Girls vaping at higher rates than boys, national study finds

For decades, boys and men were more likely than their female peers to use nicotine. But a new study from MUSC shows that among U.S. adolescents, that pattern has reversed for vaping.

Girls have been vaping at higher rates than boys since 2021, with the gap becoming particularly pronounced among older teenagers, according to the study published in JAMA Pediatrics.

The findings offer the first look at how smoking and vaping patterns have changed by age and gender across a full decade – from the rapid rise of e-cigarettes in the late 2010s through the shifting patterns of youth nicotine use seen today.

Benjamin Toll, Ph.D., director of the MUSC Health Tobacco Treatment Program and co-director of the Lung Cancer Screening Program at MUSC Hollings Cancer Center, said the latest numbers should serve as a warning that the youth vaping problem has not gone away.

“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.”

A decade of changing nicotine use

Previous research has captured pieces of the changing youth vaping landscape, but the new study is the first to examine smoking and vaping trends by age and gender across a full decade, from 2014 through 2024. That wider view allowed researchers to follow the evolution of youth vaping – from historically higher rates among boys, through the dramatic surge in use in 2018 and 2019 to the more recent emergence of higher rates among girls.

To get that broader view, the researchers analyzed data from the Population Assessment of Tobacco and Health, or PATH, Study, a large, nationally representative study of tobacco use in the U.S. Their analysis included adolescents ages 12 to 17 and the 2014 to 2024 data.

The study focused on “current established” smoking and vaping – meaning these were not adolescents who had simply tried a cigarette or e-cigarette at some point. Participants had to report having used the product regularly and within the past 30 days.

“That makes this a pretty conservative estimate of use,” said lead author Brandon Sanford, Ph.D. “These aren’t youth who simply tried vaping once or twice. We’re talking about adolescents who are regularly using e-cigarettes now.”

Historically, nicotine use has been more common among males. The researchers found that this pattern had held for vaping from 2014 through 2018. Vaping was also consistently more common among older teens ages 15 to 17 than younger adolescents ages 12 to 14.

Then came a dramatic surge in youth vaping in 2018 and 2019, when rates climbed sharply among both boys and girls, and the longstanding gender gap largely disappeared. The surge coincided with the growing popularity of a new generation of e-cigarettes, including products like JUUL, which used nicotine salts and came in small, pod-based devices that made vaping more appealing, easier to use and more discreet.

Rates then dropped by 2021 – but what came next differed by age and gender.

Among younger adolescents ages 12 to 14, vaping rates remained relatively low and fluctuated from year to year. Girls generally had higher rates than boys after 2021, although vaping among girls declined in the latest data.

Naomi Brownstein, Ph.D., co-first author and a biostatistician at MUSC, cautioned against viewing the recent decline as evidence that the problem has disappeared.

“Even though the rate dropped from 2023 to 2024, it’s still high,” Brownstein said. “There are still a lot of middle school girls vaping.”

Among older teens ages 15 to 17, the shift was much more pronounced. Regular vaping among girls consistently climbed from 4.9% in 2021 to 7.8% in 2024, approaching the peak seen during the 2018-2019 youth vaping surge. By comparison, 4.6% of boys the same age were regular users in 2024.

While the difference between boys and girls is striking, the researchers stressed that vaping among boys remains a public health concern as well.

“We have to sound the alarm bells for girls,” Toll said. “But we also need to make sure that we’re addressing the boys, too.”

Cigarette smoking approaches historic lows

Against those vaping trends, the decade-long data also reveal an encouraging shift: Traditional cigarette smoking among adolescents has fallen dramatically. By the final wave of data, fewer than half of 1% of both boys and girls were established smokers.

Toll described the decline in cigarette smoking as a “massive public health win.”

Sanford added that the changing patterns suggest that vaping may be displacing at least some cigarette smoking among young people. But this shift also means that public health efforts must contend with a different form of nicotine use.

E-cigarettes do expose users to fewer known toxicants and carcinogens than combustible cigarettes, which is part of why they may have a role in helping adults who smoke to transition away from cigarettes.

But that does not make them harmless, particularly for young people who otherwise might not use nicotine. Because e-cigarettes are relatively new, researchers do not yet know their long-term health effects. And for adolescents, regular vaping can lead to nicotine addiction at a time when the brain is still developing.

E-cigarettes can also make patterns of nicotine use harder to track. Unlike cigarettes, which have a natural stopping point, e-cigarette cartridges offer hundreds or thousands of puffs, allowing users to vape repeatedly throughout the day. The devices are also easy to conceal, making it harder for users and those around them to recognize how much they are vaping.

