e-Cigarette Use Among Youth in the United States, 2019

Abstract

Importance: The prevalence of e-cigarette use among US youth increased from 2011 to 2018. Continued monitoring of the prevalence of e-cigarette and other tobacco product use among youth is important to inform public health policy, planning, and regulatory efforts.

Objective: To estimate the prevalence of e-cigarette use among US high school and middle school students in 2019 including frequency of use, brands used, and use of flavored products.

Design, setting, and participants: Cross-sectional analyses of a school-based nationally representative sample of 19 018 US students in grades 6 to 12 participating in the 2019 National Youth Tobacco Survey. The survey was conducted from February 15, 2019, to May 24, 2019.

Main outcomes and measures: Self-reported current (past 30-day) e-cigarette use estimates among high school and middle school students; frequent use (≥20 days in the past 30 days) and usual e-cigarette brand among current e-cigarette users; and use of flavored e-cigarettes and flavor types among current exclusive e-cigarette users (no use of other tobacco products) by school level and usual brand. Prevalence estimates were weighted to account for the complex sampling design.

Results: The survey included 10 097 high school students (mean [SD] age, 16.1 [3.0] years; 47.5% female) and 8837 middle school students (mean [SD] age, 12.7 [2.8] years; 48.7% female). The response rate was 66.3%. An estimated 27.5% (95% CI, 25.3%-29.7%) of high school students and 10.5% (95% CI, 9.4%-11.8%) of middle school students reported current e-cigarette use. Among current e-cigarette users, an estimated 34.2% (95% CI, 31.2%-37.3%) of high school students and 18.0% (95% CI, 15.2%-21.2%) of middle school students reported frequent use, and an estimated 63.6% (95% CI, 59.3%-67.8%) of high school students and 65.4% (95% CI, 60.6%-69.9%) of middle school students reported exclusive use of e-cigarettes. Among current e-cigarette users, an estimated 59.1% (95% CI, 54.8%-63.2%) of high school students and 54.1% (95% CI, 49.1%-59.0%) of middle school students reported JUUL as their usual e-cigarette brand in the past 30 days; among current e-cigarette users, 13.8% (95% CI, 12.0%-15.9%) of high school students and 16.8% (95% CI, 13.6%-20.7%) of middle school students reported not having a usual e-cigarette brand. Among current exclusive e-cigarette users, an estimated 72.2% (95% CI, 69.1%-75.1%) of high school students and 59.2% (95% CI, 54.8%-63.4%) of middle school students used flavored e-cigarettes, with fruit, menthol or mint, and candy, desserts, or other sweets being the most commonly reported flavors.

Conclusions and relevance: In 2019, the prevalence of self-reported e-cigarette use was high among high school and middle school students, with many current e-cigarette users reporting frequent use and most of the exclusive e-cigarette users reporting use of flavored e-cigarettes.

Figure.. Flavor Types Reported Among Current Exclusive e-Cigarette Users Who Reported Flavored e-Cigarette Use, 2016-2019

The error bars indicate 95% CIs. Data are statistically unreliable due to unweighted denominator less than 50 or relative standard error greater than 30%. Among high school students, estimates of chocolate (2016-2017), alcohol (2016-2018), and clove/spice (2016-2019) were suppressed. Among middle school students, estimates of chocolate (2016-2018), alcohol (2016-2018), clove/spice (2016-2019), and other (2016-2017) were suppressed. Among past 30-day flavored e-cigarette users, flavor type was determined by responses to the question, “What flavors of tobacco products have you used in the past 30 days? (Select one or more).” Participants could select from a list of options to designate the flavor they had used including menthol or mint; clove or spice; fruit; chocolate; alcoholic drink (such as wine, cognac, margarita, or other cocktails); candy, desserts, or other sweets; or some other flavor not listed here (specify). Respondents could select 1 or more of the 7 prespecified flavors. Those who indicated “some other flavor not listed here” could specify with a write-in response; the qualitative assessment of these responses (n = 358) is not included in this report. Those who did not select any of the prespecified flavors were set to missing. Past 30-day use of e-cigarettes was determined by asking, “During the past 30 days, on how many days did you use e-cigarettes?” Current use was defined use on 1 or more days in the past 30 days. Exclusive electronic cigarette use was defined as use of only e-cigarettes in the past 30 days. Flavored e-cigarette use was determined by the response to the question, “Which of the following tobacco products that you used in the past 30 days were flavored to taste like menthol (mint), alcohol (wine, cognac), candy, fruit, chocolate, or any other flavors? (Select one or more).” Participants could select from a list of options to designate the flavored tobacco product they used in the past 30 days including cigars, cigarillos, or little cigars; chewing tobacco, snuff, or dip; e-cigarettes; tobacco in a hookah or waterpipe; pipe filled with tobacco (not waterpipe); snus; dissolvable tobacco products; bidis; roll-your-own cigarettes; or I did not use any flavored tobacco products in the past 30 days. Among those who reported past 30-day e-cigarette use, those who selected e-cigarettes were defined as current flavored e-cigarette users. Respondents who were past 30-day e-cigarette users and did not select e-cigarettes or selected I did not use any flavored tobacco products in the past 30 days were classified as unflavored. Respondents missing a response were classified as unknown. Between 2018 and 2019, the National Youth Tobacco Survey changed from paper and pencil to electronic administration. Please see the Methods section for a complete description of changes. Although direct comparisons between 2018 and 2019 are not conducted, trends using multiple years of data are not as affected by the mode change.