Most Teens Heard About the Vaping Lung Injury Outbreak — But Most Blamed Nicotine, Not Cannabis | Research

The takeaway

While 75% of 157,500 California students had heard about EVALI (vaping lung injuries), only 11% correctly identified cannabis vapes as the cause — most blamed nicotine, revealing a major gap between media coverage and public understanding.

Public health communicators, school health educators, journalists covering health crises, and parents discussing vaping with teens.

What the researchers found

75% of middle and high school students were aware of EVALI, primarily from media (63.1%). However, 55% incorrectly believed nicotine caused EVALI, while only 11% correctly identified cannabis-related vapes. Students aware of EVALI were more likely to view daily vaping as extremely harmful (67.8% vs 50.9%).

Why it matters

The EVALI crisis killed 68 people, primarily from vitamin E acetate in illicit cannabis vapes. But the public health message was garbled — most teens think nicotine vapes were the problem. This misinformation may cause teens to avoid less-harmful nicotine vapes while underestimating risks of illicit cannabis products.

The numbers in context

157,499 students surveyed. 75% aware of EVALI. Primary source: media (63.1%), parents (16.6%), teachers (8.1%). 55% blamed nicotine. Only 11% correctly identified cannabis. 19,661 EVALI news reports analyzed: 55.9% mentioned cannabis. Awareness increased perceived vaping harm (67.8% vs 50.9%).

How the study worked

Analysis of archived EVALI news reports from Tobacco Watcher (July 2019–March 2020) and California Student Tobacco Survey data from 157,499 8th, 10th, and 12th graders surveyed September 2019–March 2020. Students' EVALI awareness, perceived cause, information sources, and vaping risk perceptions examined.

What this study cannot tell us

California-specific student sample. Self-reported awareness and beliefs. Survey conducted during the outbreak, so perceptions may have shifted. Cannot determine long-term behavioral effects of misperceptions. Media analysis limited to one monitoring tool.

How to read the evidence

Very large representative student survey (157,499) with concurrent media analysis, providing strong population-level evidence on knowledge and perceptions.

When this study was published

Published 2025, data from 2019–2020.

The bigger picture

EVALI is a case study in how media coverage can increase awareness of a health threat while simultaneously spreading misinformation about its cause. The result may paradoxically push teens away from regulated nicotine products toward the illicit cannabis products that actually caused the crisis.

Questions still open

Did EVALI misinformation lead teens to avoid nicotine vapes but not cannabis vapes? Would corrected messaging about the actual cause change teen behavior? How can public health communication better convey nuanced causal information during outbreaks?

Common questions

What actually caused the vaping lung injuries?

EVALI was caused primarily by vitamin E acetate, an additive found in illicit cannabis vape cartridges — not by nicotine vapes. The CDC identified this in 2019–2020 after the outbreak sickened 2,807+ people and killed 68.

Why did most teens blame nicotine?

Early media reports often didn't clearly distinguish between nicotine and cannabis vaping. The word 'vaping' was used broadly, and many reports didn't mention cannabis. By the time the cause was identified, the nicotine-blaming narrative had already taken hold.

Read the original research

Media Reports and Knowledge of e-Cigarette or Vaping Use-Associated Lung Injury Among Adolescents in California: Population-Based Cross-Sectional Study.

Journal of medical Internet research, 27, e69151

View on PubMed ↗Publisher’s paper ↗

Citation

Wang, Jijiang; Ayers, John; Leas, Eric; Gamst, Anthony; Zhu, Shu-Hong. (2025). Media Reports and Knowledge of e-Cigarette or Vaping Use-Associated Lung Injury Among Adolescents in California: Population-Based Cross-Sectional Study.. Journal of medical Internet research, 27, e69151. https://doi.org/10.2196/69151