Tobacco Product Use among Middle and High School Students, United States, 2020

MMWR Introduction

Tobacco use is the leading cause of preventable disease and death in the United States; nearly all tobacco use begins during youth and young adulthood.

CDC and the Food and Drug Administration (FDA) analyzed data from the 2019 and 2020 National Youth Tobacco Surveys to determine changes in the current (past 30-day) use of seven tobacco products among U.S. middle (grades 6–8) and high (grades 9–12) school students.

The comprehensive and sustained implementation of evidence-based tobacco control strategies, combined with tobacco product regulation by the FDA, is warranted to help sustain this progress and prevent and reduce all forms of tobacco product use among U.S. youths. In addition, as the tobacco product landscape continues to diversify, surveillance for all forms of tobacco product use, including novel products, by youths is important to inform public health policy and practice at the local, state, and national levels.

MMWR Highlights

Current (past 30-day) tobacco product use among high school students, 2020

• E-cigarettes, 19.6%.
• Cigars, 5.0%.
• Cigarettes, 4.6%.
• Smokeless tobacco, 3.1%.
• Hookah, 2.7%.
• Heated tobacco products, 1.4%.
• Pipe tobacco, 0.7%.
• Any tobacco product,* 23.6%.

Current (past 30-day) tobacco product use among middle school students, 2020

• E-cigarettes, 4.7%.
• Cigarettes, 1.6%.
• Cigars, 1.5%.
• Heated tobacco products, 1.3%.
• Hookah, 1.3%.
• Smokeless tobacco, 1.2%.
• Pipe tobacco, 0.4%.
• Any tobacco product, 6.7%.

Additional Findings

Among middle and high school students combined:

• Any current tobacco product use declined from 23.0% (6,200,000) in 2019** to 16.2% (4,470,000)  in 2020.
• Current e-cigarette use declined from 20.0% (5,380,000) in 2019 to 13.1% (3,580,000) in 2020.
• Current use of multiple tobacco products declined from 7.8% (2,110,000) in 2019 to 5.9% (1,620,000) in 2020.
• By sex, current use of any tobacco product was 16.7% among males and 15.8% among females in 2020.
• By race/ethnicity, current use of any tobacco product use was 17.8% among non-Hispanic whites, 17.2% among Hispanics, 13.2% among non-Hispanic blacks, and 10.1% among non-Hispanic students of other races in 2020.
• By sexual identity, current use of any tobacco product was 25.5% among those identifying as lesbian, gay, or bisexual; 15.1% among those identifying as heterosexual; and 11.1% among those reporting “not sure” about sexual identity in 2020.

*In 2020, any tobacco product use was defined as use of any of the following tobacco products for at least 1 day during the past 30 days: e-cigarettes, cigarettes, cigars, smokeless tobacco, hookah, pipe tobacco, bidis (small brown cigarettes wrapped in a leaf), or heated tobacco products. In 2019, consistent with previously published estimates, any tobacco product use was defined as use of any of the following tobacco products for at least 1 day during the past 30 days: e-cigarettes, cigarettes, cigars, smokeless tobacco, hookah, pipe tobacco, or bidis.

**All 2019 numbers are from the previous year’s Morbidity and Mortality Weekly Report surveillance summary, Tobacco Product Use and Associated Factors Among Middle and High School Students—United States, 2019.