The Lifetime Mortality Implications of Vaping and Smoking Initiated During Adolescence.

Abstract

Whether, and if so how much, adolescent vaping increases the risk of future premature mortality is unknown. This microsimulation model and Monte Carlo analysis evaluated plausible lifetime vaping- and smoking-associated mortality outcomes with vaping and smoking initiated during adolescence for the 4.1 million U.S. 12-year-olds in 2016. Outcomes with e-cigarettes available throughout life were compared with a counterfactual in which e-cigarettes never existed. The analysis considered three ways vaping could impact mortality: (i) vaping during adolescence followed by smoking continuing into adulthood; (ii) vaping continuing into adulthood without smoking; and (iii) vaping increasing adult smoking cessation for cohort members who began smoking in adolescence. Parameters included vaping's mortality risk (5%-30% that of smoking), the smoking cessation increase attributable to vaping (0%-30%), the vaping cessation rate (1-4 times the smoking cessation rate), and years of vaping after vaping-induced smoking cessation (5-20). Data were collected in 2024 and analyzed in 2024-2025. E-cigarette availability was associated with the average cohort member's vaping-associated lifetime probability of premature mortality ranging from an increase of 0.44 percentage points to a decrease of 0.06 percentage points, corresponding, respectively, to a loss of ≤31.3 days of life expectancy to a gain of ≤2.7 days. In two illustrative model setups, individuals who smoked at age 20 years had a lifetime probability of premature mortality of 7-8%. Those who vaped but did not smoke had a probability of 0.15-0.84%. If youth vaping affects lifetime premature mortality, the increase or decrease is projected to be very small.