Teenage girls are now vaping at higher rates than boys, reversing a longstanding pattern in youth nicotine use, according to a new study from the Medical University of South Carolina (MUSC). Researchers found that girls have outpaced boys in vaping since 2021, raising concerns that the youth vaping problem remains far from resolved.

The study, published in JAMA Pediatrics, analyzed nationally representative data from 2014 through 2024 involving American adolescents ages 12 to 17. Researchers examined established smoking and vaping, focusing on young people who used these products regularly and within the past 30 days rather than those who had merely tried them.

Vaping was historically more common among boys until a sharp increase in use among both sexes in 2018 and 2019. That surge coincided with the growing popularity of newer e-cigarettes, including Juul devices that used nicotine salts and offered compact, discreet ways to vape.

Vaping rates subsequently declined, but the trends among boys and girls began to diverge. Among teenagers ages 15 to 17, regular vaping among girls increased from 4.9% in 2021 to 7.8% in 2024. By comparison, 4.6% of boys in the same age group were regular users in 2024.

Among younger adolescents ages 12 to 14, vaping remained less common, although girls generally had higher rates than boys after 2021. Researchers cautioned that even recent declines among younger girls do not mean the problem has disappeared.

Benjamin Toll, director of the MUSC Health Tobacco Treatment Program, said the findings should prompt renewed prevention and intervention efforts.

“We have to understand why, and we need to mobilize our public health efforts,” Toll said. “We need both prevention and intervention for these young people who are vaping at alarmingly high rates.”

The study also found a major decline in traditional cigarette smoking among adolescents. By the final period examined, established cigarette smoking had fallen to less than 0.5% among both boys and girls, a development researchers described as a significant public health achievement.

However, the decline in cigarette smoking does not eliminate concerns about nicotine use. Researchers said vaping can lead to addiction while the adolescent brain is still developing, and the long-term health effects of e-cigarettes remain uncertain.

E-cigarettes can also make nicotine consumption harder to track. Unlike traditional cigarettes, vaping devices can be used repeatedly throughout the day, and their discreet design can make it difficult for parents, teachers and even users themselves to recognize how frequently they are being used.

Researchers stressed that the study does not explain why vaping has become more prevalent among girls. Possible factors requiring further investigation include marketing, social influences, motivations for use and teenagers’ perceptions of vaping. Because the research was observational, it cannot establish that any particular factor caused the shift.

The findings have implications for parents, pediatricians, coaches, and others who regularly interact with teenagers. Toll warned against assuming that the earlier youth vaping surge has passed, particularly when it comes to teenage girls.

“There may be some complacency with people thinking we've gotten through the Juul crisis,” Toll said. “I want pediatricians to pay attention to possible vaping, especially for their female patients.”

Researchers said further investigation could help develop more targeted prevention campaigns and cessation programs. Although cigarette smoking among adolescents has reached historically low levels, the growing prevalence of vaping among girls underscores the need to continue addressing nicotine use among young people.