Sanford described seeing that challenge firsthand with his patients. When he asks how much they vape, he said, many struggle to give a clear answer because they cannot keep track of individual vaping sessions or how long a device lasts.

Why are girls vaping more?

The study shows a clear shift in who is vaping – but it was not designed to determine what is driving that change. And because the study is observational, Brownstein emphasized that the researchers can only point to associations – not conclude that any one factor caused the increased use among girls.

“There are certainly factors associated with these rates we’re seeing that are quite fascinating,” Brownstein said. “There’s a lot more work that we could delve into.”

Sanford said understanding what drives use is one of the most important next questions.

“We would love to look into some of the whys,” he said. “Are there shifts in motivation to use, marketing, social influences or perceptions?”

Answering those questions could ultimately help researchers to develop more targeted ways to prevent and treat youth vaping, including prevention messages and cessation programs tailored to the factors influencing use among girls and youth more generally.

The findings also have implications beyond researchers and public health officials. Toll said pediatricians, parents, coaches and others who regularly interact with teenagers should be aware that youth vaping remains a problem.

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

For the research team, the changing trends point to where more attention may be needed.

“I think it says a lot about where we ought to be putting our resources,” Sanford emphasized, “in terms of prevention efforts, treatment development and public health policy.”

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Journal

JAMA Pediatrics

DOI

10.1001/jamapediatrics.2026.4918

Building social and emotional skills in preschool improved life for young adults

 Almost two decades later, preschool students who received supplemental instruction to build their social, emotional and language skills reported a higher quality of life than peers who did not receive the same skill instruction, according to an interdisciplinary team of Penn State researchers.

In a new study published in the journal American Psychologist, the researchers found that young adults who participated during preschool in the Research Based, Developmentally Informed (REDI) program — which teaches friendship, social problem-solving, language and other skills — reported experiencing fewer depressive symptoms, less loneliness, more empathy and higher levels of life satisfaction than their peers who did not participate in REDI. REDI was developed at Penn State in the early 2000s and deployed in preschool programs across three Pennsylvania counties.

“REDI improved lives in meaningful ways,” said Damon Jones, research professor in the Edna Bennett Pierce Prevention Research Center and co-author of the study. “For example, young adults who participated in REDI as children reported almost two more healthy days per month on average compared to peers who did not participate in REDI. That could add up to more than 20 extra healthy days every year, and that benefit may extend for years.”

In the 1960s, the federal government created Head Start, a preschool program for children from low-income families. Head Start was designed to develop skills — like turn taking and listening — that are needed to start elementary school successfully because, on average, students who begin school without these skills have lower lifetime academic achievement than their peers. Over the last 50 years, many studies have demonstrated that Head Start contributes to school readiness and long-term academic and life success, but there is still an achievement gap between students from low-income households and their peers, the researchers said.

“Researchers know that early childhood is a prime time to equip students for a life of learning, problem solving and healthy relationships,” said Karen Bierman, Evan Pugh University Professor of Psychology at Penn State, lead author of the study and primary designer of the REDI program. “We wanted to understand whether providing students with social, problem-solving and language skills could set them on the path for lifelong success. Despite all the different paths children’s lives can take, participation in REDI — a supplemental program delivered in Head Start classrooms — was still associated with a meaningfully better life when they reached adulthood.”

The researchers compared 164 students who were in standard Head Start classrooms to 192 students in classrooms that participated in REDI. Everyone in the study received the benefits of the Head Start program, but REDI participants still reported higher quality of life compared to their peers in standard Head Start classrooms.

In REDI, preschool students received two lessons per week around one of four types of skills: friendship skills, including sharing and taking turns; emotional-understanding skills, including recognizing feelings and awareness of how one’s behavior affects others; problem-solving skills, including how to remain calm when upset; and language skills, including vocabulary and reading so that children have the language to employ their emotional and social skills.

Additionally, classroom teachers were trained both in how to deliver the REDI lessons and how to employ the lesson skills to address real-life conflicts — like when two students wanted the same toy or one child did not want to sit next to another — that occurred naturally during the school day.

Bierman and her colleagues previously found that children who participated in REDI displayed improved behavior and peer relationships throughout elementary and high school compared to students who did not participate in REDI.

In this study, the researchers surveyed young adults who had participated in one of 44 Head Start programs across three Pennsylvania counties and were between the ages of 21 and 22. Participants answered questions about 11 aspects of their well-being, social adjustment and quality of life, including loneliness, life satisfaction and depression symptoms.

