Most Teens Heard About the Vaping Lung Injury Outbreak — But Most Blamed Nicotine, Not Cannabis
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.
Quick Facts
What This Study 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%).
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- Evidence Grade:
- Very large representative student survey (157,499) with concurrent media analysis, providing strong population-level evidence on knowledge and perceptions.
- Study Age:
- Published 2025, data from 2019–2020.
- Original Title:
- Media Reports and Knowledge of e-Cigarette or Vaping Use-Associated Lung Injury Among Adolescents in California: Population-Based Cross-Sectional Study.
- Published In:
- Journal of medical Internet research, 27, e69151 (2025)
- Authors:
- Wang, Jijiang(2), Ayers, John, Leas, Eric, Gamst, Anthony, Zhu, Shu-Hong
- Database ID:
- RTHC-07912
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked 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.
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Cite This Study
https://rethinkthc.com/research/RTHC-07912APA
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
MLA
Wang, Jijiang, et al. "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, 2025. https://doi.org/10.2196/69151
RethinkTHC
RethinkTHC Research Database. "Media Reports and Knowledge of e-Cigarette or Vaping Use-Ass..." RTHC-07912. Retrieved from https://rethinkthc.com/research/wang-2025-media-reports-and-knowledge
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.