Notes from the Field: E-cigarette Use Among Middle and High School Students — United States, 2022

Since 2014, e-cigarettes have been the most commonly used tobacco product among U.S. middle and high school students (1). Most e-cigarettes contain nicotine, which is highly addictive, can harm the developing adolescent brain, and can increase risk for future addiction to other drugs (2). Among middle and high school current e-cigarette users (i.e., use on ≥1 day during the past 30 days), use of disposable e-cigarette devices* increased significantly between 2019 and 2020 (3) and was the most commonly used device type reported in 2021 (4). In 2020 and 2021, approximately eight in 10 middle and high school students who used e-cigarettes reported using flavored e-cigarettes (4,5). CDC and the Food and Drug Administration (FDA) analyzed nationally representative data from the 2022 National Youth Tobacco Survey (NYTS), a school-based, cross-sectional, self-administered survey conducted during January 18–May 31, 2022,^† using a web-based survey instrument and administered to U.S. middle school (grades 6–8) and high school (grades 9–12) students.^§ Participating students could complete the survey whether they were physically in school or at home engaging in remote learning; 99.3% of students reported completing the survey in school. Current e-cigarette use was assessed overall and by frequency of use, device type, flavors, and brands used (any brand used and usual brand used).^¶ Weighted prevalence estimates and population totals were calculated.** The NYTS study protocol was reviewed and approved by CDC’s institutional review board.^††

In 2022, 14.1% of high school students and 3.3% of middle school students reported current e-cigarette use (Table). Among current e-cigarette users, 42.3% reported using e-cigarettes frequently,^§§ including 46.0% of high school students and 20.8% of middle school students; daily use was reported among 27.6% of current e-cigarette users, including 30.1% of high school students and 11.7% of middle school students. Among current e-cigarette users, the types of devices most often used were disposables (high school = 57.2%; middle school = 45.8%), followed by prefilled or refillable pods or cartridges (high school = 25.7%; middle school = 21.6%), and tanks or mod systems (high school = 5.9%; middle school = 9.8%), with 11.2% of high school students and nearly 23% of middle school students reporting not knowing the type of e-cigarette device used.

Among current e-cigarette users, Puff Bar was the most commonly reported brand used in the past 30 days by both middle and high school students (29.7%), followed by Vuse (23.6%), JUUL (22.0%), SMOK (13.5%), NJOY (8.3%), Hyde (7.3%), and blu (6.5%). Among current e-cigarette users, 14.5% reported that the brand they usually used was Puff Bar, followed by Vuse (12.5%), Hyde (5.5%), and SMOK (4.0%). Approximately one fifth (21.8%) of current e-cigarette users reported “some other brand” as their usual brand.

Among current e-cigarette users overall, 84.9% used flavored e-cigarettes; of these, the reported flavor types, in descending order of use, were fruit (69.1%); candy, desserts, or other sweets (38.3%); mint (29.4%); and menthol (26.6%). A similar pattern was observed among current users of flavored disposable e-cigarettes: fruit (75.2%); candy, desserts, or other sweets (40.4%); mint (29.6%); and menthol (16.7%) (Supplementary Table, https://stacks.cdc.gov/view/cdc/121630). Among current users of flavored pods or cartridges, the reported flavor types used were fruit (58.4%); menthol (53.9%); candy, desserts, or other sweets (30.3%); and mint (27.6%). Among current users of flavored tanks or mod systems, the reported flavor types used were fruit (69.6%); candy, desserts, or other sweets (47.7%); mint (40.1%); and menthol (35.2%).

In 2022, 2.55 million U.S. middle and high school students currently used e-cigarettes. Most reported using flavored products, and, among those students, approximately seven of 10 used fruit flavors. Disposable products were the most commonly reported device type. Further, among middle and high school students who used e-cigarettes, approximately four in 10 reported frequent use, and approximately one in four reported daily use. The use of tobacco products in any form, including e-cigarettes, by middle and high school students is unsafe. Sustained implementation of comprehensive tobacco prevention and control strategies at the national, state, and local levels,^¶¶ coupled with FDA regulation and enforcement, is critical to addressing e-cigarette use among middle and high school students (2).

Corresponding author: Maria Cooper, Maria.Cooper1@fda.hhs.gov, 240-402-5726.

¹Center for Tobacco Products, Food and Drug Administration; ²Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

References

1. Arrazola RA, Singh T, Corey CG, et al. Tobacco use among middle and high school students—United States, 2011–2014. MMWR Morb Mortal Wkly Rep 2015;64:381–5. PMID:25879896
2. CDC. E-cigarette use among youth and young adults: a report of the surgeon general. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Full_Report_non-508.pdf
3. Wang TW, Gentzke AS, Neff LJ, et al. Disposable e-cigarette use among U.S. youth—an emerging public health challenge. N Engl J Med 2021;384:1573–6. https://doi.org/10.1056/NEJMc2033943 PMID:33725431
4. Park-Lee E, Ren C, Sawdey MD, et al. Notes from the field: e-cigarette use among middle and high school students—National Youth Tobacco Survey, United States, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1387–9. https://doi.org/10.15585/mmwr.mm7039a4 PMID:34591834
5. Wang TW, Neff LJ, Park-Lee E, Ren C, Cullen KA, King BA. E-cigarette use among middle and high school students—United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1310–2. https://doi.org/10.15585/mmwr.mm6937e1 PMID:32941408

* Past 30-day use of e-cigarettes was determined by the question, “During the past 30 days, on how many days did you use e-cigarettes?” Current use was defined as use on ≥1 day during the past 30 days.
^† Estimated total number of users was rounded down to the nearest 10,000 students. Overall population totals might not directly sum to corresponding estimates by school level because of rounding or inclusion of students who did not self-report grade level.
^§ Daily e-cigarette use was defined as use on all 30 of the past 30 days.
^¶ Device type was determined by the question, “Which of the following best describes the type of e-cigarette you have used in the past 30 days? If you have used more than one type, please think about the one you use most often.”
** All current e-cigarette users were asked, “During the past 30 days, what e-cigarette brands did you use? (Select one or more).” Those who selected “some other brand(s) not listed here” could provide a write-in response. Write-in responses corresponding to an original response option were recoded. Data for Posh are not shown because of statistically unreliable estimates.
^†† Hyde was not included in the list of prespecified response options, but it was the most commonly provided write-in response for “some other brand.” Write-in responses for Hyde were recoded, and all remaining responses were maintained as “some other brand.”
^§§ Data were statistically unreliable because of unweighted denominator <50 or a relative SE >30%.
^¶¶ If a single brand was selected for the question, “During the past 30 days, what e-cigarette brands did you use (Select one or more),” it was reported as their usual brand. Those who selected one or more brand were asked, “During the past 30 days, what brand of e-cigarettes did you usually use? (Choose only one answer).” Those who selected “some other brand(s) not listed here” could provide a write-in response. Write-in responses corresponding to an original response option were recoded. Data for blu, Eonsmoke, Leap, Logic, Mojo, NJOY, Posh, STIG, and Suorin are not shown because of statistically unreliable estimates.
*** Flavored e-cigarette use was assessed by response to the question, “Were any of the e-cigarettes that you used in the past 30 days flavored to taste like menthol, mint, clove or spice, alcoholic drinks, candy, fruit, chocolate, or any other flavor?”
^††† Flavor type was determined by response to the question, “What flavors were the e-cigarettes that you have used in the past 30 days? (Select one or more).” Those who selected “some other flavor not listed here” could provide a write-in response. Write-in responses corresponding to an original response option were recoded.