Youth and Tobacco Use
Youth use of tobacco products in any form is unsafe.
If cigarette smoking continues at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 will die early from a smoking-related illness. That’s about 1 of every 13 Americans aged 17 years or younger who are alive today.1
Preventing tobacco product use among youth is critical to ending the tobacco epidemic in the United States.
- Tobacco product use is started and established primarily during adolescence.1,2
- Nearly 9 out of 10 adults who smoke cigarettes daily first try smoking by age 18, and 99% first try smoking by age 26.2
- Each day in the U.S., about 1,600 youth smoke their first cigarette and nearly 200 youth start smoking every day.2,3
- Flavorings in tobacco products can make them more appealing to youth.4,5
- In 2021, 80.2% of high school students and 74.6% of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product during that time.6
- In 2022, 85.5% of high school students and 81.5% of middle school students who used e-cigarettes in the past 30 days reported using a flavored e-cigarette during that time.7
During 2019-2020, current use of any tobacco product, any combustible tobacco product, multiple tobacco products, e-cigarettes, cigars, and smokeless tobacco among middle and high school students decreased. These declines resulted in an estimated 1.73 million fewer current youth tobacco product users in 2020 (4.47 million) compared to 2019 (6.20 million).8
Electronic cigarettes (E-cigarettes)
- E-cigarettes have been the most commonly used tobacco product among youth since 2014.
- In 2022, about 1 out of every 30 middle school students (3.3%) reported that they had used electronic cigarettes in the past 30 days.7
- In 2022, about 1 of every 7 high school students (14.1%) reported that they had used electronic cigarettes in the past 30 days.7
Cigarettes
- In 2022, about 1 of every 100 middle school students (1.0%) reported that they had smoked cigarettes in the past 30 days.7
- In 2022, nearly 2 of every 100 high school students (2.0%) reported that they had smoked cigarettes in the past 30 days.7
Cigars
- In 2022, nearly 1 of every 100 middle school students (0.6%) reported that they had smoked cigars in the past 30 days. 7
- In 2022, nearly 3 of every 100 high school students (2.8%) reported that they had smoked cigars in the past 30 days. 7
Smokeless Tobacco
- In 2022, nearly 1 of every 100 middle school students (0.7%) reported that they had had used smokeless tobacco in the past 30 days. 7
- In 2022, nearly 2 of every 100 high school students (1.6%) reported that they had had used smokeless tobacco in the past 30 days. 7
Hookah
- In 2022, less than 1 of every 100 middle school students (0.5%) reported that they had smoked hookah in the past 30 days. 7
- In 2022, about 1 of every 100 high school students (1.5%) reported that they had smoked hookah in the past 30 days. 7
Heated Tobacco Products
- In 2022, less than 1 of every 100 middle school students (0.7%) and about 1 of every 100 high school students (1.1%) reported using heated tobacco products in the past 30 days.7
- Heated tobacco products, also known as “heat-not-burn” products, deliver nicotine to the user by heating tobacco leaves rather than a nicotine-containing liquid like e-cigarettes.
Nicotine Pouches
- In 2022, less than 1 of every 100 middle school students (0.5%) and about 1 of every 100 high school students (1.4%) reported using nicotine pouches in the past 30 days. 7
- Nicotine pouches are microfiber pouches with flavored nicotine powder that users dissolve in the mouth without spitting. Sales of nicotine pouches have increased rapidly in the U.S.8
All Tobacco Product Use
- In 2022, about 4 of every 100 middle school students (4.5%) and about 1 of every 6 high school students (16.5%) reported current use of a tobacco product.7
- In 2021, about 11 of every 100 middle school students (11.3%) and about 1 of every 3 high school students (34.0%) said they had ever tried a tobacco product.6
Many young people use two or more tobacco products.
- In 2022, about 1 of every 100 middle school students (1.5%) and about 1 of every 20 high school students (5.0%) reported current use of two or more tobacco products in the past 30 days.7
- In 2021, about 4 of every 100 middle school students (4.0%) and nearly 15 of every 100 high school students (14.6%) reported they had ever tried two or more tobacco products.6
Youth who use multiple tobacco products are at higher risk for developing nicotine dependence and might be more likely to continue using tobacco into adulthood.1, 2
| Tobacco Product | Overall | Girls | Boys |
|---|---|---|---|
| Any tobacco product† | 16.5% | 17.6% | 15.3% |
| Electronic cigarettes | 14.1% | 15.4% | 12.8% |
| Cigarettes | 2.0% | 1.8% | 2.3% |
| Cigars | 2.8% | 2.1% | 3.5% |
| Smokeless tobacco | 1.6% | 0.9% | 2.3% |
| Hookah | 1.5% | 1.3% | 1.7% |
| Nicotine Pouches | 1.4% | 0.8% | 2.1% |
| Heated tobacco products | 1.1% | 1.0% | 1.3% |
| Pipe tobacco | 0.7% | 0.5% | 0.9% |
Notes:
*“Current use” is determined by respondents indicating that they have used a tobacco product on at least 1 day during the past 30 days.
