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  1. Youth and Tobacco

2018 NYTS Data: A Startling Rise in Youth E-cigarette Use

2018 National Youth Tobacco Survey Cause for Concern

According to 2018 National Youth Tobacco Survey (NYTS) data, current e-cigarette use—or “vaping”—among middle and high school students increased alarmingly between 2017 and 2018, with over 3.6 million kids currently using e-cigarettes in 2018. Each year, the NYTS—a nationally representative survey funded by FDA and CDC—sheds light on the latest rates of tobacco use among both middle and high school students. In recent years, e-cigarettes have become the most commonly used tobacco product by U.S. teens; however, rates of use generally declined between 2015 and 2017. Unfortunately, the 2018 NYTS data show a sharp and startling reversal of overall declines in youth tobacco use from previous years.1

E-cigarette Use among High School Students

78% increase in e-cigarette use in high school students

From 2017 to 2018, current e-cigarette use—defined by use on at least one day in the past 30 days—by high school students increased 78 percent, from 11.7 to 20.8 percent, accounting for a troubling 3.05 million American high school students using e-cigarettes in 2018.  In addition, the proportion of current e-cigarette users in high school who reported use on 20 days or more in the past 30-day period increased from 20 percent to 27.7 percent between 2017 and 2018.1

Flavors: A Reason for Use

68% more high school students used e-cigarettes

During the one-year period between 2017 and 2018, among high school students who currently used e-cigarettes, use of flavored e-cigarettes increased as well. Use of any flavored e-cigarette went up among current users from 60.9 percent to 67.8 percent, and menthol use increased from 42.3 percent to 51.2 percent among all current e-cigarette users—including those using multiple products—and from 21.4 percent to 38.1 percent among exclusive e-cigarette users.

Flavors in tobacco products are problematic, as they can be very appealing to youth, and are frequently listed as one of the top three reasons this population uses e-cigarettes.2,3 Additionally, kids whose first tobacco product was flavored are more likely to become current tobacco users than those whose first product was tobacco-flavored.4

E-cigarette Use Among Middle School Students

There was a 48% increase in e-cigarette use among middle school students

E-cigarette use among middle school students is also on the rise, jumping 48 percent from 2017 to 2018. Today, a total of 4.9 percent of middle school students—or 570,000 kids—are current e-cigarette users.1

What caused this sharp increase in use?

NYTS study authors hypothesize the last year’s increase in e-cigarette use among youth could be attributable to use of USB-flash-drive-like e-cigarettes, including JUUL, which have garnered popularity among youth. These products have high nicotine content; appealing flavors; and the ability to be easily concealed and used discreetly.

Reasons for Concern

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The significant rise in e-cigarette use among both student populations has resulted in overall tobacco product use increases of 38 percent among high school students and 29 percent among middle school students between 2017 and 2018, negating declines seen in the previous few years.1

This is a cause for concern because tobacco use is the leading cause of preventable disease and death in the United States and because nearly all tobacco products contain nicotine. As adolescent brains are still developing, nicotine exposure during youth and young adulthood can change the way the brain works, leading to a lifetime of addiction and, in some cases, causing long-lasting effects such as increased impulsivity and mood disorders.5 Studies also find teens who use e-cigarettes have an increased risk of trying combustible cigarettes.6 
While completely switching from combustible cigarettes to e-cigarettes may potentially benefit addicted adult smokers’ health,6 no tobacco product—including e-cigarettes—is safe for youth to use.

FDA is committed to protecting future generations by preventing youth access to tobacco products, curbing marketing of tobacco products aimed at youth, and educating teens about the dangers of using any tobacco product, including e-cigarettes, as well as educating retailers about their key role in protecting youth. Learn more: FDA’s Youth Tobacco Prevention Plan.

Additional Resources

1. Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Increase in use of electronic cigarettes and any tobacco product among middle and high school students — United States, 2011–2018. MMWR Morbid Mortal Wkly Rep. 2018;67(45):XX-XX
2. Tsai J, Walton K, Coleman BN, et al. Reasons for Electronic Cigarette Use Among Middle and High School Students — National Youth Tobacco Survey, United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:196–200.
3. Ambrose BK, Day HR, Rostron B, et al. Flavored Tobacco Product Use Among US Youth Aged 12-17 Years, 2013-2014. JAMA. 2015;314(17):1871–1873.
4. Villanti, A.C., A.L. Johnson, B.K. Ambrose, et al., ‘‘Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013–2014),’’ American Journal of Preventive Medicine, 53(2):139–151, 2017.
5. U.S. Department of Health and Human Services (USDHHS). E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016.
6. National Academies of Sciences, Engineering, and Medicine (NASEM). 2018. Public Health Consequences of E-cigarettes. Washington, DC: The National Academies Press.

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