United States: Flavor-driven tobacco and nicotine use among youth

Results of the National Youth Tobacco Survey (NYTS)[1] 2021 data published on March 11 show that despite continued progress, nicotine use among middle and high school students remains a significant public health problem in the United States, driven by the availability of flavored products.

The National Youth Tobacco Survey (NYTS) is an annual, cross-sectional, school-based survey of middle and high school students in the United States. The survey, which ran from January to May 2021, was the first to be conducted entirely during the COVID-19 pandemic, with half of the students responding online at school and the other half at home. The Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) have cautioned that the 2021 results cannot be compared with those of previous years due to methodological changes related to the pandemic.

The electronic cigarette is the product most consumed by young people

The survey asked middle and high school students about their use of nine types of tobacco and nicotine products. More than 2.5 million students reported currently using a tobacco or nicotine product (within the 30 days preceding the survey). Among these 2.5 million, 2.06 million were high school students and 470,000 were middle school students.

E-cigarettes were the most commonly used product in the 30 days preceding the survey. They were cited by 7.6% of middle and high school students, followed by traditional cigarettes (1.5%), cigars (1.4 %), chewing tobacco (0.9 %), hookahs (0.8 %), nicotine pouches (0.8 %), heated tobacco (0.7%), and finally pipe tobacco (0.3%). This was the first time this survey collected data on the use of nicotine pouches.

More than one in two e-cigarette consumers (53.7%) use a disposable device (puff type)

Consumption motivated by aromas

About 8 in 10 young users of tobacco and other nicotine products (79.1%) reported using flavored products. This rate rises to 85% among young users of e-cigarettes, 70% for chewing tobacco, 61.6% for nicotine pouches, 46.6% for hookahs, 44.4% for cigars, 44.1% for heated tobacco, 38.8% for cigarettes (menthol only), and 34.4% for pipe tobacco. The most popular flavors for all products are fruity and menthol flavors.

A confirmed decline in smoking

The survey shows that youth smoking rates are at historic lows, with only 1.5% of high school and middle school students reporting they currently smoke cigarettes (compared to over 14% in 2000). While these results may be influenced by the pandemic and changes in survey administration, the low youth smoking rates are part of a long-term downward trend. These declines underscore the importance of proven public health strategies implemented in recent years at both the federal and state levels.

Higher consumption among certain categories of the population

Tobacco and nicotine use was higher in some population groups. For example, regular use was reported by 14.2% of students identifying as lesbian, gay, or bisexual (compared to 7.9% of heterosexual students) and 18.9% of students identifying as transgender (compared to 8.2% of non-transgender students).

Additionally, current use of any tobacco and nicotine product was reported by 14.2% of students reporting severe psychological distress (compared to 5.5% without distress).

Keywords: Survey, high school students, middle school students, United States, vaping, nicotine, flavors

©Generation Without Tobacco

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[1] Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1–29. DOI: http://dx.doi.org/10.15585/mmwr.ss7105a1