Background and Objectives: E-cigarette use among middle and high school students steadily increased in the last decade, raising significant public health concerns. It is argued that e-cigarettes contain a lower level of toxicants than combustible tobacco cigarettes. This perception has contributed to the growing popularity of e-cigarettes among youth. However, lower level of toxicants does not mean addiction is less likely. In this study, we examine trends in the usage of electronic cigarettes among middle and high school students in the U.S. from 2018 to 2023, compare these patterns with traditional cigarette use over the same period and population, and explore the underlying reasons driving e-cigarette use within this demographic. Understanding patterns and motivations are essential for developing effective prevention and intervention strategies. Materials and Methods: Data were derived from the National Youth Tobacco Survey (NYTS), administered by the Centers for Disease Control and Prevention (CDC). Population-level estimates and standard errors were calculated to facilitate comparisons across subgroups and time points. Results: A declining trend in e-cigarette use was observed over the study period. The proportion of students who reported exclusive e-cigarette use was significantly higher than that of those who used combustible cigarettes exclusively. Among reported motivations, anxiety consistently ranked among the top three reasons for vaping for current users. Conclusions: The downward trend in youth e-cigarette experimentation is encouraging. However, the period from 2020 to 2023, which includes the COVID-19 pandemic (2020 and 2021) era, may have impacted usage patterns. Alarmingly, the number of students who vape exclusively is approximately five times greater than that of those who smoke only cigarettes. This finding contradicts claims by e-cigarette manufacturers that their products facilitate smoking cessation. Further rising e-cigarette smoking exclusively is of public health concern, which warrants targeted intervention.