E-Cigarette and Vaping Practices, Patterns Among US Millennials, with Sonali Bose, MD, MPH

Electronic cigarettes, also known as e-cigarettes or vapes, are the most commonly used tobacco product among youth in the United States, with data from the 2024 National Youth Tobacco Survey showing that 5.9% of middle and high school students used electronic cigarettes in the past 30 days.1

While cigarettes remain the most commonly used tobacco product among adults, recent trends indicate electronic cigarette use is increasing among this population, necessitating additional research to better understand vaping practices and patterns in this age group. Seeking to address this need for further research, Sonali Bose, MD, MPH, Icahn School of Medicine at Mount Sinai, presented an analysis of data from the American Lung Association Lung Health Cohort at the American Thoracic Society (ATS) International Conference 2025.2

“Vaping practices and patterns and e-cigarette use are really a very understudied topic at the moment, given that they are the new kids on the block in terms of inhaled exposures, in contrast to more traditional inhaled exposures like tobacco from cigarette smoke,” Bose explained to HCPLive. “We really don't understand very much about how people are using these and what kind of health effects might occur, and the current evidence that's out there is really focused on children and adolescents, but there really isn't much in the literature about young adults.”

Recognizing this gap in research, Bose and colleagues sought to address it through a descriptive cross-sectional analysis of vaping practices and patterns in the American Lung Association Lung Health Cohort, which enrolled US adults aged 25-35 years without severe cardiopulmonary disease starting in 2021 in 27 sites in the US.2

In their analysis of the first 1500 enrollees, they found 64% reported never vaping, 11% vaped in the last month (current vapers), and 23% were former vapers while 2% were unsure of last use or were missing responses. Compared to never vapers, current and former vapers were younger (median age, 28 vs 29 years), a lower percentage were females (57% vs 69%), and a lower proportion had college degrees (89% vs 78%).2

A greater proportion of current versus never or former vapers used concomitant combustible cigarettes, and > 90% of current vapers had ever used inhaled marijuana. Symptoms attributed to vaping were reported in 34% of current or former vapers, most commonly dry mouth, cough, and shortness of breath. Of note, among current vapers, 39% indicated they were not at all willing to quit.2

“It's very striking that a significant number of these participants actually reported some type of respiratory symptom in the setting of using these products,” Bose said, later going on to describe the large portion of these participants who refused to quit: “One of the most exciting things about our findings is that even though the majority of participants reported some sort of symptom, including respiratory symptoms, the desire to quit was actually quite low.”

The most popular devices were 4th generation (pod mods or JUUL, 38%), 2nd generation (vape pens with a prefilled or refillable cartridge, 20%), and vaporizers such as dab rigs, bongs, or dab pens (20%).2

While the single most common product used by current vapers was e-liquid containing nicotine (38%), cannabis products together made up the majority of products used (57%), with the most common being e-liquid containing THC (27%).2

“Our next steps are basically to try to see if e-cigarette or vaping use is actually associated with these poor health outcomes,” Bose explained, describing how millennials are generally considered to be at “peak lung health” and emphasizing why it is so important to intercept the development of chronic lung disease between the ages of 25 and 35. “If we understand that inhaled exposures, such as e-cigarette use and vaping, are important factors in the development of chronic lung disease, then now is the time to intervene, and that's what makes this study so unique and so critical to accomplish.”

Editors’ note: Bose has relevant disclosures with 4D Medical, Regeneron, Sanofi, and Sills Cummis & Gross.

References

1. Vahratian A, Briones EM, Jamal A, Marynak KL. Electronic cigarette use among adults in the United States, 2019–2023. NCHS Data Brief, no 524. Hyattsville, MD: National Center for Health Statistics. 2025. doi:https://dx.doi.org/10.15620/cdc/174583

2. Wharton R, Sugar E, Vu T-HT, et al. E-cigarette and Vaping Practices and Patterns Among U.S. Millennial Adults: A Preliminary Report From the American Lung Association Lung Health Cohort Study [abstract]. Am J Respir Crit Care Med 2025;211:A7954. https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A7954