E-cigarette Use Among Middle and High School Students — United States, 2020

September 18, 2020 / Vol. 69 / 37

MMWR Introduction

The use of any tobacco product by youths is unsafe, including electronic cigarettes (e-cigarettes). Most e-cigarettes contain nicotine, which is highly addictive, can harm the developing adolescent brain, and can increase risk for future addiction to other drugs.

E-cigarette use has increased considerably among U.S. youths since 2011. Multiple factors have contributed to this increase, including youth-appealing flavors and product innovations. On February 6, 2020, the Food and Drug Administration (FDA) implemented a policy prioritizing enforcement against the manufacture, distribution, and sale of certain unauthorized flavored prefilled pod or cartridge-based e-cigarettes (excluding tobacco or menthol).

CDC and FDA analyzed nationally representative data from the 2020 National Youth Tobacco Survey (NYTS), a cross-sectional, school-based, self-administered sur­vey of U.S. middle school (grades 6–8) and high school (grades 9–12) students conducted during January 16–March 16, 2020.

Comprehensive implementation of evidence-based strate­gies at the national, state, and local levels, in coordination with FDA regulation, can prevent and reduce youth tobacco product use. Strategies to address factors driving youth e-cigarette use are particularly critical. In addition to FDA’s enforcement policy that prohibits the sale of prefilled pod- or cartridge-based e-cigarettes in any flavor other than tobacco or menthol, several states and communities have restricted all flavored e-cigarette sales, including menthol.

MMWR Highlights

Current use of e-cigarettes, 2020

  • High school students, 3.02 million, 19.6%.
  • Middle school students, 550,000, 4.7%.

Use of flavors among current e-cigarette users, 2020

  • High school students, 2.53 million, 84.7%.
  • Middle school students, 400,000, 73.9%.

Device types used among current e-cigarette users, 2020

High school

  • Pre-filled pods/cartridges, 1.45 million, 48.5%.
  • Disposables, 790,000, 26.5%.
  • Tanks, 440,000, 14.8%.

Middle school

  • Prefilled pods/cartridges, 220,000, 41.3%.
  • Tanks, 110,000, 21.5%.
  • Disposables, 80,000, 2%.

Current use of flavored, pre-filled pods/cartridges, 2020

Middle and high school

  • Fruit, 66.0%.
  • Mint, 57.5%.
  • Menthol, 44.5%.
  • Candy, desserts, or other sweets (35.6%).

Current use of flavored, disposable e-cigarettes, 2020

Middle and high school

  • Fruit, 82.7%.
  • Mint, 51.9%.
  • Candy, desserts, or other sweets, 41.7%.
  • Menthol 23.3%.

Other Key Findings

  • These data reflect a decline in current e-cigarette use among middle and high school students since 2019; however, 3.6 million U.S. youths still currently used e-cigarettes in 2020, and among current users, more than 8 in 10 reported using flavored e-cigarettes.
  • Consistent with 2019, prefilled pods/cartridges were the most commonly used device type; however, compared to 2019, disposable e-cigarette use increased 400% among middle school and 1000% among high school student current e-cigarette users in 2020.
  • Although use of fruit flavored e-cigarettes was common among users in 2020, findings also suggest prominent menthol e-cigarette use (mint and menthol were not separated out in 2019).