Tobacco Product Use and Associated Factors Among Middle and High School Students—
United States, 2019

MMWR Introduction

Most tobacco product use begins during adolescence. In recent years, tobacco products have evolved to include various smoked, smokeless, and electronic products.

CDC’s Office on Smoking and Health, in collaboration with the U.S. Food and Drug Administration’s (FDA’s) Center for Tobacco Products, analyzed data from the 2019 National Youth Tobacco Survey (NYTS) to assess tobacco product use patterns and associated factors among U.S. middle (grades 6-8) and high (grades 9-12) school students. NYTS had been conducted via paper and pencil questionnaires since 1999. In 2019, NYTS for the first time was administered in schools using electronic data collection methods.

Youth use of tobacco products in any form is unsafe, regardless of whether the products are smoked, smokeless, or electronic. The comprehensive and sustained implementation of evidence-based tobacco control strategies, combined with FDA’s regulation of tobacco products, is important for preventing and reducing all forms of tobacco product use among U.S. youths. In addition, because tobacco products might continue to diversify, surveillance among youths for all forms of tobacco product use and associated factors is important to the development of public health policy and action at the national, state, and community levels.

MMWR Highlights

Current (past 30-day) tobacco product use among high school students, 2019

• E-cigarettes, 27.5%.
• Cigars, 7.6%.
• Cigarettes, 5.8%.
• Smokeless tobacco, 4.8%.
• Hookahs, 3.4%.
• Pipe tobacco, 1.1%.

Current (past 30-day) tobacco product use among middle school students, 2019

• E-cigarettes, 10.5%.
• Cigars, 2.3%.
• Cigarettes, 2.3%.
• Smokeless tobacco, 1.8%.
• Hookahs, 1.6%.

Other Key Highlights (NYTS, 2019)

• Flavored Tobacco Products: Nearly 7 in 10 (69.6%, 4.3 million) middle and high school student current tobacco product users reported flavored tobacco product use.
• Reasons for E-Cigarette Use: Among middle and high school students who ever tried using e-cigarettes, the most common reasons for e-cigarette use were: “I was curious about them” (55.3%); “friend or family member used them” (30.8%); “they are available in flavors, such as mint, candy, fruit or chocolate” (22.4%); and “I can use them to do tricks” (21.2%).
• Product Advertising and Promotions: Nearly 9 in 10 middle and high school students (86.3%, 22.9 million) reported exposure to tobacco product advertisements or promotions from at least one source.
• Curiosity: Among students who reported ever having tried e-cigarettes, the most common reason for use was: “I was curious about them” (55.3%). Among students who never used e-cigarettes, 39.1% were curious about using e-cigarettes, and 37.0% were curious about smoking cigarettes.
• Misperceptions of Harm: Among all students, perceiving no harm or little harm from intermittent tobacco product use (use on some days but not every day) was 28.2%, e-cigarettes, 16.4% for hookahs, 11.5% for smokeless tobacco products, and 9.5% for cigarettes.
• Urges to Use Tobacco Products: Among current users of any tobacco product, 24.7% reported experiencing cravings to use tobacco products during the past 30 days, including 25.8% of high school students and 21.4% of middle school students. Overall, 13.7% of current tobacco product users reported wanting to use a tobacco product within 30 minutes of waking, including 15.6% of high school students and 7.3% of middle school students.
• Quitting Behaviors: Among current users of any tobacco product, 57.8% reported they were seriously thinking about quitting the use of all tobacco products. Among current tobacco product users, 57.5% reported they stopped using all tobacco products for a day or more because they were trying to quit.