Youth tobacco use rates declined slightly in US, but ‘work is far from over,’ health officials say

Overall tobacco use among youths dropped slightly, by about 1%, since last year, largely driven by declines in e-cigarette use among high schoolers, according to data released Thursday by the US Centers for Disease Control and Prevention and the US Food and Drug Administration from the 2023 National Youth Tobacco Survey.

The new report finds that about 10% of students in those grades — or 2.8 million youth — reported using any type of tobacco product during 2022-2023.

Overall current tobacco use dropped among high school students, from 16.5% to 12.6%, and about 580,000 fewer high schoolers reported currently using e-cigarettes.

But among middle school students, overall tobacco use increased from 4.5% to 6.6%, and and use of multiple tobacco products, such as cigarettes, cigars, e-cigarettes and smokeless tobacco, increased from 1.5% to 2.5%. E-cigarette use among middle school students stayed about the same as last year, the report says.

“E-cigarettes remained the most commonly used tobacco product among both high school and middle school students for the 10th year in a row,” the FDA said in a news release.

Approximately 2.1 out of 2.8 million students who reported using tobacco the past year were e-cigarette users, Dr. Brian King, director of the FDA’s Center for Tobacco Products, told CNN on Thursday.

About 1 in 4 students who use e-cigarettes use them daily and nearly all (89.4%) use flavored products, according to the FDA.

“The decline in e-cigarette use among high school students shows great progress, but our work is far from over,” said Deirdre Lawrence Kittner, the director of the CDC’s Office on Smoking and Health, in a statement. “Findings from this report underscore the threat that commercial tobacco product use poses to the health of our nation’s youth. It is imperative that we prevent youth from starting to use tobacco and help those who use tobacco to quit.

Middle school and high school students chose to use disposable e-cigarette products the most, the survey found, and for the first time ever, the survey asked about concept flavors like “iced” or “island bash.”

“Accounting for these products provides a more robust picture of flavored tobacco product use among youth, with the results suggesting that flavored tobacco product use among youth might be higher than previously thought,” the FDA said in a statement.

King said the report is an indicator of the “good progress” the agency has made.

“Just back in 2019, we had over 5 million kids using e-cigarettes and we’re now down to just over 2 million and that’s a public health win that we want to celebrate,” King said. “But we can’t rest on our laurels and we have to continue to redouble our efforts to reduce all tobacco use among kids, including e-cigarettes.”

These efforts include enforcement and compliance actions against all the stages of the supply chain, from manufacturers to distributors and importers to retailers. It also means learning from the survey about the types of brands and products students are using.

“We want to make sure that we have strategies in place to address the diversity of products kids are using so we’re not playing whack-a-mole in terms of reducing e-cigarette use among kids,” King said.

In addition to those steps, King says it’s important to be mindful of the increase in tobacco use among middle school students and consider the factors driving that increase, such as advertising, youth-appealing flavors and the high levels of nicotine in the products.

“We know nicotine is highly addictive, it can harm the developing adolescent brain and it can also prime the brain for addiction to other drugs. And so it’s very critical that we take a prevention lens and make sure we continue to implement those population-based interventions including regulation, to make sure that we continue the important declines that we’ve seen,” he said.

There are also actions families and teachers can take to help protect students, such as familiarizing themselves with the brands that are popular, being aware of the risks of nicotine use in kids and having the health care resources to help students quit if they are using the products, King said.

It’s also an “important reminder that prevention is key for both youth but also young adults, particularly those who have not used other tobacco products,” he added.

New research published in JAMA Network Open on Friday found that about 18% of young adults age 18 to 24 used e-cigarettes, according to survey data from 2021.

The study zoomed in for a closer look at 18- to 20-year-old e-cigarette users and found that nearly 72% had never used combustible cigarettes.

“Some of this is kids who had previously used e-cigarettes as youth and are now aging into young adulthood, and so it’s an important reminder for us to continue that prevention lens, but also making sure that we have resources available to help these youth and young adults quit using these tobacco products, so they don’t continue into full adulthood continuing to use these products,” King said.

Yolonda Richardson, the president and CEO of the Campaign for Tobacco-Free Kids, said in part that the survey results of middle and high school students were “terrific news,” but more progress needs to be made.

“These results are powerful evidence that, with the right policies and public education campaigns, we can drive down and even eliminate youth use of all tobacco products. They show that we can reduce youth e-cigarette use without a resurgence in cigarette smoking,” she said in a statement. “Despite this progress, youth e-cigarette use remains a serious public health problem in the United States, and it continues to be driven by the widespread availability of illegal and unauthorized flavored products that must be taken off the market.”

Richardson urged the FDA to “clear the market of all flavored e-cigarettes” and said, “states and cities must ramp up their efforts to end the sale of flavored e-cigarettes and other flavored tobacco products, especially as industry lawsuits continue to delay FDA action.”

The National Youth Tobacco Survey is a web-based survey given to young people in grades 6 through 12. The survey was administered from March 9-June 16.

Limitations include that the data is all self-reported and there were fewer responses this year than for the 2022 survey. Additionally, only public and private school youth were surveyed, which the report says may mean that the results are not generalizable to young people who are being home schooled, are in detention centers or who have dropped out of school.

According to the CDC, e-cigarettes are not safe for young people, as nicotine can harm the developing brain, and they may contain other potentially harmful chemicals. Use of nicotine in youth can increase risk of future addiction to other substances, the agency says.

Smoking cigarettes is the “leading cause of preventable disease, disability, and death in the United States,” harming almost every organ in the body and costing the US hundreds of billions of dollars every year.

“Each day, about 1,600 youth try their first cigarette,” the CDC says.

Correction: A previous version of this story gave the incorrect name for Dr. Brian King.

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