Tobacco Product Use Among U.S. Middle and High School Students — National Youth Tobacco Survey, 2023

MMWR Introduction

The U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration used data from the 2023 National Youth Tobacco Survey (NYTS) to assess tobacco product use patterns and associated factors among U.S. middle school (grades 6–8) and high school (grades 9–12) students.

The study analyzed ever use and current (past 30-day) use of 9 tobacco product types, flavored tobacco products, and e-cigarette use behaviors. E-cigarettes—for the 10th year—were the most commonly used tobacco product among all students.

Youth use of tobacco products, in any form, is unsafe. Tobacco products contain nicotine and can harm the developing adolescent brain. Moreover, youth tobacco product use can lead to lifelong nicotine addiction and subsequent disability, disease, and death.

Continued monitoring of youth tobacco product use behaviors and a comprehensive approach to prevent youth from starting to use tobacco, and strategies to help youth who use tobacco to quit, are critical to eliminating tobacco product use among youth.

MMWR Highlights

Key Findings

Ever Use, All Tobacco Products, 2023
Middle and High School Students Combined

  • 2% or 6.21 million reported ever using any tobacco product.
  • Notably, among those who had ever used an e-cigarette, approximately half (46.7%), reported current use, suggesting that many youth who try e-cigarettes remain e-cigarette users.

Current Use, All Tobacco Products, 2023
Middle and High School Students Combined

  • E-cigarettes—for the 10th year—were the most commonly used tobacco product among all students.
  • Any tobacco product, 10.0% or 2.80 million.
  • By Product Type
    • E-cigarettes, 7.7%
    • Cigarettes, 1.6%.
    • Cigars, 1.6%.
    • Nicotine pouches, 1.5%.
    • Smokeless tobacco, 1.2%.
    • Other oral nicotine products, 1.2%.
    • Hookahs, 1.1%.
    • Heated tobacco products, 1.0%.
    • Pipe tobacco, 0.5%.
    • Any combustible product, 3.4%.
    • Multiple tobacco products, 3.4%.

Among Students Who Reported Current E-Cigarette Use, 2023
Middle and High School Students Combined

  • By Device Type
    • Disposables, 60.7%.
    • Prefilled or refillable pods or cartridges, 16.1%.
    • Tanks or mod system, 5.9%.
    • Don’t know, 17.3%.
  • By Frequency
    • 1–5 days, 46.1%.
    • 6–19 days, 19.1%.
    • 20–30 days, 34.7%.
    • Daily (30 out of the past 30 days), 25.2%.
  • By Brands Used
    • Elf Bar, 56.7%.
    • Esco Bars, 21.6%.
    • Vuse, 20.7%.
    • JUUL, 16.5%.
    • Fog, 13.6%.
  • By Flavor
    • Fruit, 63.4%.
    • Candy, desserts, or other sweets, 35.0%.
    • Mint, 27.8%.
    • Menthol, 20.1%.
    • Unflavored, 11.6%.
    • Non-alcoholic drinks, 11.3%.
    • Alcoholic drinks, 8.4%.
    • Tobacco-flavored, 6.4%.
    • Clove or spice, 6.0%.
    • Chocolate, 4.9%.
    • Some other flavor, 6.0%.
    • Reported use of any flavor that included the word, “ice” or “iced,” 57.9%.
    • Reported use of concept flavors (products with names that do not describe a specific flavor, such as “solar,” “purples,“ jazz,” etc.,) 16.1%.