Notes from the Field: E-cigarette Use Among Middle and High School Students—National Youth Tobacco Survey, United States, 2021

October 1, 2021 / Vol. 70 / 39

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The 2021 National Youth Tobacco Survey was fully conducted amid the global COVID-19 pandemic (administered January 18–May 21, 2021). Data were collected using an online survey; eligible students could participate in the classroom, at home, or some other p­­­lace to account for various school instructional models during this time. Thus, results from the 2021 NYTS cannot be compared to results from previous NYTS surveys, which were conducted primarily on school campuses.

MMWR Introduction

CDC and the Food and Drug Administration (FDA) analyzed representative data from the 2021 National Youth Tobacco Survey (NYTS) to assess e-cigarette use behaviors among U.S. middle and high school students. Because of the ongoing COVID-19 pandemic, data were collected online to allow participation of eligible students in remote learning settings.

The study found that more than 2 million youths currently used e-cigarettes, within the past 30-days of the survey, in 2021, with more than 8 in 10 of those young people using flavored e-cigarettes. Additionally, disposable e-cigarettes were the most used e-cigarette device type among youths in 2021. The study found that youth e-cigarette use was a public health concern—even amid the COVID-19 pandemic when many students were in remote learning environments that might have affected their access to tobacco. As the tobacco product landscape continues to evolve, sustained implementation of comprehensive tobacco control and prevention strategies at the national, state, and local levels, coupled with FDA regulation, can help to prevent and reduce tobacco product initiation and use among U.S. youths.

MMWR Highlights

Self-reported current (past 30-day) e-cigarette use, 2021

  • Overall: An estimated* 7.6%, (2.06 million).
    • Middle school: An estimated* 2.8% (320,000).
    • High school: An estimated* 11.3% (1.72 million).

Among middle and high school students who currently use e-cigarettes, 2021

  • Frequency of e-cigarette use, past 30 days, 2021
    • 1–19 days, 60.6%.
    • 20–30 days, 39.4%.
  • Daily e-cigarette use, past 30 days 2021
    • All 30 days, 24.6%.
  • E-cigarette device type used, 2021
    • Disposables, 53.7%.
    • Prefilled or refillable pods or cartridges, 28.7%.
    • Tanks or mod systems, 9.0%.
    • Don’t know, 8.6%.
  • Usual e-cigarette brand used, 2021
    • Puff Bar, 26.8%.
    • Vuse, 10.5%.
    • SMOK (including NOVO), 8.6%.
    • JUUL, 6.8%.
    • Suorin, 2.1%.
    • No usual brand, 2.4%.
    • Some other brand not listed, 19.8%.
    • Don’t know, 16.1%.
  • Flavored e-cigarette use, 2020
    • Yes, 84.7%.
    • No, 8.8%.
    • Don’t know, 6.5%.
  • Flavor types used, † 2021
    • Fruit, 71.6%.
    • Candy, desserts, or other sweets, 34.1%.
    • Mint, 30.2%.
    • Menthol, 28.8%.
    • Alcoholic drink, 6.0%.
    • Chocolate, 2.9%.
    • Clove or spice, 2.1%.
    • Some other flavor not listed, 10.4%.

*Estimated total number of users was extrapolated from probability weights, rounded down to the nearest 10,000 people. Overall population totals might not directly sum to corresponding estimates by school level because of rounding or inclusion of students who did not self-report grade level.

†Responses were from students who used flavored e-cigarettes. Respondents could select from one more flavor types. Flavor types were not mutually exclusive.

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