For Thomas Pugsley, the initial appeal of vaping was popularity.
“It was just sort of the culture of the group that I was hanging around with,” he said.
But as time went on, his reasons for vaping changed. Now the 21-year-old uses e-cigarettes to manage his anxiety. He’s tried to quit “four or five” times, he said.
“There’s not much of an appeal now necessarily,” he said.
The appeal may be eroding among his peers as well. According to data from the Utah Department of Health and Human Services, 14.4% of Utahns aged 18-24 reported using e-cigarettes in 2021. That’s down from a peak of 18.5% in 2019.
Denitza Blagev, a pulmonologist at Intermountain Healthcare who studies vaping, noted the drop post-2019 coincided with a nationwide outbreak of hospitalizations from lung injuries tied to THC vaping products treated with Vitamin E acetate.
“That really was a turning point,” she said. “Up until that, vaping was largely sold as a safe alternative to smoking.”
In contrast with the dangers of smoking, which can take decades to materialize, Blagev said the outbreak showed the consequences of vaping can be immediate and drastic.
“We had 20-year-olds coming to the ICU that would be sick, with breathing tubes and lungs full of fluid and inflammation. They couldn't breathe,” she said.
Blagev said this may have undermined the perception that vaping is safe.
Although the outbreak has subsided and Vitamin E acetate “largely went away,” vaping-related lung injuries still occur, so it is “not just a matter of cleaning up one chemical,” Blagev said.
The outbreak also highlighted vaping’s addictive power. Blagev co-authored a study that analyzed the long-term effects of e-cigarette or vaping use-associated lung injury after patients had been hospitalized, including the success they had in quitting.
“Right after the hospital, people are like, ‘I'm never touching this again,’” she said. “It turns out most of them cut down or they change their dealer or something, but a lot of them go back to vaping in some form.”
Only 38% of patients in the study quit e-cigarettes completely. And younger patients were more likely to do so, Blagev said.
The decline in vaping among younger adults also coincided with what state health department Tobacco Prevention and Control Program Manager Braden Ainsworth called a “vape storm of policy and legislation” from the state legislature in 2020.
That storm included a new law limiting the sale of most flavored products to smoke shops only, as well a separate e-cigarette tax of 56% of the manufacturer’s sales price.
“It's not huge,” Ainsworth said of the tax. “But it really does impact people's willingness to purchase because they see that price difference and it makes a behavioral change in them.”
There’s precedent, as Ainsworth pointed out that when Utah or other states have taxed cigarettes and other tobacco products “it has historically taken a pretty quick trend downward.”
Thomas cited cost as one reason why e-cigarette use might be coming down among his peers.
“They get really expensive because they're so addictive,” he said. “Now it's just a burden, and another expense, another expenditure.”
Thomas has his own policy recommendation for reducing vaping among young adults.
“I would honestly prefer if all of this was taken off the shelf, because my wallet would be a little bit thicker and my anxiety would go down. And it's easier that way.”