Tobacco Product Use Among Middle and High School Students - United States, 2020

Abstract

Tobacco use is the leading cause of preventable disease and death in the United States; nearly all tobacco product use begins during youth and young adulthood (1,2). CDC and the Food and Drug Administration (FDA) analyzed data from the 2019 and 2020 National Youth Tobacco Surveys (NYTS) to determine changes in the current (past 30-day) use of seven tobacco products among U.S. middle (grades 6-8) and high (grades 9-12) school students. In 2020, current use of any tobacco product was reported by 16.2% (4.47 million) of all students, including 23.6% (3.65 million) of high school and 6.7% (800,000) of middle school students. Electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high school (19.6%; 3.02 million) and middle school (4.7%; 550,000) students. From 2019 to 2020, decreases in current use of any tobacco product, any combustible tobacco product, multiple tobacco products, e-cigarettes, cigars, and smokeless tobacco occurred among high school and middle school students; these declines resulted in an estimated 1.73 million fewer current youth tobacco product users in 2020 than in 2019 (6.20 million) (3). From 2019 to 2020, no significant change occurred in the use of cigarettes, hookahs, pipe tobacco, or heated tobacco products. The comprehensive and sustained implementation of evidence-based tobacco control strategies at the national, state, and local levels, combined with tobacco product regulation by FDA, is warranted to help sustain this progress and to prevent and reduce all forms of tobacco product use among U.S. youths (1,2).

FIGURE 1

Percentage of current use of selected tobacco products, any tobacco product, any combustible tobacco product, and multiple tobacco products among high school students — National Youth Tobacco Survey, United States, 2019 and 2020 * Current use is defined as use on ≥1 day during the past 30 days for each product. ^† In 2020, any tobacco product use was defined as use of any tobacco product (e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, bidis [small brown cigarettes wrapped in a leaf], or heated tobacco products) on ≥1 day during the past 30 days. In 2019, consistent with previously published estimates, any tobacco product use was defined as use of any tobacco product (e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, or bidis) on ≥1 day during the past 30 days. ^§ Any combustible tobacco product use was defined as use of cigarettes, cigars, hookahs, pipe tobacco, or bidis on ≥1 day during the past 30 days. ^¶ In 2020, multiple tobacco product use was defined as use of two or more tobacco products (e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, bidis, or heated tobacco products) on ≥1 day during the past 30 days. In 2019, consistent with previously published estimates, multiple tobacco product use was defined as use of two or more tobacco products (e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, or bidis) on ≥1 day during the past 30 days. ** During 2019–2020, significant declines in the use of any tobacco product (p<0.001), any combustible tobacco product (p = 0.018), multiple tobacco products (p = 0.020), e-cigarettes (p<0.001), cigars (p<0.001), and smokeless tobacco (p = 0.031) were observed. No significant change in use of cigarettes, hookah, heated tobacco products, or pipe tobacco occurred.

FIGURE 2

Percentage of current use of selected tobacco products,, any tobacco product, any combustible tobacco product, and multiple tobacco products among middle school students — National Youth Tobacco Survey, United States, 2019 and 2020 * Current use is defined as use on ≥1 day during the past 30 days for each product. ^† Estimate for “pipe tobacco, 2019” is suppressed because of relative standard error >30% or unweighted denominator <50. ^§ In 2020, any tobacco product use was defined as use of any tobacco product (e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, bidis [small brown cigarettes wrapped in a leaf], or heated tobacco products) on ≥1 day during the past 30 days. In 2019, consistent with previously published estimates, any tobacco product use was defined as use of any tobacco product (e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, or bidis) on ≥1 day during the past 30 days. ^¶ Any combustible tobacco product use was defined as use of cigarettes, cigars, hookahs, pipe tobacco, or bidis on ≥1 day during the past 30 days. ** In 2020, multiple tobacco product use was defined as use of two or more tobacco products (e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, bidis, or heated tobacco products) on ≥1 day during the past 30 days. In 2019, consistent with previously published estimates, multiple tobacco product use was defined as use of two or more tobacco products (e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, or bidis) on ≥1 day during the past 30 days. ^†† During 2019–2020, significant declines in the use of any tobacco product (p<0.001), any combustible tobacco product (p = 0.013), multiple tobacco products (p = 0.025), e-cigarettes (p<0.001), cigars (p = 0.012), and smokeless tobacco (p = 0.038) were observed. No significant change in use of cigarettes, hookahs, or heated tobacco products occurred. Because of the suppression of the pipe tobacco estimate in 2019, no comparison was made during 2019–2020.