Vital Signs: Tobacco Product Use Among Middle and High School Students—United States, 2011–2018

MMWR Introduction

Tobacco use is the leading cause of preventable disease and death in the United States; nearly all tobacco product use begins during youth and young adulthood. CDC, the Food and Drug Administration, and the National Cancer Institute analyzed data from the 2011–2018 National Youth Tobacco Surveys to estimate use of seven tobacco product types among U.S. middle (grades 6–8) and high (grades 9–12) school students: cigarettes, cigars, smokeless tobacco, electronic cigarettes (e-cigarettes), hookahs (water pipes used to smoke tobacco), pipe tobacco, and bidis (small brown cigarettes wrapped in a leaf).

A considerable increase in e-cigarette use among U.S. youths, coupled with no change in use of other tobacco products during 2017–2018, has erased recent progress in reducing overall tobacco product use among youths. The sustained implementation of comprehensive tobacco control strategies, in coordination with Food and Drug Administration regulation of tobacco products, can prevent and reduce the use of all forms of tobacco products among U.S. youths.

MMWR Highlights

Current (past 30-day) tobacco product use among middle and high school students, 2017–2018

• Among high school students, current use of any tobacco product increased from 19.6% (2.95 million) in 2017 to 27.1% (4.04 million) in 2018.
• Among middle school students, current use of any tobacco product increased from 5.6% (670,000) in 2017 to 7.2% (840,000) in 2018.

Current (past 30-day) tobacco product use* among high school students, 2018

• Any tobacco product: 27.1%.
• Any combustible tobacco product: 13.9%.
• Two or more tobacco products: 11.3%.
• E-cigarettes: 20.8%.
• Cigarettes: 8.1%.
• Cigars: 7.6%.
• Smokeless tobacco: 5.9%.
• Hookah: 4.1%.
• Pipe tobacco: 1.1%.

Current (past 30-day) tobacco product use* among middle school students, 2018

• Any tobacco product: 7.2%.
• Any combustible tobacco product: 3.3%.
• Two or more tobacco products: 2.4%.
• E-cigarettes: 4.9%.
• Cigarettes: 1.8%.
• Cigars: 1.6%.
• Smokeless tobacco: 1.8%.
• Hookah: 1.2%.
• Pipe tobacco: 0.3%.

* Beginning in 2018, prevalence estimates are not provided for bidis (small brown cigarettes wrapped in a leaf) by school level, sex, or race/ethnicity. However, use of bidis is captured in the composite measures of any tobacco product use, use of any combustible tobacco product, and use of two or more tobacco products to maintain consistent definitions over time.

Other key highlights

• Frequent use (more than 20 days in the past 30 days) of e-cigarettes increased from 20% in 2017 to 27.7% in 2018 among current high school e-cigarette users, but no significant change in frequent use was observed for other tobacco products.
• Among current tobacco product users, about 2 in 5 (1.68 million) high school students and 1 in 3 (270,000) middle school students used two or more tobacco products in 2018. E-cigarettes were the most commonly reported product used in combination with other tobacco products among both middle and high school students.
• Among high school students in 2018, any tobacco product use was reported by 32.4% of non-Hispanic white, 21.7% of Hispanic, 18.4% of non-Hispanic other race, and 17.4% of non-Hispanic black students.
• Among middle school students in 2018, any tobacco product use was reported by 9.5% of Hispanics, 6.8% of non-Hispanic blacks, 6.6% of non-Hispanic whites, and 3.8% of non-Hispanic students of other races.
• By sex in 2018, use of any tobacco product, two or more tobacco products, e-cigarettes, cigarettes, cigars, smokeless tobacco, and pipe tobacco was higher among male high school students than females.
• By race/ethnicity in 2018, e-cigarettes were the most commonly used product among all racial/ethnic groups except black high school students, among whom cigars were the most commonly reported tobacco product.