E-cigarette use among children is skyrocketing across the United States, but teens living in rural areas of the country are the most likely to pick up the habit.
The researchers reviewed state-by-state data provided by the Campaign for Tobacco-Free Kids, an advocacy group that works to prevent youth smoking.
Based on the 2023 survey, the team found that Wyoming has the highest rate of youth e-cigarette use, with nearly one in three teens using e-cigarettes in the last year, despite the state banning the sale of e-cigarettes to residents under the age of 21.
Meanwhile, California, owing to Governor Gavin Newsom’s recent ban on the sale of flavored e-cigarettes to people of all ages, had the lowest prevalence of e-cigarette use at 6%.
The findings come amid a growing body of denouncing research about the harms of e-cigarettes, particularly among young people, including irreversible lung damage and cancer.
Wyoming led the way in youth e-cigarette users, followed by West Virginia and Alaska.
A May analysis found that e-cigarette use increases the risk of asthma by 200%, and previous studies have linked vaping products to lung cancer, respiratory disease, pulmonary disease and organ damage.
Overall, rRecent JAMA Numbers It is suggested that more than 2 million children under the age of 18 and over 17 million adults regularly use e-cigarettes.
Researchers from online prescription marketplace Universal Drugstore analyzed federal and state health data on air quality, youth obesity, sports participation, mental health, test scores and youth e-cigarette use.
The researchers then combined these percentages into a single score to determine the “healthiest” and “unhealthiest” states for children.
Wyoming had the highest rate of youth e-cigarette use, with 30% of kids under the age of 18 reporting using e-cigarettes in 2023.
“Although states have numerous laws aimed at reducing e-cigarette use, such as banning the sale or distribution of e-cigarette products to those under the age of 21 and mandating that e-cigarettes use child-resistant packaging, e-cigarette use rates remain among the highest in the country,” the researchers wrote.
In addition to these laws, e-cigarettes are banned in child care facilities and anyone who buys tobacco products must pay a 15% tax.
However, the state’s largely rural nature and small population may contribute to the high rates of e-cigarette use among young people: About 80 percent of Wyoming residents live in rural areas, with much of the land used for agriculture and national parks.
Large rural areas can make it more difficult to enforce state e-cigarette laws, and rural areas also tend to have less access to clinics and resources about the health risks of e-cigarettes.
Wyoming has one of the lowest health care budgets in the nation, accounting for just 0.1% of annual U.S. health care spending.

The CDC found that the number of adults who smoke cigarettes has fallen to an all-time low of 11 percent.

West Virginia came in second, with 28 percent of its teens using e-cigarettes last year.
The mountain state has fewer restrictions than Wyoming, allowing the sale of e-cigarettes to people under the age of 21, and does not enforce smoke-free zones in schools.
West Virginia was also ranked as the unhealthiest state to raise children, scoring just 0.75 out of 10.
And by 2022, the state’s adult smoking rate was 25%, the highest in the nation.
E-cigarettes are often promoted as a healthier alternative to smoking and are used as a way to encourage smokers to quit, which may contribute to the state’s high rates of e-cigarette use.
Alaska had the third highest percentage of young people who had tried e-cigarettes, at 26%.
Last year, Alaska Senate President Gary Stevens, a Republican, introduced Senate Bill 89, which would have been the first in the state to tax e-cigarette products.
A bill that would have raised the minimum age to purchase tobacco products and e-cigarettes from 19 to 21 was also introduced in 2022, but was vetoed by Gov. Mike Dunleavy.
Like Wyoming, the state’s large rural areas could make it difficult to enforce regulations on youth e-cigarette use.
Louisiana and Montana tied for the top five, with a quarter of teens in both states using e-cigarettes.

Studies have linked e-cigarettes to adverse health effects such as asthma, pneumonia and bronchitis, but smoking has long been linked to more serious health risks, including lung cancer and heart disease.

When it comes to adult e-cigarette use, a recent study in JAMA found that Oklahoma leads the way.
Meanwhile, California had the lowest rate of youth e-cigarette use, with only 6% of teenagers vaping habitually.
California has some of the strictest tobacco restrictions in the nation, including a ban on the sale of flavored tobacco products to residents of all ages.
The minimum age for purchasing e-cigarettes and other tobacco products has also been raised to 21.
In California, e-cigarette products are required to carry health warnings under California law regarding the use of nicotine and other chemicals.
After California, Washington state has the second-lowest rate of youth e-cigarette use at 8%. In the Evergreen State, the legal age to purchase e-cigarettes is 21, and all flavors of e-cigarettes are banned.
E-cigarette advertising is also restricted in areas where young people gather, such as parks.
Indiana, Utah and Oregon all rounded out the bottom five states with teen e-cigarette use rates below 10 percent.