Trends in Tobacco Use Among Youth

At a glance

  • CDC and the Food and Drug Administration (FDA) support the National Youth Tobacco Survey (NYTS).
  • NYTS is administered annually to students in middle and high schools and used to monitor trends in youth tobacco product use in the United States.
  • Read on to learn about trends in tobacco product use among youth.

Overview

About youth tobacco use trend data

Trend data are used to look for changes in tobacco product use behaviors among youth in the United States. These data are used to understand which tobacco products are becoming more popular among middle and high school students.

Tobacco product use among U.S. youth has recently declined. However, continued efforts are needed to sustain this progress and to prevent and reduce all forms of youth tobacco product use.

Electronic cigarettes (e-cigarettes)

After increasing from 2017 to 2019, current (past 30-day) use of e-cigarettes went down among middle and high school students from 2019 to 2020.1234

  • About 1 in 20 middle school students (4.7%) reported in 2020 that they used e-cigarettes in the past 30 days. This is a decrease from 10.5% in 2019.34
  • About 1 in 5 high school students (19.6%) reported in 2020 that they used electronic cigarettes in the past 30 days. This is a decrease from 27.5% in 2019.343

Cigarettes

From 2011 to 2020, current (past 30-day) cigarette smoking went down among middle and high school students.12345

  • Nearly 2 of every 100 middle school students (1.6%) reported in 2020 that they smoked cigarettes in the past 30 days. This is a decrease from 4.3% in 2011.45
  • Nearly 5 of every 100 high school students (4.6%) reported in 2020 that they smoked cigarettes in the past 30 days. This is a decrease from 15.8% in 2011.45

Cigars

From 2011 to 2020, current use of cigars went down among middle and high school students.12345

  • Nearly 2 of every 100 middle school students (1.5%) reported in 2020 that they had used cigars in the past 30 days. This is a decrease from 3.5% in 2011.45
  • About 5 of every 100 high school students (5.0%) reported in 2020 that they had used cigars in the past 30 days. This is a decrease from 11.6% in 2011.45

Why are more recent NYTS estimates not included in these trends?‎

COVID-19 protocols were in place across the country when CDC and FDA conducted the 2021 NYTS. The 2021 survey was administered online to allow students to complete the survey at home, school, or somewhere else.6 Thus, we cannot directly compare the 2021 NYTS results with previous NYTS survey results when data were primarily collected on school campuses. In 2022, the NYTS methodology changed again.7 Therefore, there is limited ability to compare the results from the 2022 NYTS data and subsequent years with either the 2021 NYTS results or results from previous years.67 When there are enough years of comparable NYTS data, updated youth tobacco trend data will be made available.

Smokeless tobacco

From 2011 to 2020, current use of smokeless tobacco went down among middle and high school students:12345

  • About 1 of every 100 middle school students (1.2%) reported in 2020 that they had used smokeless tobacco in the past 30 days. This is a decrease from 2.2% in 2011.45
  • About 3 of every 100 high school students (3.1%) reported in 2019 that they had used smokeless tobacco in the past 30 days. This is a decrease from 7.9% in 2011.45

Hookah

From 2011 to 2020, current use of hookahs did not change much among middle school students. Current use of hookahs among high school students declined from 2011 to 2019. There was no change in hookah use from 2019 to 2020.12345

  • About 1 of every 100 middle school students (1.3%) reported in 2020 that they had smoked hookah in the past 30 days. The prevalence was 1.0% in 2011.45
  • Nearly 3 of every 100 high school students (2.7%) reported in 2020 that they had smoked hookah in the past 30 days. The prevalence was 4.1% in 2011.45

Any tobacco product use*

From 2019 to 2020, current use of any tobacco product went down among middle and high school students.34

  • About 7 of every 100 middle school students (6.7%) reported in 2020 that they had used any tobacco product in the past 30 days. This is a decrease from 12.5% in 2019.34
  • About 23 of every 100 high school students (23.6%) reported in 2020 that they had used any tobacco product in the past 30 days. This is a decrease from 31.2% in 2019.34

*In 2020, any tobacco product use was defined as current use of one or more of the following tobacco products on ≥1 day during the past 30 days:

  • E-cigarettes
  • Cigarettes
  • Cigars
  • Smokeless tobacco
  • Hookahs
  • Pipe tobacco
  • Bidis
  • Heated tobacco products

In 2019, any tobacco product use was defined as current use of one or more of the following tobacco products on ≥1 day during the past 30 days. This is consistent with previously published estimates:

  • E-cigarettes
  • Cigarettes
  • Cigars
  • Smokeless tobacco
  • Hookahs
  • Pipe tobacco
  • Bidis

In 2020, the NYTS survey included questions about heated tobacco products. Inclusion of heated tobacco products did not significantly change overall estimates of any tobacco product use among youth in 2020.

Two or more tobacco products use**

From 2019 to 2020, current use of two or more tobacco products went down among middle and high school students.34

  • About 3 of every 100 middle school students (2.8%) reported in 2020 that they had used 2 or more tobacco products in the past 30 days. This is a decrease from 4.0% in 2019.34
  • About 8 of every 100 high school students (8.2%) reported in 2020 that they had used 2 or more tobacco products in the past 30 days. This is a decrease from 10.8% in 2019.34

** In 2020, multiple tobacco product use was defined as current use of two or more of the following tobacco products on ≥1 day during the past 30 days:

  • E-cigarettes
  • Cigarettes
  • Cigars
  • Smokeless tobacco
  • Hookahs
  • Pipe tobacco
  • Bidis
  • Heated tobacco products

In 2019, multiple tobacco product use was defined as current use of two or more of the following tobacco products on ≥1 day during the past 30 days:

  • E-cigarettes
  • Cigarettes
  • Cigars
  • Smokeless tobacco
  • Hookahs
  • Pipe tobacco
  • Bidis

Inclusion of heated tobacco products did not significantly change overall estimates of multiple tobacco product use among youth in 2020.

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Content Source:
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  4. Gentzke AS, Wang TW, Jamal A, et al. Tobacco product use among middle and high school students — United States, 2020. MMWR Morb Mortal Wkly Rep . 2020;69:1881–1888. DOI: http://dx.doi.org/10.15585/mmwr.mm6950a1.
  5. Centers for Disease Control and Prevention (CDC). Tobacco product use among middle and high school students — United States, 2011 and 2012. MMWR Morb Mortal Wkly Rep. 2013;62(45):893–7.
  6. Gentzke AS, Wang TW, Cornelius M, et al. Tobacco product use and associated factors among middle and high school students — National Youth Tobacco Survey, United States, 2021. MMWR Morb Mortal Wkly Rep. 2022;71(No. SS-5):1–29.DOI: http://dx.doi.org/10.15585/mmwr.ss7105a1.
  7. Park-Lee E, Ren C, Cooper M, Cornelius M, Jamal A, Cullen KA. Tobacco product use among middle and high school students — United States, 2022 MMWR Morb Mortal Wkly Rep. 2022;71(45):1429–1435.