Who would have predicted, in 2012, when about 13% of US High School students smoked, that by 2021 that figure would be down to under 2%?

Who would have predicted, in 2019, when over 27% of High School students were vaping, that by 2021 the percentage would be down to under 12%?

A youth smoking rate of under 2% signals the beginning of the end for the commercial tobacco industry and a huge bonus for public health. The young people who do not smoke in High School are not going to start smoking cigarettes in their 20s or 30s. If only 2% of 18 year-olds smoke now, in 20 years’ time less than 2% of 38 year-olds will smoke. Somehow, we have created the fabled “smoke-free generation! The next generation, the children of non-smokers, will be even less likely to smoke.

The fear that vaping is a gateway to smoking has been completely eliminated by the data that shows vaping is in fact a diversion from smoking. And why not? It is safer, cheaper, more convenient and more discrete. Teenage smokers will soon become curiosities, like people who still listen to cassettes tapes.

We have arrived at a really good place, where teen smoking rates are lower than we could have hoped for before vaping became a viable alternative, and even teen vaping rates are relatively low and falling. “Total nicotine use” is now back down to under 2013 levels, and more than 3/4 of student nicotine users are now exclusively vaping, which is many times safer than smoking.

Did we arrive at this position by careful planning? Absolutely not! We got here by a devious path full of chaos, confusion, outright lies, illegal actions and misdirection.

The tobacco industry broke the laws about advertising to youth. By using influencers on social media such as Instagram, they were able to fly under the regulatory radar until the idea that vaping was a cool and trendy thing was embedded in the psyche of many teenagers. This was followed by the moral outrage from media, from parents and from youth groups like the so-called “Truth Initiative”.

Teenagers could hardly miss the messages:

“There is this new thing that everyone is doing, called vaping. Your parents and teachers are worried that so many young people are taking up this new fashion. If you do not try it out, you will be missing out!”

“Vaping is dangerous and your parents your doctor are worried that you will get “popcorn lung” or “EVALI”. But only foolish people believe this nonsense, brave kids vape anyway because they are not afraid.”

There could hardly have been a more effective marketing campaign for vaping. Every High School kid heard about vaping and most had a friend who was vaping, or knew someone who had a spare vape they could try.

In the six years 2015 – 2020, there was an explosion of vaping in High Schools, with 15 – 30% of students vaping at least once a month. Everyone who thought that vaping might be for them had the chance to try it out and see if it was something that they enjoyed, that added pleasure to their lives, that was worth the expense.

Where will the youth vaping rate go now? Clearly vaping is not that addictive, as over half of all the students who were vaping in 2019 had quit by 2021. It is likely that, for many of them, vaping was mainly a fashion fad, like the hula-hoop or Tamagotchis, that will now fade from memory. But I think it is likely that at least some of the 12% of youth that are currently vaping are dependent on nicotine. The interesting issue is whether this is doing them harm or good. Given what we know about the psychological and neurological effects of nicotine, it is probable that many of them are using nicotine vaping to self-medicate for anxiety, depression, ADHD or even schizophrenia, and that their mental health would deteriorate if they quit using nicotine. So many teenagers in modern times have mental health issues, and there are inadequate resources to help them. Currently available medical therapies have significant side effects, are not very effective, and are difficult to quit. If some teenagers find that nicotine vaping helps them through a difficult stage of life, we should probably not discourage them. There is no evidence that legal nicotine-based teen vaping is causing an increase in the incidence of any disease in youth. In Canada and the United Kingdom, there have been no confirmed vaping-related deaths.

In Sweden, about 22% of men use snus, a form of oral tobacco that provides a significant amount of nicotine. This is associated with by far the lowest rate of smoking in Europe, and the lowest rates of lung, oral and pancreatic cancers, as well as a low rate of male heart disease. A country can have excellent health outcomes even in the presence of a 30% rate of nicotine use.

The problem of youth smoking and vaping is now solved, and we should turn our attention to adult smokers. We need to let them know that there are much safer sources of nicotine than cigarettes. We need to persuade millions of adult smokers to try vaping, to see if it is a way for them to quit smoking, to show them how their health will improve if they quit tobacco use, and to prevent them from dying. We need to follow up on our accidental success at eliminating teen smoking with a plan to succeed in eliminating adult smoking.