†In 2022, any tobacco product includes electronic cigarettes, cigarettes, cigars, smokeless tobacco (including chewing tobacco, snuff, dip, snus, and dissolvable tobacco), pipe tobacco, bidis, hookah, heated tobacco products, and nicotine pouches.
| Tobacco Product | Overall | Girls | Boys |
|---|---|---|---|
| Any tobacco product† | 4.5% | 5.3% | 3.8% |
| Electronic cigarettes | 3.3% | 4.1% | 2.5% |
| Cigarettes | 1.0% | 1.1% | 0.8% |
| Cigars | 0.6% | 0.6% | 0.6% |
| Smokeless tobacco | 0.7% | 0.6% | 0.7% |
| Hookah | 0.5% | 0.6% | 0.4% |
| Nicotine Pouches | 0.5% | — | 0.4% |
| Heated tobacco products | 0.7% | 0.7% | 0.6% |
| Pipe tobacco | 0.3% | — | 0.3% |
Factors associated with youth tobacco product use include the following:
- Social and physical environments2,10,11
- The way mass media show tobacco product use as a normal activity can make young people want to try these products.
- Youth are more likely to use tobacco products if they see people their age using these products.
- High school athletes are more likely to use smokeless tobacco than those of the same age who are not athletes.11
- Young people may be more likely to use tobacco products if a parent uses these products.
- Biological and genetic factors1,2,10
- There is evidence that youth may be sensitive to nicotine and that teens can feel dependent on nicotine sooner than adults.
- Genetic factors may make quitting smoking harder for young people.
- Smoking during pregnancy may increase the likelihood that the child will smoke cigarettes regularly in the future.
- Mental health: There is a strong relationship between youth smoking and depression, anxiety, and stress.2
- Personal views: When young people expect positive things from smoking, such as coping with stress better or losing weight, they are more likely to smoke.2,10
- Other influences that affect youth tobacco use include:2,10
- Lower socioeconomic status, including lower income or education
- Not knowing how to say “no” to tobacco product use
- Lack of support or involvement from parents
- Accessibility, availability, and price of tobacco products
- Doing poorly in school
- Low self-image or self-esteem
- Seeing tobacco product advertising in stores, on television, the Internet, in movies, or in magazines and newspapers
National, state, and local program activities have been shown to reduce and prevent youth tobacco product use when implemented together.2,12,13 These activities include:
- Higher costs for tobacco products (for example, through increased taxes)2,13
- Prohibiting smoking in indoor areas of workplaces and public places2,13
- Raising the minimum age of sale for tobacco products to 21 years2,12
- TV and radio commercials, posters, and other media messages aimed at kids and teens in order to counter tobacco product ads2,13
- Community programs and school and college policies that encourage tobacco-free places and lifestyles2,12
- Community programs that lower tobacco advertising, promotions, and help make tobacco products less easily available2,13
Some social and environmental factors are related to lower smoking levels among youth. Among these are:2
- Being part of a religious group or tradition
- Racial/ethnic pride and strong racial identity
- Higher academic achievement
It is important to keep working to prevent and reduce the use of all forms of tobacco product use among youth.
- U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2019 Feb 28].
- U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012 [accessed 2019 Feb 28].
- Substance Abuse and Mental Health Services Administration. 2018 National Survey on Drug Use And Health: Detailed Tables. Substance Abuse and Mental Health Data Archive [accessed 4 Dec 2019].
- Centers for Disease Control and Prevention. Flavored Tobacco Product Use Among Middle and High School Students—United States, 2014. Morbidity and Mortality Weekly Report, 2015;64(38):1066–70 [accessed 2019 Feb 28].
- Wang TW, Gentzke AS, Neff LJ, et al. Characteristics of e-Cigarette Use Behaviors Among US Youth, 2020. JAMA Netw Open. 2021;4(6):e2111336. doi:10.1001/jamanetworkopen.2021.11336
- 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.
- Park Lee E, Ren C, Cooper M, Cornelius M, Jamal A, Cullen KA. Tobacco Product Use Among Middle and High School Students – United States, 2022. Morbidity and Mortality Weekly Report, 2022; 71:45.
- Gentzke AS, Wang TW, Jamal A, Park-Lee E, Ren C et al. Tobacco Product Use Among Middle and High School Students, United States, 2020. Morbidity and Mortality Weekly Report 2020;69(50);1881–1888 [accessed 2020 Dec 17].
- Marynak KL, Wang X, Borowiecki M, et al. Nicotine Pouch Unit Sales in the US, 2016-2020. JAMA. 2021;326(6):566–568. doi:10.1001/jama.2021.10366
- U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000 [accessed 2019 Feb 28].
- Centers for Disease Control and Prevention. Combustible and Smokeless Tobacco Use Among High School Athletes—United States, 2001–2013. Morbidity and Mortality Weekly Report, 2015;64(34):935–9 [accessed 2019 Feb 28].
- Gentzke AS, Glover-Kudon R, Tynan M, Jamal A. Adults’ attitudes toward raising the minimum age of sale for tobacco products to 21 years, United States, 2014-2017. Prev Med. 2020 Feb 3;133:106012. doi: 10.1016/j.ypmed.2020.106012. Epub ahead of print. PMID: 32027916.
- Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2019 Feb 28].
