Tobacco Product Use Among Middle and High School Students — United States, 2022

November 11, 2022 / Vol. 71 / No. 45

The 2022 National Youth Tobacco Survey was administered January 18–May 31, 2022. Changes in methodology limit the ability to compare estimates from 2022 with those from prior years.

MMWR Introduction

Commercial* tobacco product use is the leading cause of preventable disease, disability, and death among adults in the United States. Youth use of tobacco products in any form is unsafe, and nearly all tobacco use begins during youth and young adulthood.

The U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention analyzed data from the National Youth Tobacco Survey, a cross-sectional, self-administered survey of U.S. middle school (grades 6–8) and high school (grades 9–12) students.

This study assessed current (past 30-day) use of eight tobacco products: cigarettes, cigars, e-cigarettes, heated tobacco products, hookah, nicotine pouches, pipe tobacco, and smokeless tobacco. E-cigarettes—for the ninth consecutive year—were the most commonly used tobacco product among all students. This study also reported use of any tobacco product, any combustible tobacco product, and multiple (two or more) tobacco products.

Additionally, the study reported disparities in tobacco product use among students, by race and ethnicity and by selected demographic characteristics and social determinants of health.

Everyone can help reduce youth tobacco use. Parents, educators, and healthcare providers can help youth recognize and avoid the dangers of tobacco use, and support and encourage youth who use tobacco products to quit. Furthermore, it is imperative to address policy and environmental factors that are driving tobacco-related disparities.

MMWR Highlights

Key Findings

Overall Current Tobacco Product Use, 2022
Middle and High School Students Combined

  • E-cigarettes, 9.4%.
  • Cigars, 1.9%.
  • Cigarettes, 1.6%.
  • Smokeless tobacco, 1.3%.
  • Hookah, 1.1%.
  • Nicotine pouches, 1.1%.
  • Heated tobacco products, 1.0%.
  • Pipe tobacco, 0.6%.
  • Any tobacco product, 11.3%.
  • Any combustible tobacco product, 3.7%.
  • Multiple tobacco products, 3.5%.

Overall Current Tobacco Product Use, 2022—By Race and Ethnicity
Middle and High School Students Combined

  • Any Tobacco Product Use
    • Non-Hispanic AI/AN, 13.5%.
    • Non-Hispanic Multiracial, 13.0%.
    • Non-Hispanic White, 12.4%.
    • Non-Hispanic Black, 11.5%.
    • Hispanic, 11.1%.
    • Non-Hispanic Asian, 3.1%.
  • Any Combustible Tobacco Product Use
    • Non-Hispanic Black, 5.7%.
    • Non-Hispanic Multiracial, 4.7%.
    • Non-Hispanic AI/AN, 4.6%.
    • Hispanic, 3.9%.
    • Non-Hispanic White, 3.4%.
    • Non-Hispanic Asian, —.
  • E-cigarettes
    • Non-Hispanic White, 11.0%.
    • Non-Hispanic Multiracial, 10.6%.
    • Non-Hispanic AI/AN, 9.6.%.
    • Hispanic, 8.8%.
    • Non-Hispanic Black, 8.2%.
    • Non-Hispanic Asian, —.

Overall Current Tobacco Product Use, 2022—By Selected Demographic Characteristics and Social Determinants of Health
Middle and High School Students Combined

  • Sexual Identity
    • Gay, lesbian, or bisexual, 16.0%.
    • Heterosexual, 9.7%.
    • Not sure, 7.1%.
  • Transgender
    • Yes, transgender, 16.6%.
    • Not sure, 14.5%.
    • No, not transgender, 10.2%.
    • I don’t know what this question is asking, 8.1%.
  • Psychological Distress
    • Severe, 18.3%.
    • Moderate, 13.1%.
    • Mild, 10.9%.
    • None, 7.2%.
  • Family Affluence Scale
    • Low, 12.5%.
    • Medium, 9.6%.
    • High, 9.6%.
  • Grades in School
    • Mostly Fs, 27.2%.
    • Mostly Ds, 22.7%.
    • Mostly Cs, 16.5%.
    • Mostly Bs, 11.3%.
    • Mostly As, 6.6%.

*Smoking and tobacco product use here refer to use of commercial tobacco products and not to tobacco used for  medicinal and spiritual purposes by some American Indian communities.
In this study, current cigarette smoking was defined as smoking 100 or more cigarettes during a person’s lifetime and smoking cigarettes “every day” or “some days” at the time of survey. For all other tobacco products, current use was defined as having smoked at least once during a person’s lifetime and reported use “every day” or “some days,” at the time of the survey.
Dashes indicate numbers that are too small to be statistically reliable.