National Youth Tobacco Survey, United States, 2021 | Notes from the Field

Since 2014, e-cigarettes have been the most commonly used tobacco product among U.S. youths (1). In 2020, an estimated 3.6 million (13.1%) U.S. middle and high school students reported using e-cigarettes within the past 30 days (current use); more than 80% of current users reported flavored e-cigarette use (2). Whereas the most commonly used device type in 2019 and 2020 was a prefilled pod or cartridge,* disposable e-cigarette use increased significantly during this time among youths who currently used e-cigarettes in middle school (from 3.0% to 15.2%) and high school (from 2.4% to 26.5%) (3). CDC and the Food and Drug Administration (FDA) analyzed nationally representative data from the 2021 National Youth Tobacco Survey (NYTS), a school-based, cross-sectional, self-administered survey of U.S. middle school (grades 6–8) and high school (grades 9–12) students conducted during January 18–May 21, 2021 (20,413 students from 279 schools; overall response rate = 44.6%). Because of the ongoing COVID-19 pandemic, data were collected online to allow participation of eligible students in remote learning settings.§ Current e-cigarette use was assessed overall, by frequency of use, device type, flavors, and usual brand. Weighted prevalence estimates and population totals were calculated. This study was reviewed and approved by the CDC IRB.**

In 2021, 11.3% of high school students (1.72 million) and 2.8% (320,000) of middle school students reported current e-cigarette use (Table). Among current e-cigarette users, 43.6% of high school students and 17.2% of middle school students reported using e-cigarettes on ≥20 of the past 30 days; daily use was 27.6% among current high school e-cigarette users and 8.3% among current middle school e-cigarette users. Among both middle and high school current e-cigarette users, the most commonly used device type was disposables, followed by prefilled or refillable pods or cartridges and tanks or mod systems. Among high school current e-cigarette users, 26.1% reported that their usual brand was Puff Bar, followed by Vuse (10.8%), SMOK (9.6%), JUUL (5.7%), and Suorin (2.3%). Among middle school current users, 30.3% reported that their usual brand was Puff Bar, and 12.5% reported JUUL. Notably, 15.6% of high school users and 19.3% of middle school users reported not knowing the e-cigarette brand they usually used.

Among current youth e-cigarette users overall, 84.7% used flavored e-cigarettes, including 85.8% of high school users and 79.2% of middle school users. Among all current flavored e-cigarette users, the most commonly used flavor types among both middle and high school students were fruit, followed by candy, desserts, or other sweets; mint; and menthol. When examined by device type used, the most commonly used flavor types among current flavored disposable e-cigarette users were fruit (78.7%; 760,000); candy, desserts, or other sweets (34.3%; 330,000); mint (30.1%; 290,000); and menthol (21.5%; 200,000). The most commonly used flavor types among current flavored pod or cartridge users were fruit (57.9%; 270,000); menthol (46.3%; 210,000); mint (30.7%; 140,000); and candy, desserts, or other sweets (28.2%; 130,000). The most commonly used flavor types among current flavored tanks or mod systems users were fruit (70.9%; 100,000); candy, desserts, or other sweets (51.2%; 70,000); mint (34.5%; 50,000); and menthol (24.7%; 30,000). Among current flavored e-cigarette users, fruit was the most commonly reported flavor type overall, by school level, and across all e-cigarette devices.

The 2021 NYTS was fully conducted amid the global COVID-19 pandemic, during which time eligible students could participate in the survey in classrooms, at home, or at some other place. Differences in tobacco use estimates by location†† might be due to potential underreporting of tobacco use behaviors or other unmeasured characteristics among youths participating outside of the classroom. Thus, estimates from the 2021 NYTS should not be compared with previous NYTS survey waves that were primarily conducted on school campuses.

Approximately 2.06 million youths were estimated to be current e-cigarette users in 2021. Use of tobacco products by youths in any form, including e-cigarettes, is unsafe. Most e-cigarettes contain nicotine, and nicotine exposure during adolescence can harm the developing brain (5). Ongoing efforts to address youth e-cigarette use, including FDA’s prioritized enforcement against certain unauthorized flavored, cartridge-based e-cigarettes in 2020, are critical (4). As the tobacco product landscape continues to evolve, sustained implementation of comprehensive tobacco control and prevention strategies at the national, state, and local levels, coupled with FDA regulation, can reduce and prevent tobacco product initiation and use among youths (5).

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U.S. Centers for Disease Control – 2021-09-30

Corresponding author: Eunice Park-Lee, Eunice.Park-Lee@fda.hhs.gov, 301-837-7342

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