Tobacco Product Use Among Middle and High School Students - United States, 2011-2017

Abstract

Tobacco use is the leading cause of preventable disease and death in the United States, and nearly all tobacco use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2017 National Youth Tobacco Surveys (NYTS)* to determine patterns of current (past 30-day) use of seven tobacco product types among U.S. middle school (grades 6-8) and high school (grades 9-12) students and estimate use nationwide. Among high school students, current use of any tobacco product decreased from 24.2% (estimated 3.69 million users) in 2011 to 19.6% (2.95 million) in 2017. Among middle school students, current use of any tobacco product decreased from 7.5% (0.87 million) in 2011 to 5.6% (0.67 million) in 2017. In 2017, electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high (11.7%; 1.73 million) and middle (3.3%; 0.39 million) school students. During 2016-2017, decreases in current use of hookah and pipe tobacco occurred among high school students, while decreases in current use of any tobacco product, e-cigarettes, and hookah occurred among middle school students. Current use of any combustible tobacco product, ≥2 tobacco products, cigarettes, cigars, smokeless tobacco, and bidis did not change among middle or high school students during 2016-2017. Comprehensive and sustained strategies can help prevent and reduce the use of all forms of tobacco products among U.S. youths (1,2).

Figure 1

Estimated percentage of high school students who currently use any tobacco product, any combustible tobacco product, ≥2 tobacco products, and selected tobacco products — National Youth Tobacco Survey, United States, 2011–2017,, * Use of any tobacco product was defined as use of electronic cigarettes (e-cigarettes), cigarettes, cigars, smokeless tobacco, hookah, pipe tobacco, and/or bidis on at least one day in the past 30 days. ^† Use of any combustible tobacco product was defined as use of cigarettes, cigars, hookah, pipe tobacco, and/or bidis on at least one day in the past 30 days. ^§ Use of ≥2 tobacco products was defined as use of two or more of the following tobacco products: e-cigarettes, cigarettes, cigars, smokeless tobacco, hookah, pipe tobacco, and/or bidis on at least one day in the past 30 days. ^¶ During 2016–2017, current use of hookah and pipe tobacco decreased significantly (p<0.05). ** During 2011–2017, current use of cigarettes, cigars, and smokeless tobacco exhibited linear decreases (p<0.05). Current use of any tobacco product, any combustible tobacco product, ≥2 types of tobacco products, pipe tobacco, and bidis exhibited nonlinear decreases (p<0.05). Current use of e-cigarettes exhibited a nonlinear increase (p<0.05). Current use of hookah exhibited a nonlinear change (p<0.05). ^†† Beginning in 2015, the definition of smokeless tobacco included chewing tobacco/snuff/dip, snus, and dissolvable tobacco to better reflect this class of tobacco products. Thus, estimates for individual smokeless tobacco products (chewing tobacco/snuff/dip, snus, and dissolvable tobacco) are not reported. This definition was applied across all years (2011–2017) for comparability purposes.

Figure 2

Estimated percentage of middle school students who currently use any tobacco product, any combustible tobacco product, ≥2 tobacco products, and selected tobacco products — National Youth Tobacco Survey, United States, 2011–2017,, * Use of any tobacco product was defined as use of electronic cigarettes (e-cigarettes), cigarettes, cigars, smokeless tobacco, hookah, pipe tobacco, and/or bidis on at least one day in the past 30 days. ^† Use of any combustible tobacco product was defined as use of cigarettes, cigars, hookah, pipe tobacco, and/or bidis on at least one day in the past 30 days. ^§ Use of ≥2 tobacco products was defined as use of two or more of the following tobacco products: e-cigarettes, cigarettes, cigars, smokeless tobacco, hookah, pipe tobacco, and/or bidis on at least one day in the past 30 days. ^¶ During 2016–2017, current use of any tobacco product, e-cigarettes, and hookah decreased significantly (p<0.05). ** During 2011–2017, current use of any tobacco product, any combustible tobacco product, ≥2 tobacco products, cigars, smokeless tobacco, and pipe tobacco exhibited significant linear decreases (p<0.05). Cigarettes and bidis exhibited significant nonlinear decreases (p<0.05). E-cigarettes and hookah exhibited significant nonlinear increases (p<0.05). ^†† Beginning in 2015, the definition of smokeless tobacco included chewing tobacco/snuff/dip, snus, and dissolvable tobacco to better reflect this class of tobacco products. Thus, estimates for individual smokeless tobacco products (chewing tobacco/snuff/dip, snus, and dissolvable tobacco) are not reported. This definition was applied across all years (2011–2017) for comparability purposes.