Ms. Koval said.
Another striking change seen in the new data was the decline in popularity of Juul, the once-dominant e-cigarette maker, whose sleek devices, sometimes dubbed “the iPhone of e-cigarettes,” are considered by many to started the youth vaping trend. Juul now only sells menthol and tobacco flavors, after the F.D.A. banned flavored pods in early 2020.
The latest survey showed that Puff Bars, which sells a variety of flavors, is the most popular brand among youth, with 26 percent of regular high school e-cigarette users reporting Puff as “their usual brand.” Other popular brands include Vuse (10.8 percent) and SMOK (9.6 percent), while just 5.7 percent said their usual brand is Juul.
That change reflects a loophole in federal regulations that allowed flavors to be sold in disposable e-cigarettes while banning them in the pods go in refillable cartridge-based devices that companies like Juul sell. The loophole caused a surge in sales of disposables and in popularity among disposable brands, notably Puff Bars.
In 2021, disposables were most commonly used, by about 53 percent of youth who vape, followed by refillable or prefilled cartridges at 28.7 percent. A year ago, those figures were essentially flipped, with prefilled pods and cartridges leading and disposables taking a distant second.
The new numbers renewed calls to close the loophole and ban flavors for all devices, including disposables.
“Today’s survey results point to clear actions the FDA must take to end the youth e-cigarette epidemic for good: It must eliminate all flavored e-cigarettes, including menthol-flavored products,” said Matthew L. Myers, President for the Campaign for Tobacco-Free Kids, a nonprofit advocacy organization.
The C.D.C. and the F.D.A., which regulates e-cigarettes and tobacco products, emphasized that the year-to-year comparisons are complicated by changes to data collection: In 2021, because of the pandemic, youth responses were gathered entirely electronically, through online questionnaires, whereas the data had previously been conducted in classroom surveys.
Ms. Koval and other public health advocates said the change in methodology could have meant that some youth were answering questionnaires at home — with parents around — which could have caused them to be less truthful then in prior years.
But the data have considerable implications for policy decisions currently in front of the F.D.A. The agency is deciding which e-cigarette companies can be allowed to remain on the market, following a review of whether their products provide more public benefit — by helping smokers quit cigarettes — than harm, by creating a new generation of nicotine addicts.