Young adults who had participated in REDI reported lower levels of depressive symptoms, loneliness and conduct problems — a measure of antisocial behavior — than their peers in regular Head Start. They also reported higher levels of empathy, emotional support, healthy days and life satisfaction. No differences were detected on the other four attributes: hyperactivity, symptoms of emotional problems, sociability, and sense of security and belonging.

“Not only did REDI affect seven out of the 11 factors that we measured, but the differences were large enough to matter in the children’s lives,” Bierman said.

The ability to detect any difference after 18 years points to the value of promoting skill-building when children are young, the researchers said.

“This study adds to the resoundingly clear body of literature that supporting children early in their lives can reverberate for decades,” Bierman said. “Also, it demonstrates that social and emotional skills are important for preparing children to succeed in life.”

Though the study revealed how effective REDI can be, it also underscored how much work remains to be done, according to Janet Welsh, research professor in the Edna Bennett Pierce Prevention Research Center and co-author of the study.

Over the 18 years of the REDI study, the researchers measured difficult experiences — including separation from parents and family instability — that participants experienced during childhood. These experiences had a long-lasting negative impact on the children’s health and adjustment at the time of this study, Welsh said.

“Whether children participated in REDI or not, we found that those who faced a higher number of difficult experiences when they were young had poorer well-being as adults,” Welsh said. “We need to do everything we can to protect children from harm while also helping them build skills to handle whatever they experience in life. This costs money, but it represents a solid investment in our collective future.”

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Journal

American Psychologist

DOI

10.1037/amp0001765

Transportation as a Barrier to Education Access

School choice can weaken the link between residential neighborhood and educational opportunity only if students can reach the schools available to them. This study involves school choice in Chicago, where high schoolers can choose among schools throughout the city but generally rely on public transit, making the structure of the transit network a key determinant of opportunity. 

Using student-level rankings and public transit travel times, the study documents two systematic patterns: Black students are less likely to rank top-rated schools first and face longer public transit times to such schools. 

The authors estimate a discrete choice model to separate the value placed on schools from the costs of reaching them. They find that high schools vary substantially in how they are valued and that there is a high degree of agreement across racial groups in their relative ranking. However, transit times vary significantly across neighborhoods, generating racial differences in demand for top-rated schools. 

Counterfactually, giving Black students the travel times of white students increases demand for top-rated schools by 23 percentage points. 

Finally, the authors identify underserved neighborhoods where public transit access constrains demand and quantify how targeted bus service would increase demand for high-quality schools. Their counterfactuals quantify how transportation expands school access. 

Effects of Coach-Delivered Text Messages in an Adult High School

 More than 23 million adults in the United States lack a high school diploma, and most who return to school drop out before graduating. This study evaluates a randomized intervention of adult high school students in which coaches delivered text messages that encouraged persistence. 

The authors find that assignment to treatment increased graduation by 4.9 percentage points, and the effect of message receipt among compliers is 9.3 percentage points, a 41 percent increase relative to the control mean. The intervention operated on the intensive margin by increasing the number of courses completed, but did not affect student enrollment. The effects of the intervention are concentrated among students assigned to experienced coaches, who customized their messages more extensively. 

The authors contextualize the economic impact of the low-cost intervention by comparing labor market earnings of graduates to non-graduates, which implies an earnings benefit of $149 per treated student over four years.

Children's caffeine habits linked to shorter sleep and brain differences

 

• Young people aged 9 to 11 who consumed more caffeine had slightly lower surface area across the brain's outer layer 

• Children who had more caffeine also slept less, and this shorter sleep was linked to brain differences, and ultimately mental health 

• Children with higher caffeine intake reported more mental health problems six months later 

• Associations between caffeine consumption and brain structure emerged as low as 1 cup per week 

Young people who consume more caffeine, mostly from soft drinks, sleep less and show small differences in how their brains are developing, according to a study led by researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London. 

The researchers drew on data from 9,632 children aged nine to eleven taking part in the Adolescent Brain Cognitive Development (ABCD) Study, which follows the brain development and health of young people across the US. Each child said how many caffeinated drinks they usually had in a week, whether coffee, tea or soft drinks, with parents reporting how long the children usually sleep on average. MRI scans then measured thickness and surface area of the cortex, the brain's folded outer layer, which plays a part in cognitive processing, decision making, attention and emotions, among other important functions. 

The children were then asked to report back on their mental health 6 and 18 months later with the results showing that greater caffeine consumption is associated with lower surface area across the cortex, even after we adjust for household socioeconomic circumstances like parental educational attainment and income. The pattern showed up in 22 separate regions, spanning all four lobes of the brain. These effects were largely driven by the consumption of soft drinks, which were the biggest source of caffeine in the study. Differences in overall surface area showed up from as little as one caffeinated drink a week, compared with none.  

