Notes from the Field: E-Cigarette and Nicotine Pouch Use Among Middle and High School Students — United States, 2024

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Current e-cigarette use among U.S. youth has declined considerably since 2019*; however, approximately 2.13 million youths used e-cigarettes in 2023 (1). As sales of nicotine pouches (small, dissolvable, flavored pouches containing nicotine derived from tobacco that users place in the mouth between the lip and gum)^† have continued to rise nationally since 2016, their use among U.S. youths has become concerning (2,3). All pouches and most e-cigarettes contain nicotine,^§ which is highly addictive and can harm the developing adolescent brain (4,5).

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

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

References

1. Birdsey J, Cornelius M, Jamal A, et al. Tobacco product use among U.S. middle and high school students—National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023;72:1173–82. https://doi.org/10.15585/mmwr.mm7244a1 PMID:37917558
2. Marynak KL, Wang X, Borowiecki M, et al. Nicotine pouch unit sales in the US, 2016–2020. JAMA 2021;326:566–8. https://doi.org/10.1001/jama.2021.10366 PMID:34374729
3. Robichaud MO, Seidenberg AB, Byron MJ. Tobacco companies introduce ‘tobacco-free’ nicotine pouches. Tob Control 2020;29:e145–6. PMID:31753961
4. 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://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf
5. CDC. The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf

* Current use of e-cigarettes or nicotine pouches was determined by asking, “During the past 30 days, on how many days did you use [e-cigarettes/a nicotine pouch]?” Current use was defined as use on ≥1 day during the previous 30 days.
^† Estimated number of students was rounded down to the nearest 10,000 persons. Subgroup estimates might not sum to overall population estimates because of rounding or exclusion of students who currently used e-cigarettes and who did not report grade level (154), device type (61), any brand (65), usual brand (77), flavor types used (105), use of flavor including the word “ice” or “iced” (83), or use of flavors without specific flavor descriptor (97).
^§ Frequent use was defined as use on ≥20 days during the previous 30 days. Daily use was defined as use during all of the previous 30 days. These estimates are not mutually exclusive.
^¶ Device type was ascertained by response to 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.”
** Students currently using e-cigarettes or nicotine pouches were asked, “During the past 30 days, what [e-cigarette/nicotine pouch] 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.
^†† Geek Bar and Lost Mary were not included in the list of prespecified response options but were the two most common write-in responses for “some other brand(s) not listed here.” Estimates for Geek Bar and Lost Mary might be underestimated.
^§§ Data were statistically unreliable because of an unweighted denominator <50 or a relative SE >30%.
^¶¶ If a student currently using e-cigarettes or nicotine pouches reported a single brand when asked, “During the past 30 days, what [e-cigarette/nicotine pouch] brands did you use (Select one or more),” it was reported as the usual brand. Those who selected two or more brands were asked, “During the past 30 days, what brand of [e-cigarettes/nicotine pouches] did you usually use? (Choose only one answer).” Write-in responses of “some other brand(s) not listed here” were recoded to a corresponding original response option.
*** Students currently using e-cigarettes or nicotine pouches were asked, “In the past 30 days when you used [e-cigarettes/nicotine pouches], what flavors did you use? (Select one or more)?” Those who provided no valid responses were classified as using “unspecified” flavors.
^††† Flavor type was ascertained by response to the question, “In the past 30 days when you used [e-cigarettes/nicotine pouches], what flavors did you use? (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.
^§§§ These flavor options provided examples: “alcoholic drinks (such as wine, margarita, or other cocktails)”; “non-alcoholic drinks (such as coffee, soda, lemonade, or other beverage)”; and “spice (such as cinnamon, vanilla, or clove).”
^¶¶¶ Students currently using e-cigarettes or nicotine pouches were asked, “Did any of the flavors you used in the past 30 days have names or descriptions that included the word ‘ice’ or ‘iced’ (for example, blueberry ice or strawberry ice)?”
**** Students currently using e-cigarettes or nicotine pouches were asked, “Did any of the flavors that you used in the past 30 days have a name that did not describe a specific flavor, such as ‘solar,’ ‘purple,’ ‘jazz,’ ‘island bash,’ ‘fusion,’ or some other word or phrase?”
^†††† Estimated population number of students was rounded down to the nearest 10,000 persons. The total of subgroup estimates might not sum to overall population estimates because of rounding or exclusion of students who currently used nicotine pouches and who did not report grade level (129), any brand (nine), usual brand (12), flavor types used (24), use of flavor including the word “ice” or “iced” (20), or use of flavors without specific flavor descriptor (33).