WASHINGTON, D.C. — A recent report from the Centers for Disease Control and Prevention (CDC), in collaboration with the Food and Drug Administration (FDA), found that current tobacco product use declined among U.S. middle and high school students from 2019 to 2020—driven by decreases in e-cigarette, cigar, and smokeless tobacco use. However, the National Youth Tobacco Survey (NYTS) data analysis also found that about 1 in 6 (nearly 4.5 million) students were current users of some type of tobacco product in 2020.
The report was released in last week’s Morbidity and Mortality Weekly Report. The study assessed current (past 30-day) use of tobacco products, including e-cigarettes, cigarettes, cigars, smokeless tobacco, hookah, pipe tobacco, and heated tobacco products. This is the first study to present NYTS data on the use of heated tobacco products (products that heat processed tobacco leaf to produce an emission, which the user inhales into their lungs), and tobacco product use by sexual identity.
The study found that nearly 1 in 4 high school students (3.65 million) were current users of any tobacco product in 2020, down about 25% from about 1 in 3 (4.7 million) in 2019. About 1 in 15 middle school students (800,000) were current users of any tobacco product in 2020, down nearly 50% from about 1 in 8 (1.5 million) in 2019. From 2019 to 2020, decreases among both middle and high school students also occurred in use of any combustible tobacco product, the use of 2 or more tobacco products, e-cigarettes, cigars, and smokeless tobacco. In contrast, no change occurred in current use of cigarettes, heated tobacco products, hookah, or pipe tobacco during 2019–2020.
For the 7th year in a row, e-cigarettes were the most commonly used tobacco product among both middle and high school students. Additionally, many youths used multiple tobacco products; among current tobacco product users, about 1 in 3 high school students (1.27 million) and about 2 in 5 middle school students (340,000) used two or more tobacco products in 2020.
“The decline in tobacco product use over the past year is a win for public health,” said CDC Director Robert R. Redfield, MD. “Yet, our work is far from done. Nearly 4.5 million U.S. youths still use tobacco products, putting a new generation at risk for nicotine addiction and other health risks.”
- Among high school students, current tobacco product use was highest for e-cigarettes (19.6%), followed by cigars (5.0%), cigarettes (4.6%), smokeless tobacco (3.1%), hookah (2.7%), heated tobacco products (1.4%), and pipe tobacco (0.7%).
- Among middle school students, current tobacco product use was highest for e-cigarettes (4.7%), followed by cigarettes (1.6%), cigars (1.5%), hookah (1.3%), heated tobacco products (1.3%), smokeless tobacco (1.2%), and pipe tobacco (0.4%).
- Among middle and high school students combined by sex, any current tobacco product use was 16.7% among males and 15.8% among females.
- Among middle and high school students combined by race/ethnicity, any current tobacco product use was 17.8% among non-Hispanic whites, 17.2% among Hispanics, 13.2% among non-Hispanic blacks, and 10.1% among non-Hispanic students of other races.
- Among middle and high school students combined by sexual identity, any current tobacco product use was 25.5% among those identifying as lesbian, gay, or bisexual; 15.1% among those identifying as heterosexual; and 11.1% among those reporting “not sure” about their sexual identity.
“These findings demonstrate success in reducing youth use of tobacco overall, while also revealing changes in use patterns that will inform policymakers,” said FDA Commissioner Stephen M. Hahn, M.D. “We remain very concerned about the overall tobacco use rates for young people, including the nearly 3.6 million youth who currently use e-cigarettes. FDA will continue to monitor the marketplace, expand our public education efforts, and use our regulatory authority to further ensure all tobacco products, and e-cigarettes in particular, are not marketed to, sold to, or used by kids.”
What more can be done about youth tobacco use?
Youth use of tobacco products—in any form—is unsafe. Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Nearly all tobacco use begins during youth and young adulthood.
The comprehensive and sustained implementation of evidence-based tobacco control strategies, combined with tobacco product regulation by FDA, is warranted for continuing progress toward reducing and preventing all types of tobacco product use among U.S. youths. Additionally, as the tobacco product landscape continues to diversify, surveillance of youth tobacco product use, including novel products, is important to inform public health policy and practice at national, state, and local levels.
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