Just fifteen years ago, it was common for teenagers to sneak out during school to smoke cigarettes nearby. Today, with the rise of vaping, cigarettes have nearly disappeared for high school-age students. Rather than leaving school to smoke, high schoolers now vape in the bathrooms, halls, and sometimes in class. In the analysis I am currently doing on cigarette taxes in Ohio, this cultural change matters.
To estimate the effects of an increase in Ohio’s cigarette excise tax, we need to know how the tax will affect teenagers, both current smokers and those who will become smokers later in life. Ohio high school and especially middle school smoking data is somewhat limited in terms of the years it is available. However, like national and state trends, it is clear that cigarette smoking is declining (FDA). In a 2023 survey, 1.5% of middle schoolers and 3.6% of high schoolers reported smoking a cigarette in the last 30 days.
We estimated smoking prevalence in 2026 to better predict the impacts of the cigarette tax for our cost-benefit analysis. Since the state only offers three data points for smoking in middle schools through the Youth Tobacco Survey, our prediction might be optimistic. Mapping a linear trendline using past data on smoking rates, we estimate that the middle school smoking rate would be negative in 2026, which means nearly no middle school students in Ohio will be smokers next year. High school smoking data collected through the same survey stretches back much further, but a six year gap between 2013 and 2019 leaves much to the imagination about how the prevalence fell 10.2 percentage points. Using an exponential decay trendline, we estimate that high school smoking will be only 2% in 2026.
So why has youth cigarette smoking fallen so much? Was the sharp drop in smoking in 2019 caused by increasing the legal tobacco purchase age to 21 (FDA)? Is it thanks to public health campaigns like the “Real Cost” or “Truth” which have increased anti-smoking campaigns’ visibility to over 75% of middle and high school students (FDA)? Or is it merely youth transitioning away from cigarettes towards the potentially safer, less-studied vaping as an alternative (Johns Hopkins)?
Nationally, 5.9% of middle and high school (3.5% of middle school and 7.8% of high school) students reported current e-cigarette usage while 1.4% smoked cigarettes in 2024. Nicotine pouches are more popular nationally than cigarettes, with 1.8% of teens using them currently in 2024. In Ohio, 6.4% of middle school and 18.8% of high schoolers vaped once in the past 30 days in 2023, according to the Youth Tobacco Survey. This data is a year behind the national data and is likely to have fallen considering state and national trends the years prior. Higher youth e-cigarette usage trends in Ohio complement higher youth and adult cigarette smoking trends as well. Comparatively, 1.5% of middle schoolers and 3.6% of high schoolers smoked cigarettes in the last 30 days in 2023.
Teen vaping is definitely a problem for public health advocates. Its safety is uncertain, it is more easily marketed towards teenagers than smoking, and it can be easier to hide than cigarettes. Although vaping was sold as a safer alternative to smoking, the National Institute of Drug Abuse is skeptical of that claim. Vapes contain a variety of chemicals and may contain carcinogens or toxic metals. Many contain more nicotine than cigarettes, making them more addictive, which is compounded by teens using vapes more frequently than they used to smoke cigarettes. They also smell less potent, making them easier to hide, which has prompted some schools to install vaping detectors in the bathrooms.
But youth cigarette smoking isn’t the only downward trend: youth vaping is falling as well. Although the prevalence is higher than cigarette smoking, teens seem to be reducing their tobacco or nicotine consumption in general. This trend is true in Ohio as well.
So is vaping causing the fall in smoking by replacing cigarettes, or are these two trends a coincidence complemented by an overall trend downward in youth tobacco use?
A 2025 study on smoking and vaping trends from 1997 to 2020 found that the increase in vaping in the United States was independent of the fall in cigarette smoking. A 2017 meta-analysis, on the other hand, found a strong relationship between initial e-cigarette use and subsequent cigarette smoking initiation. A 2018 study determined that electronic cigarettes have some causal relationship with cigarette smoking but that it is negligible in the face of such a strong decline in smoking. So it’s possible that vaping could actually keep smoking around by introducing teens to tobacco usage, but that overall, it is unlikely to be the reason for the decline in smoking.
Since tobacco use among teens is at its lowest recorded levels ever, according to 2024 National Youth Tobacco Survey (NYTS) data, it is likely that there are external factors at play besides increased e-cigarette usage. The CDC attributes the decline to prevention strategies like price increases, mass media education campaigns targeted at youth about the negative health effects, and smoke-free policies which include e-cigarette usage.
The CDC also says that almost all tobacco use begins in adolescence, citing 9 out of 10 adults who smoke cigarettes every day as having tried smoking by age 18. Most health problems from smoking develop later in life. If efforts can be maintained to reduce overall youth tobacco use, we have the chance to greatly limit adult use and the accompanying health problems.
So yes, children are substituting away from cigarette smoking to vaping. But no, that is not the only reason children are smoking less than they used to. Tobacco use in general has declined due to a range of policy and cultural factors. This will mean longer lives and new opportunities for children later in life, which is something that both health analysts and economists should be happy about.