Despite years of public health campaigns warning about the dangers of tobacco use, a growing body of research shows that some adolescents continue to smoke or vape—not just out of curiosity or peer pressure, but because they believe it helps them cope emotionally. This perceived benefit may, for some, outweigh the well-known health risks.
A recent study led by psychology professors Adriana Espinosa and Lesia M. Ruglass from the City University of New York reveals that while many teens are aware of the dangers of smoking, a significant number still turn to cigarettes or e-cigarettes to deal with stress, anxiety, or negative emotions.
Tobacco Use Remains Widespread Among Adolescents
More than 2.25 million adolescents globally currently use some form of tobacco, according to recent estimates. While cigarette smoking among youth has declined significantly over recent decades, tobacco use—primarily through vaping—remains a persistent public health challenge.
In 2024, just over 8% of U.S. middle and high school students reported using tobacco products. Among these, nearly 6% used e-cigarettes, and over a quarter of e-cigarette users reported daily use.
The researchers, who study behavioral health, are analyzing data from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative survey involving more than 8,000 U.S. adolescents aged 12 to 17. This long-term project tracks tobacco use across a wide range of products, including cigarettes, e-cigarettes, cigars, hookahs, smokeless tobacco, and dissolvables.
Teens Know the Risks—But See Benefits, Too
One key finding of the study is that while many adolescents recognize the risks of smoking, some still believe tobacco products help them manage negative feelings. This perception increases the likelihood of both initiating and continuing use.
Dr. Espinosa shared a personal example: “For months, my 14-year-old son had been vaping in his room without my knowledge. When he finally told me that he vapes whenever he feels down, it brought the reality of our research into sharp focus.”
The incident reflects two central concerns: first, that many teens are turning to nicotine as an emotional coping mechanism, and second, that parents are often unaware their children are vaping or smoking.
Nicotine and the Adolescent Brain
The research highlights that emotional distress and the belief that tobacco helps regulate mood are powerful motivators for teen tobacco use. This remains true even among those who are fully aware of the long-term health consequences.
E-cigarettes, in particular, appeal to teens because of their discreet design, lack of odor, and wide array of flavors. These features make them easier to hide and more socially acceptable than traditional cigarettes.
However, health experts warn that nicotine exposure during adolescence can interfere with brain development, impair attention and learning, and increase the risk of substance abuse later in life. Studies also show that vaping can harm lung development and lead to nicotine dependence.
Public Health Strategies May Overlook Emotional Drivers
Despite restrictions on youth access to tobacco products and awareness campaigns on health risks, the researchers argue that current policies may not adequately address the emotional reasons why teens use tobacco.
“Policies that focus solely on limiting access or warning about health dangers are unlikely to be effective for young people who are using nicotine to manage emotional challenges,” said Dr. Ruglass.
Even with bans and regulations in place, teens can still obtain products from friends, online sellers, or unregulated markets. According to the researchers, prevention strategies that fail to address the emotional drivers of use may miss the most vulnerable youth altogether.
Addressing the Root Causes
The study recommends that emotional and behavioral health support be integrated into tobacco prevention programs. This means expanding access to school- and community-based mental health services and recognizing the psychological reasons behind substance use.
Public education campaigns like The Real Cost have made strides in reducing teen vaping rates, but the researchers believe more targeted interventions are needed—particularly those that focus on stress, anger, and emotional regulation.
“Our findings make it clear: emotional distress and the belief that nicotine helps cope with it are major reasons teens continue to use these products, even when they know the health risks,” said the authors.
They conclude that real progress will require policymakers to move beyond a one-size-fits-all approach and instead address the root motivations behind youth tobacco use.
This research is funded by several branches of the U.S. National Institutes of Health, including the National Cancer Institute (NCI), National Institute on Minority Health and Health Disparities (NIMHD), National Institute on Drug Abuse (NIDA), and National Institute of General Medical Sciences (NIGMS).
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