Dr Divyangana Rakesh, senior author of the study from the IoPPN at King’s College London, said:  

“Caffeine is such a normal part of daily life that it's easy to forget young people are consuming it too. Studies have found that two-thirds of adolescents consume caffeine at least once a week. Despite it being a psychoactive substance, it is completely unregulated. 

“We found that even fairly low levels of intake were linked to small differences in brain structure and later mental health, and lower sleep duration seems to be an important underlying link. Although we cannot comment on causality, our results do suggest that both caffeine intake, including from soft drinks, and sleep are worth paying attention to when we think about young people's mental health."  

The researchers then looked at what might connect caffeine to differences in brain structure. Young people who consumed more caffeine slept less, which was in turn linked to lower surface area. Together, shorter sleep and lower surface area partly explained the link between higher caffeine intake and more mental health problems six months later, including problems with attention, mood and behaviour. At 18 months, only the link through overall surface area was still there. 

Jiayi Zheng, first author of the study from the IoPPN at King’s College London, said:  
 
"Soft drinks contain a lot of sugar and often go hand in hand with less healthy lifestyle habits and more risk-taking behaviours, so we can't yet separate the role of caffeine from everything else that comes with them. That's the next question we want to answer, ideally with more precise measures of what young people drink, when they drink it and how well they sleep."  

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Journal

Biological Psychiatry Cognitive Neuroscience and Neuroimaging

DOI

10.1016/j.bpsc.2026.09.011 

Frequent abdominal pain in children associated w/school-related stress/ peer harassment

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“If a school-age child has abdominal pain, it can be worth looking a little deeper and asking whether they also experience pain elsewhere. If they do, this may suggest that the pain may not simply be a symptom of an organic condition, but part of a more complex pain disorder. This can be the case even if the child was previously diagnosed with an organic condition such as celiac disease or Crohn’s disease, because that condition may no longer be what is causing the symptoms,” says Dr. János Major, first author of the study, assistant professor at the Institute of Behavioural Sciences at Semmelweis University and head of the Paediatric Pain Centre at Bethesda Children’s Hospital. 

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Credit: Photo: Boglárka Zellei - Semmelweis University, Budapest, Hungary

Many parents feel reassured when their child’s recurrent abdominal pain is investigated and no underlying organic condition is found. However, a study by researchers at Semmelweis University, published in the International Journal of Pediatrics, suggests that this may be when it is worth asking a few further questions: Does the child experience pain elsewhere in the body? Has the pain persisted for at least a year? If the answer to either question is yes, it may be a warning sign.  

Researchers at Semmelweis University analyzed data from 522 Hungarian schoolchildren aged 11 to 18 in a nationally representative study. Their findings show that in adolescents with functional abdominal pain disorders (FAPDs) — conditions characterized by recurrent or persistent abdominal pain that is not explained by an organic disease — abdominal pain often occurs alongside pain in other parts of the body. Overall, 80.6% experienced multisite pain, meaning pain at two or more body sites, while 54.8% reported their primary pain site outside the abdomen. Headache was the most common, while joint and back pain were also reported. In more than half of those affected, symptoms had persisted for at least a year. 

According to the researchers, the process may initially be triggered, for example, by an infection or inflammation. However, if the pain persists and is accompanied by stress, anxiety, or other psychological strain, the pain-processing system may gradually become hypersensitive and remain in this state even after the original trigger has resolved. Even relatively mild stimuli may then be enough to trigger pain, and over time even normal bodily processes — such as digestion beginning after a meal — may become painful despite normally causing no discomfort. This may help explain why the pain can persist and occur in several parts of the body. 

“If a school-age child has abdominal pain, it can be worth looking a little deeper and asking whether they also experience pain elsewhere. If they do, this may suggest that the pain may not simply be a symptom of an organic condition, but part of a more complex pain disorder. This can be the case even if the child was previously diagnosed with an organic condition such as celiac disease or Crohn’s disease, because that condition may no longer be what is causing the symptoms,” says Dr. János Major, first author of the study, assistant professor at the Institute of Behavioural Sciences at Semmelweis University and head of the Paediatric Pain Centre at Bethesda Children’s Hospital. 

Adolescents with FAPDs were more likely to feel that they faced too many assessments at school, that there was not enough peace and quiet in the classroom, or that teachers treated them unfairly. Peer exclusion and other forms of harassment were also more common among them. 

