Study Projects Small Lifetime Mortality Impact From Youth Vaping

Youth vaping is unlikely to have a significant effect on premature deaths over a lifetime, according to a new modeling study that challenges one of the central claims of the teen-vaping panic.

The study, published online Aug. 9 in the American Journal of Preventive Medicine, projected lifetime health outcomes for the approximately 4.1 million Americans who were 12 years old in 2016. Researchers compared a world in which e-cigarettes existed with a hypothetical one in which they had never been introduced.

Across a wide range of assumptions, the modeled change in an average cohort member's probability of premature death ranged from an increase of 0.44 percentage points to a decrease of 0.06 percentage points. That translated into a projected loss of up to 31.3 days of life expectancy, or a gain of up to 2.7 days.

The researchers, Kenneth Warner, Ruoyan Sun, Andrew Brouwer, and David Méndez, considered three possible consequences of vaping: teenagers who vape and later smoke, people who continue vaping without smoking, and smokers who eventually quit cigarettes with the help of vaping.

Because nobody has yet followed a generation of adolescent vapers through an entire lifetime, those outcomes cannot be measured directly. The team instead ran computer simulations, varying vaping's assumed mortality risk from five to 30 percent of smoking's, the rate at which users quit vaping, and vaping's possible contribution to smoking cessation.

Under two illustrative sets of assumptions, people who smoked at age 20 had a projected lifetime probability of smoking-attributable premature death of roughly seven to eight percent. For those who vaped but had never smoked, the corresponding probability of vaping-attributable premature death was 0.15 to 0.84 percent. Those are model estimates, not observed death rates or proof that vaping is harmless.

The model estimated that 25,039 more members of the cohort would be smoking at age 20 in a world with vaping than in a hypothetical world without it. But that difference cannot establish that vaping caused those young people to smoke. Young people inclined to experiment with nicotine might have taken up cigarettes regardless of whether e-cigarettes existed, while others may have vaped instead of smoking.

The analysis drew on the National Youth Tobacco Survey and previous research on quitting smoking. A 2022 study by Méndez and colleagues estimated that annual adult smoking cessation rates had risen to about 5.4–5.6 percent in 2014–2019, providing a basis for the simulation's cessation assumptions.

Youth vaping prevalence has also changed since the cohort entered adolescence. According to the Centers for Disease Control and Prevention's 2024 survey report, current e-cigarette use among U.S. middle and high school students fell from 2.13 million in 2023 to 1.63 million in 2024.

The authors acknowledge major limitations. Their model does not estimate nonfatal respiratory or cardiovascular illness, and its vaping-risk assumptions cannot substitute for decades of follow-up data. It also cannot fully separate a possible smoking “gateway” effect from adolescents' underlying tendency to use nicotine products.

While those uncertainties are important, they do not justify treating modeled lifetime mortality from youth vaping as equivalent to the established death toll from smoking. In the researchers' simulations, the projected mortality effect across the entire adolescent cohort remained small, even under assumptions unfavorable to vaping.