Vaping among children is alarmingly on the rise across the United States, but teens in rural parts of the country are the most likely to pick up the habit.
Researchers analyzed state-by-state data from the Campaign for Tobacco-Free Kids, an advocacy group that aims to stop smoking among young people.
Based on a 2023 survey, the team found that Wyoming had the highest rate of vaping among youth: Nearly one in three teens used e-cigarettes in the past year, despite the state’s laws banning sales to residents under 21.
Meanwhile, California had the lowest vaping rate (six percent) due to strict regulations by Governor Gavin Newsom, who recently banned the sale of flavored vapes to people of all ages.
The findings come as damning research mounts into the harms of e-cigarettes, particularly in young people, including irreversible lung damage and even cancer.
Wyoming topped the list for the highest number of youth e-cigarette users, closely followed by West Virginia and Alaska.
A May analysis found that vaping increases the risk of asthma by 200 percent, and previous studies have linked the products to lung cancer, respiratory conditions, lung disease and organ damage.
In general, rrecent JAMA figures suggest that more than 2 million children under the age of 18 vape regularly, along with 17 million adults.
Online prescription market researchers Universal Pharmacyanalyzed federal and state health data on air quality, youth obesity, sports participation, mental health, test results, and e-cigarette use among youth.
They then compiled these rates into a score to determine the “healthiest” and “unhealthiest” states for children.
Wyoming had the highest rate of youth vaping: 30 percent of kids under 18 reported using e-cigarettes in 2023.
The researchers wrote: ‘While the state has a number of laws aimed at reducing vaping, including banning the sale or distribution of vapor products to people under 21 and enforcing laws requiring e-cigarettes to have child-resistant packaging, vaping rates remain the highest in the country.’
In addition to these laws, the use of e-cigarettes in daycare centers is prohibited and people who buy tobacco products have to pay a 15 percent tax.
However, the state’s predominantly rural landscape and small population could be partly responsible for the high rate of vaping among youth. About 80 percent of Wyoming residents live in rural areas, as much of the land area is used for agriculture and national parks.
The sheer size of rural areas can make it difficult to enforce state vaping laws. Rural areas also often have less access to clinics and resources about vaping-related health harms.
Wyoming also has one of the smallest health care budgets in the U.S., accounting for just 0.1 percent of the country’s annual health care spending.
The CDC has found that the number of adults who smoke cigarettes has fallen to a historic low of 11 percent.
West Virginia came in second, with 28 percent of teens vaping last year.
The Mountain State has fewer restrictions than Wyoming, allowing the sale of e-cigarettes to people under 21. It also does not enforce smoke-free school zones.
West Virginia was also ranked as the unhealthiest state to raise a child, with a score of just 0.75 out of 10.
And in 2022, the state had the highest adult smoking rate in the U.S., at 25 percent.
Vaping is often promoted as a healthier alternative to smoking and used as a tool to get smokers to quit, which may have contributed to the state’s high vaping rate.
Alaska had the third-highest number of youth who tried e-cigarettes, at 26 percent.
Last year, Alaska Senate President Gary Stevens, a Republican, introduced Senate Bill 89, aimed at imposing the state’s first-ever tax on e-cigarette products.
A bill was also introduced in 2022 to raise the minimum age to purchase tobacco and vaping products from 19 to 21, but was vetoed by Gov. Mike Dunleavy.
As in Wyoming, the state’s vast rural areas could make it difficult to enforce regulations around vaping among youth.
Louisiana and Montana tied to round out the top five, both with a quarter of teens using e-cigarettes.
One study linked vaping to health effects such as asthma, pneumonia and bronchitis. However, smoking has long been associated with serious health consequences, including lung cancer and heart disease.
When it comes to vaping among adults, a study recently published in JAMA found that Oklahoma topped the list.
Meanwhile, California was the least popular state among young people who vape, with only six percent of teens having picked up the habit.
California has some of the strictest regulations in the U.S., including a ban on the sale of flavored tobacco products to residents of any age.
The minimum age to purchase e-cigarettes and other tobacco products has also been raised to 21.
Vaping products in the state must also include health warnings under California state laws regarding the use of nicotine and other chemicals.
After the Golden State, Washington had the second-fewest youth vaping at 8 percent. In the Evergreen State, the legal age to purchase vapes is 21 and all flavored varieties are banned.
E-cigarette advertisements are also restricted in areas targeted at youth, such as parks.
Indiana, Utah and Oregon rounded out the bottom five, each with teen vaping rates below 10 percent.