The researchers also examined the health-related quality of life (HRQOL) of the children affected. They assessed not only physical functioning but also emotional functioning, social functioning, and everyday school functioning. Questions on emotional functioning covered issues including fear, sadness, anger, sleep problems, and worries. Social functioning looked at how children got along with their peers, including whether they were excluded or teased and how well they were able to fit in. School functioning included factors such as their ability to concentrate and keep up with schoolwork, as well as how many school days they missed because of feeling unwell or attending medical appointments. 

According to the study, adolescents with FAPDs scored significantly worse across all areas assessed, and 14.5% had overall HRQOL scores in the extremely low range. Verbal harassment — such as teasing, mocking, or name-calling — was also associated with extremely low HRQOL. Those affected also missed more days of school, and regular analgesic use was more common among them. 

The researchers say these symptoms should therefore be taken seriously. Without treatment, the underlying factors do not necessarily resolve on their own, and the pain may persist into adulthood, significantly affecting quality of life and everyday functioning. In the longer term, persistent severe pain may place a substantial burden on health care systems, lead to difficulties maintaining employment, and, in severe cases, even result in early disability.

“Parents often tend to play the problem down and say that it will pass or that the child will grow out of it. The problem is that the factors triggering or maintaining the pain do not necessarily disappear on their own,” says Dr. Szilvia Ádám, last author of the study and associate professor at the Health Services Management Training Center at Semmelweis University. 

With appropriate support, the condition can be treated successfully. In some cases, even changing schools or a short course of psychotherapy can make a considerable difference, while pain treatment initiated in childhood may reduce the likelihood that the pain will persist or recur in adulthood. 

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Journal

International Journal of Pediatrics

DOI

10.1155/ijpe/9964179

Main factors in pornography use among adolescents

A study by the Universitat Rovira i Virgili (URV) has analysed which factors are most associated with pornography use during adolescence. The results show that the most predictive variable is gender, followed by problematic internet use, cannabis and alcohol consumption, family conflict and engaging in certain risky sexual behaviours. The research, published in the journal Computation, was based on the 2023 ESTUDES survey and worked with a sample of 33,543 adolescents. The aim was to determine which personal, family, digital and behavioural variables are most useful for predicting whether an adolescent reports having viewed or used pornography in the previous 30 days.

“Our aim was not to single out individual adolescents, but to better understand which factors tend to be associated with this behaviour,” explains Jorge de Andrés-Sánchez, a researcher at the URV’s the Social and Business Research Laboratory and co-author of the article.

Detecting patterns with artificial intelligence

The study combines the conventional statistical technique of logistic regression, three machine learning models (XGBoost, LightGBM and CatBoost) and explainable artificial intelligence techniques. These tools are able to detect complex relationships between variables and reveal the weight that each variable carries in the predictions.

The different models produced similar results. The machine learning systems slightly improved some indicators, but the differences compared with logistic regression were small. The authors therefore note that more complex models should not automatically replace traditional statistical techniques. “Artificial intelligence helps us see that this behaviour does not appear in isolation, but within a broader profile of digital, family and behavioural factors,” the authors affirmed.

Sex and problematic internet use: the most influential factors

The sex of the individual is, by far, the variable that carries the most weight in the predictions, with boys being more likely to use pornography. Age is also associated with it, but has a lower predictive importance.

After gender, the next most significant factor is problematic Internet use, which includes behaviours such as having difficulty staying offline, sleeping less to be online, neglecting obligations or using the Internet to escape from worries or negative emotions. The researchers point out that problematic internet use does not equate to a clinical diagnosis of Internet addiction.

The next most predictive variables are cannabis and alcohol use and family conflict. Some risky sexual behaviours, such as having sex without a condom or having a sexual encounter that the teenager regrets the next day, are also slightly predictive. In contrast, parental control has a much more limited effect when all the variables are analysed together.

The study also identifies differences between boys and girls. Among boys, alcohol consumption is the most important predictor once the individual’s sex is excluded from the analysis, whereas among girls it is problematic internet use. The weight of family conflict also varies. Age-related differences, however, are smaller.

More comprehensive prevention

The research team insists that although the results show associations and predictive patterns, cause-and-effect relationships cannot be established. For this reason, the models should not be used to diagnose, label or sanction specific adolescents, but rather to better understand the phenomenon and to guide educational and preventative policies.

The conclusions point towards programmes that combine sex and relationship education, digital literacy, critical reflection on pornographic content, substance misuse prevention, the promotion of safe sexual practices and the strengthening of family communication.

“Pornography should not be addressed as a phenomenon disconnected from the other dimensions of adolescent life. It is part of a broader ecosystem of digital practices, family relationships, substance use and sex education,” the authors summarise.

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Journal

Computation

DOI

10.3390/computation14080177