Trends in Tobacco Use Among Youth

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Trend data for youth tobacco product use in the United States show the rates of use of these products and indicate the types of tobacco products that are becoming more popular among middle and high school students.

While tobacco product use among U.S. youth declined, continued efforts are needed to sustain this progress and to prevent and reduce all forms of their tobacco product use.

Why are the 2021 NYTS estimates not included in these trends?

Because of the implementation of COVID-19 protocols across the country when the 2021 NYTS was conducted, the survey was administered online to allow eligible students to complete the survey at home, school, or somewhere else.  The reporting of tobacco use might differ by survey completion setting and thus, the 2021 NYTS results described below cannot be directly compared with previous NYTS survey results that were primarily conducted on school campuses. As such, trends in tobacco use among youth do not include 2021.6

Electronic cigarettes (E-cigarettes)
  • After increasing between 2017 and 2019, current (past 30 day) use of e-cigarettes went down among middle and high school students from 2019 to 2020.1,2,3,4
    • About 1 of every 20 middle school students (4.7%) reported in 2020 that they used e-cigarettes in the past 30 days—a decrease from 10.5% in 2019.3,4
    • About 1 of every 5 high school students (19.6%) reported in 2020 that they used electronic cigarettes in the past 30 days—a decrease from 27.5% in 2019.3,4
Cigarettes
  • From 2011 to 2020, current (past 30 day) cigarette smoking went down among middle and high school students.1,2,3,4,5
    • Nearly 2 of every 100 middle school students (1.6%) reported in 2020 that they smoked cigarettes in the past 30 days—a decrease from 4.3% in 2011.4,5
    • Nearly 5 of every 100 high school students (4.6%) reported in 2020 that they smoked cigarettes in the past 30 days—a decrease from 15.8% in 2011.4,5
Cigars
  • From 2011 to 2020, current use of cigars went down among middle school students and high school students.1,2,3,4,5
    • Nearly 2 of every 100 middle school students (1.5%) reported in 2020 that they had used cigars in the past 30 days—a decrease from 3.5% in 2011.4,5
    • About 5 of every 100 high school students (5.0%) reported in 2020 that they had used cigars in the past 30 days—a decrease from 11.6% in 2011.4,5
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Why are the 2021 NYTS estimates not included in these trends?

Because of the implementation of COVID-19 protocols across the country when the 2021 NYTS was conducted, the survey was administered online to allow eligible students to complete the survey at home, school, or somewhere else.  The reporting of tobacco use might differ by survey completion setting and thus, the 2021 NYTS results described below cannot be directly compared with previous NYTS survey results that were primarily conducted on school campuses. As such, trends in tobacco use among youth do not include 2021.6

Smokeless Tobacco
  • From 2011 to 2020, current use of smokeless tobacco went down among middle and high school students:1,2,3,4,5
    • About 1 of every 100 middle school students (1.2%) reported in 2020 that they had used smokeless tobacco in the past 30 days—a decrease from 2.2% in 2011.4,5
    • About 3 of every 100 high school students (3.1%) reported in 2019 that they had used smokeless tobacco in the past 30 days—a decrease from 7.9% in 2011.4,5
Hookah
  • From 2011 to 2020, current use of hookahs did not change much among middle school students. Current use of hookahs among high school students declined from 2011 to 2019, then saw no change from 2019 to 2020.1,2,3,4,5
    • About 1 of every 100 middle school students (1.3%) reported in 2020 that they had smoked hookah in the past 30 days. The prevalence was 1.0% in 2011.4,5
    • Nearly 3 of every 100 high school students (2.7%) reported in 2020 that they had smoked hookah in the past 30 days. The prevalence was 4.1% in 2011.4,5
All Tobacco Product Use*
  • From 2019 to 2020, current use of any tobacco product went down among middle and high school students.3,4
    • About 7 of every 100 middle school students (6.7%) reported in 2020 that they had used any tobacco product in the past 30 days—a decrease from 12.5% in 2019.3,4
    • About 23 of every 100 high school students (23.6%) reported in 2020 that they had used any tobacco product in the past 30 days—a decrease from 31.2% in 2019.3,4
*In 2020, any tobacco product use was defined as current use of one or more of the following tobacco products on ≥1 day during the past 30 days: e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, bidis, or heated tobacco products. In 2019, consistent with previously published estimates, any tobacco product use was defined as current use of one or more of the following tobacco products on ≥1 day during the past 30 days: e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, or bidis. In 2020, inclusion of heated tobacco products did not significantly change overall estimates of any current tobacco product use among youths.
Many young people use two or more tobacco products**.
  • From 2019 to 2020, current use of two or more tobacco products went down among middle and high school students.3,4
    • About 3 of every 100 middle school students (2.8%) reported in 2020 that they had used two or more tobacco products in the past 30 days—a decrease from 4.0% in 2019.3,4
    • About 8 of every 100 high school students (8.2%) reported in 2020 that they had used two or more tobacco products in the past 30 days—a decrease from 10.8% in 2019.3,4
** In 2020, multiple tobacco product use was defined as current use of two or more of the following tobacco products on ≥1 day during the past 30 days: e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, bidis, or heated tobacco products. In 2019, multiple tobacco product use was defined as current use of two or more of the following tobacco products on ≥1 day during the past 30 days: e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, or bidis. In 2020, inclusion of heated tobacco products did not change overall estimates of multiple tobacco product use among youth significantly.
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  1. Wang TW, Gentzke A, Sharapova S, Cullen KA, Ambrose BK, Jamal A. Tobacco Product Use Among Middle and High School Students – United States, 2011-2017. MMWR Morb Mortal Wkly Rep. 2018 Jun 8;67(22):629-633. DOI: http://dx.doi.org/10.15585/mmwr.mm6722a3.
  2. Gentzke AS, Creamer M, Cullen KA, et al. Vital Signs: Tobacco Product Use Among Middle and High School Students – United States, 2011-2018. MMWR Morb Mortal Wkly Rep. 2019;68(6):157-164. Published 2019 Feb 15. DOI: http://dx.doi.org/10.15585/mmwr.mm6806e1.
  3. Wang TW, Gentzke AS, Creamer MR, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — United States, 2019. MMWR Surveill Summ 2019;68(No. SS-12):1–22. DOI: http://dx.doi.org/10.15585/mmwr.ss6812a1.
  4. Gentzke AS, Wang TW, Jamal A, et al. Tobacco Product Use Among Middle and High School Students — United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1881–1888. DOI: http://dx.doi.org/10.15585/mmwr.mm6950a1.
  5. Centers for Disease Control and Prevention (CDC). Tobacco product use among middle and high school students–United States, 2011 and 2012. MMWR Morb Mortal Wkly Rep. 2013; 62(45):893-7. Erratum in: MMWR Morb Mortal Wkly Rep. 2013; 62(46):940.
  6. Gentzke AS, Wang TW, Cornelius M, Park-Lee E, Ren C, Sawdey MD, Cullen KA, Loretan C, Jamal A, Homa DM. Tobacco Product Use and Associated Factors Among Middle and High School Students – National Youth Tobacco Survey, United States, 2021. Morbidity and Mortality Weekly Report, 2022; 71(No. SS-5):1–29.
Page last reviewed: April 12, 2022
Content source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion