Youth e-cigarette rates are increasing, the link between smoking/e-cigarette use and COVID-19 is becoming clearer, and another state passes legislation prohibiting the sale of flavored tobacco products. These are some of the prominent stories concerning youth and tobacco prevention as 2020 grinds past summer into autumn.


For years, tobacco prevention and control advocates warned of a rise in youth e-cigarette use in Hawai‘i, urging the state legislature to take action to regulate these products. These suspicions were unfortunately confirmed with the recent publication of long-awaited results from the 2019 Youth Risk Behavior Survey (YRBS). According to the new 2019 YRBS data, one in three (31 percent) high school students and one in five (18 percent) middle school students report “current use” of e-cigarettes (compared to 26 percent and 16 percent respectively in 2017). Similar increases in youth e-cigarette rates were also seen in the “ever use” category. Even more worrisome are the increase in frequent and daily youth e-cigarette users, as these figures indicate that they are addicted. The 2019 YRBS data also revealed alarming disparities – Hispanic, Native Hawaiian, and Pacific Islander youth have significantly higher rates of e-cigarette use when compared to their white peers.


Hawai‘i 2019 & 2017 YRBS Data
 National (HS)High SchoolMiddle School
Ever Use50.1%48.3%42.0%30.6%27.0%
Current Use (last 30 days)32.7%30.6%25.5%17.7%15.7%
Frequent Use (≥20 of the past 30 days)10.7%10.4%5.1%3.0%1.9%
Daily Use7.2%7.9%3.5%2.3%1.2%
Purchase in store8.1%4.7%n/a3.3%n/a



In response to the ongoing epidemic of youth e-cigarette use, prevention efforts across the state have continued to grow. In 2020, our youth prevention efforts have pivoted from coordinating the 808NOVAPE counter-marketing media campaign that informs teens of the risks of vaping, to meeting the growing needs of educators for trainings and school presentations for students. HIPHI also provides technical assistance to the community-based organizations, including some health care centers, to provide youth e-cigarette prevention education across the state using the Stanford Tobacco Prevention Toolkit. Unfortunately, the delivery of e-cigarette prevention education has been severely hampered due to school closures and the remote learning model adopted by schools to mitigate the spread of COVID-19. Despite these setbacks, there have been opportunities to provide e-cigarette prevention education via online platforms and those opportunities will likely increase as the links between e-cigarettes and the adverse effects of COVID-19 on youth continues to grow.


The harmful effects of cigarette smoking on one’s immune and respiratory systems are well known. E-cigarettes are starting to become linked to some of those same harmful effects, but this information is less widely known. Today, more young people turn away from cigarettes and instead take up e-cigarettes due to deceptive marketing practices that have led them to believe they are “less harmful.” However, vaping is not without risk and has led to increasing concerns on the connection between youth e-cigarette use and COVID-19. A growing body of evidence is starting to reveal that youth e-cigarette users are unwittingly putting themselves at a greater risk of contracting COVID-19 and having a more severe case of the disease.

Studies (view here and here) are now confirming that the presence of nicotine in one’s body, through the use of tobacco products like cigarettes and e-cigarettes, can increase the chances of contracting the virus. Use of tobacco products that contain nicotine cause the user to produce higher numbers of a molecule called the angiotensin-converting enzyme 2, or ACE2. The ACE2 molecule essentially acts like a port of entry that allows the coronavirus to attach itself to the cell, invade it and replicate itself. This can occur not only in our lungs, but in our heart, our intestines, our blood vessels and our muscles. To put it simply, people that smoke or vape have higher ACE2 counts in their bodies due to the frequent use of nicotine. Because the virus uses ACE2 acts as a receptor used to infect cells, a person with higher levels of ACE2 are more likely to be infected if exposed to COVID-19.

In May 2020, Stanford University published a landmark study that found teens and young adults that use e-cigarettes had a five to seven times greater chance of be diagnosed with COVID-19 than those that did not use e-cigarettes. Considering the 2019 YRBS results that documented an increase in youth e-cigarette use, this finding is incredibly concerning. To put this into perspective, there are 52,042 high school students enrolled in Hawai‘i public schools. Using the most recent YRBS data, that translates to nearly 16,000 Hawai‘i high schoolers that used an e-cigarette in the last 30 days, and may be five to seven times more likely to be diagnosed with COVID-19 than their nonsmoking peers. Global pandemic or not, these numbers are unacceptable, but there is an increased urgency for regulatory action in light of the increased risk of COVID-19. With no end in sight for the COVID-19 crisis, it is imperative that Hawai‘i passes comprehensive legislation regulating e-cigarettes to curb usage and protect the health of our keiki.


For the last two years, Hawai‘i has been working to end the sale of flavored tobacco products in the state. When the measure was introduced in 2019, Hawai‘i had a chance to become the first state to pass this progressive legislation. While unfortunately the bill did not pass in Hawai‘i last session, five other states – Massachusetts, Rhode Island, New York, New Jersey, and California – have since enacted legislation to protect their youth from a lifetime of addiction. Recognizing the urgency and importance of this issue, California did not let COVID-19 or historic forest fires impede their efforts to pass legislation this month. This huge win for kids was dampened by the tobacco industry’s efforts to block progress, as they seek a referendum to overturn the new law. This move is likely to only delay the implementation for the next two years, as California voters have repeatedly rejected the industry’s attempts to protect their profits at the expense of our children’s health.

The Coalition for a Tobacco-Free Hawaiʻi (CTFH) is committed to continue this work and will advocate for comprehensive regulations on e-cigarettes including: prohibiting the sale of flavored tobacco products, establishing a tax, requiring a tobacco permit and license, and prohibiting online sales in 2021. If you are interested in joining in these efforts, please sign up at

To learn more about CTFH’s efforts to understand tobacco as a social justice issue, please join us at our annual Stakeholder Meeting on October 22, the first ever to be conducted via Zoom. Our featured speaker this year is Rod Lew, the founder and executive director of the Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL). The program will include a speaker on the link between COVID-19 and tobacco use, a panel, and our annual Alaka‘i Awards Ceremony to honor champions in tobacco prevention and control. Join us in registering for the 2020 Coalition for a Tobacco-Free Hawaii’s Stakeholder Meeting to be held on October 22.