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.
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).
NYTS is a cross-sectional, voluntary, school-based, self-administered electronic survey of U.S. middle and high school students. A stratified three-stage cluster sampling procedure generated a nationally representative sample of U.S. students attending public and private schools in grades 6–12. Participants complete the survey in classrooms using a tablet computer.* In 2020, data collection occurred during January 16–March 16, 2020.†
In total, 14,531 students (participation rate = 87.4%) from 180 schools (participation rate = 49.9%) participated, yielding an overall response rate of 43.6% in 2020. Detailed information about NYTS is available elsewhere.§
Prevalence, with 95% confidence intervals, of current use of seven tobacco products (e-cigarettes, cigarettes, cigars, smokeless tobacco,¶ hookahs, pipe tobacco,** and heated tobacco products††) was reported; current use was defined as use on one or more days during the past 30 days. Three composite measures of current use (any tobacco product,§§ any combustible tobacco product,¶¶ and multiple tobacco products***) also were reported.
National weighted prevalence estimates and population totals††† in 2020 were reported among all students and separately by school level. Estimates were reported overall and by selected demographic characteristics. Differences between the prevalence of current use in 2020 and that in 2019 (19,018 participants in 2019; student participation rate = 85.8%; school participation rate = 77.2%; overall response rate = 66.3%) were estimated using t-tests; p-values <0.05 were considered statistically significant.
Trend analyses during 2011–2020 were not conducted because the mode of administration changed to an electronic survey in 2019 (3). The relative percent change (RPC) from 2019 to 2020 was calculated. Unstable estimates with a relative standard error of >30% or an unweighted denominator of <50 were suppressed. Analyses were conducted using SAS-callable SUDAAN (version 11.0.3; RTI International).
In 2020, among all students, 16.2% (an estimated 4.47 million) reported current use of any tobacco product (Table). Among high school students, 23.6% (3.65 million) reported current use of any tobacco product, 9.4% (1.45 million; 39.8% of any tobacco product users) reported current use of any combustible tobacco product, and 8.2% (1.27 million; 34.7% of any tobacco product users) reported current use of multiple tobacco products.
By product, current use among high school students was highest for e-cigarettes (19.6%), followed by cigars (5.0%), cigarettes (4.6%), smokeless tobacco (3.1%), hookahs (2.7%), heated tobacco products (1.4%), and pipe tobacco (0.7%). Among high school students, any tobacco product use was reported by 24.7% of males and 22.5% of females; by 25.9% of non-Hispanic White, 23.3% of Hispanic, 18.4% of non-Hispanic Black, and 15.7% of non-Hispanic students of other races; and by 30.9% of those identifying as lesbian, gay, or bisexual, 22.0% of those identifying as heterosexual, and 20.4% of those reporting “not sure” about their sexual identity.
Among middle school students, 6.7% (800,000) reported current use of any tobacco product, 3.4% (400,000; 50.7% of any tobacco product users) reported current use of any combustible tobacco product, and 2.8% (340,000; 41.8% of any tobacco product users) reported current use of multiple tobacco products. By type of product, current use among middle school students was highest for e-cigarettes (4.7%), followed by cigarettes (1.6%), cigars (1.5%), hookahs (1.3%), heated tobacco products (1.3%), smokeless tobacco (1.2%), and pipe tobacco (0.4%). Among middle school students, any tobacco product use was reported by 6.8% of females and 6.6% of males; by 9.4% of Hispanic, 6.7% of non-Hispanic Black, and 5.7% of non-Hispanic White students; and by 16.5% of those identifying as lesbian, gay, or bisexual, 5.5% of those identifying as heterosexual, and 6.4% of those reporting “not sure” about their sexual identity.
From 2019 to 2020, among high school (Figure 1) and middle school students (Figure 2), significant declines (p<0.05) occurred in current use of any tobacco product (high school: 31.2% to 23.6%, RPC = −24.4%; middle school: 12.5% to 6.7%, RPC = −46.4%), any combustible tobacco product (high school: 12.0% to 9.4%, RPC = −21.7%; middle school: 4.8% to 3.4%, RPC = −29.2%), multiple tobacco products (high school: 10.8% to 8.2%, RPC = −24.1%; middle school: 4.0% to 2.8%, RPC = −30.0%), e-cigarettes (high school: 27.5% to 19.6%, RPC = −28.7%; middle school: 10.5% to 4.7%, RPC = −55.2%), cigars (high school: 7.6% to 5.0%, RPC = −34.2%; middle school: 2.3% to 1.5%, RPC = −34.8%), and smokeless tobacco (high school: 4.8% to 3.1%, RPC = −35.4%; middle school: 1.8% to 1.2%, RPC = −33.3%). During 2019–2010, no significant change in current use of cigarettes, hookahs, pipe tobacco, or heated tobacco products occurred among high or middle school students.
CDC – Morbidity and Mortality Weekly Report (MMWR) – December 18, 2020.