2021 Findings on Youth Tobacco Use
In March 2022, the FDA and Centers for Disease Control and Prevention (CDC) released findings on use of tobacco products by high school (grades 9-12) and middle school (grades 6-8) students from the 2021 National Youth Tobacco Survey (NYTS) in the Morbidity and Mortality Weekly Report “Tobacco Product Use and Associated Factors Among U.S. Middle and High School Students – National Youth Tobacco Survey, United States, 2021.”
Previously, FDA and CDC released findings from the 2021 NYTS focused on youth use of e-cigarettes in the Morbidity and Mortality Weekly Report “Notes from the Field: E-Cigarette Use among Middle and High School Students — National Youth Tobacco Survey, United States, 2021.”.”
Methodological changes made to conduct the NYTS during the COVID-19 pandemic prevent year-to-year comparisons of the 2021 data with data from previous surveys. In 2021, data were collected using an online survey to allow eligible students to participate in classrooms, at home, or in some other place to account for various instructional models during this time. Prior to 2021, the survey was conducted in person, inside the school classrooms.
In 2021, approximately, 2.55 million (9.3%) students reported current (past 30-day) use of a tobacco product: 2.06 million (13.4%) high school students and 470,000 (4.0%) middle school students.
The 2021 NYTS asked students about their use of nine types of tobacco products. E-cigarettes were the most commonly currently used tobacco product, cited by 2.06 million (7.6%) middle and high school students, followed by cigarettes (410,000; 1.5%), cigars (380,000; 1.4%), smokeless tobacco (240,000; 0.9%), hookahs (220,000; 0.8%), and nicotine pouches (200,000; 0.8%). This was the first time that NYTS collected data on use of nicotine pouches.
Tobacco product use was higher among certain subpopulations. For example, current use of any tobacco product was reported by 14.2% of students identifying as lesbian, gay, or bisexual (versus 7.9% of heterosexual) and 18.9% of students identifying as transgender (versus 8.2% of not transgender).
Also, current use of any tobacco product use was reported by 14.2% of students reporting severe psychological distress (versus 5.5% with no distress).
Notably, almost two-thirds (65.3%) of students who currently used any tobacco product reported seriously thinking about quitting the use of all products, and 60.2% had stopped using all products for ≥1 days because they were trying to quit during the past 12 months.
2021 Findings on Youth E-Cigarette Use
Youth e-cigarette use remains an ongoing concern as the survey found that more than 2 million U.S. middle school and high school students reporting current (past 30-day) use of e-cigarettes in 2021, and e-cigarettes were the most commonly used tobacco product among students.
Among students who currently used each tobacco product, frequent use (on ≥20 days of the past 30 days) was 39.4% for e-cigarettes compared with 18.9% for cigarettes and 20.7% for cigars. Almost 85 percent of e-cigarette users reported currently using flavored products. For comparison, 38.8% of cigarette smokers and 44.4% of cigar smokers reported currently smoking menthol cigarettes and flavored cigars, respectively.
Among students who currently used e-cigarettes, 53.7% used a disposable device, 28.7% used a prefilled/refillable pod or cartridge device, 9.0% used a tank or mod system (a system that can be customized by the user), and 8.6% did not know the device type.
Among students who currently used e-cigarettes, Puff Bar was the most commonly reported usual brand (26.8%, 520,000), followed by Vuse (10.5%, 200,000), SMOK (8.6%, 160,000), JUUL (6.8%, 130,000), and Suorin (2.1%, 40,000).
The most common reason for first trying e-cigarettes cited by students who ever used them was “a friend used them” (57.8%). Among current e-cigarette users, the most commonly cited reasons for current use were “I am feeling anxious, stressed, or depressed” (43.4%) and “to get a high or buzz from nicotine” (42.8%).
Among all students, perceiving “no” or “little” harm from intermittent tobacco product use was highest for e-cigarettes (16.6%) and lowest for cigarettes (9.6%)..
Public Education Campaigns
FDA conducts several public education campaigns aimed at young audiences to prevent youth from tobacco initiation and use. FDA’s longest-running campaign, “The Real Cost,” educates teens on the health consequences of smoking cigarettes and in recent years has prioritized e-cigarette prevention messaging.
In the 2021 NYTS, 75.2% of middle and high school students reported having seen or heard any antitobacco public education campaign ad within the past year. An estimated 15.8 million (60.9%) students reported recognizing the FDA’s “The Real Cost” campaign ad: by school level, almost two-thirds (65.8%) of high school students and more than half (54.8%) of middle school students reported recognizing “The Real Cost” campaign ad.
Education Resource Library
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However, public health education campaigns are not the only messaging about tobacco products that youth receive and notice.
They might see advertisements for tobacco products while engaging in common activities – such as going to a convenience store, supermarket, or gas station; using the Internet; watching television or streaming services or going to the movies; or reading newspapers or magazines. In the 2021 NYTS, among youth who reported engaging in those common activities, 75.7% reported exposure to marketing or advertising for any tobacco product.
Among students who reported using social media, 73.5% had ever seen e-cigarette–related content.
Goals of NYTS
FDA is committed to a science-based approach that addresses public health issues associated with tobacco use. We collaborate with CDC on this nationally representative survey of middle and high school students that focuses exclusively on tobacco use behaviors and associated factors.
NYTS was designed to provide national data on long-term, intermediate, and short-term indicators key to the design, implementation, and evaluation of comprehensive tobacco prevention and control programs.
For a deeper look at the agencies’ collaboration on the study over the years, see CDC’s “Historical NYTS Data and Documentation.”