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

Background

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 2021, 85.8% of high school students and 79.2% of middle school students who used e-cigarettes in the past 30 days reported using a flavored e-cigarette during that time.6

Estimates of Current Tobacco Use Among Youth

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.6

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).7

2021 Curremt Tobacco Use among High School Students. Any Tobacco 13.4%, E-cigarettes 11.3%, Cigars 2.1%, Cigarettes 1.9%, Smokeless tobacco 1.2%, Hookah 1.2%, Nicotine pouches 1.1%, Heated Tobacco Products 0.8%, Pipes 0.4%

Electronic cigarettes (E-cigarettes)

  • E-cigarettes have been the most commonly used tobacco product among youth since 2014.
  • In 2021, about 1 out of every 35 middle school students (2.8%) reported that they had used electronic cigarettes in the past 30 days.6
  • In 2021, about 1 of every 9 high school students (11.3%) reported that they had used electronic cigarettes in the past 30 days.6

Cigarettes

  • In 2021, about 1 of every 100 middle school students (1.0%) reported that they had smoked cigarettes in the past 30 days.6
  • In 2021, nearly 2 of every 100 high school students (1.9%) reported that they had smoked cigarettes in the past 30 days.6

Cigars

  • In 2021, nearly 1 of every 100 middle school students (0.6%) reported that they had smoked cigars in the past 30 days. 6
  • In 2021, about 2 of every 100 high school students (2.1%) reported that they had smoked cigars in the past 30 days. 6

Smokeless Tobacco

  • In 2021, nearly 1 of every 100 middle school students (0.6%) reported that they had had used smokeless tobacco in the past 30 days. 6
  • In 2021, about 1 of every 100 high school students (1.2%) reported that they had had used smokeless tobacco in the past 30 days. 6

Hookah

  • In 2021, less than 1 of every 100 middle school students (0.4%) reported that they had smoked hookah in the past 30 days. 6
  • In 2021, about 1 of every 100 high school students (1.2%) reported that they had smoked hookah in the past 30 days. 6

Heated Tobacco Products

  • In 2021, less than 1 of every 100 middle school students (0.4%) and about 1 of every 100 high school students (0.8%) reported using heated tobacco products in the past 30 days.6
  • 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 2021, less than 1 of every 100 middle school students (0.3%) and about 1 of every 100 high school students (1.1%) reported using nicotine pouches in the past 30 days. 6
  • 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
Teens in class

All Tobacco Product Use

  • In 2021, about 4 of every 100 middle school students (4.0%) and about 13 of every 100 high school students (13.4%) reported current use of a tobacco product.6
  • 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 2021, about 1 of every 100 middle school students (1.3%) and nearly 4 of every 100 high school students (3.8%) reported current use of two or more tobacco products in the past 30 days.6
  • 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

Current Tobacco Product Use* Among High School Students in 20216
Tobacco Product Overall Girls Boys
Any tobacco product 13.4% 13.8% 13.0%
Electronic cigarettes 11.3% 11.9% 10.7%
Cigarettes 1.9% 1.8% 2.0%
Cigars 2.1% 1.5% 2.6%
Smokeless tobacco 1.2% 1.7%
Hookahs 1.2% 1.3% 1.2%
Nicotine Pouches 1.1% 0.6% 1.6%
Heated Tobacco Products 0.8% 0.7% 0.9%
Pipe tobacco 0.4%

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 2021, 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.

Current Tobacco Product Use* Among Middle School Students in 20216
Tobacco Product Overall Girls Boys
Any tobacco product 4.0% 4.4% 3.6%
Electronic cigarettes 2.8% 3.2% 2.3%
Cigarettes 1.0% 1.2% 0.9%
Cigars 0.6% 0.5% 0.6%
Smokeless tobacco 0.6% 0.8%
Hookahs 0.4%
Nicotine Pouches 0.3% 0.2%
Heated Tobacco Products 0.4% 0.4% 0.4%
Pipe tobacco 0.2%

 

Factors Associated With Youth Tobacco Product Use

Factors associated with youth tobacco product use include the following:

  • Social and physical environments9,10
    • 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.10
    • Young people may be more likely to use tobacco products if a parent uses these products.
  • Biological and genetic factors1,2,9
    • 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.2,9
  • Other influences that affect youth tobacco use include:2,9
    • 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
Teens looking at a phone.

Reducing Youth Tobacco Product Use

National, state, and local program activities have been shown to reduce and prevent youth tobacco product use when implemented together.2,11,12 These activities include:

  • Higher costs for tobacco products (for example, through increased taxes)2,12
  • Prohibiting smoking in indoor areas of workplaces and public places2,12
  • Raising the minimum age of sale for tobacco products to 21 years2,11
  • TV and radio commercials, posters, and other media messages aimed at kids and teens in order to counter tobacco product ads2,12
  • 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 available2,12 

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.