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

Eunice Park-Lee, PhD1; Ahmed Jamal, MBBS2; Hannah Cowan, MPH1; Michael D. Sawdey, PhD1; Maria R. Cooper, PhD1; Jan Birdsey, MPH2; Andrenita West, PhD2; Karen A. Cullen, PhD1 (View author affiliations)

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Summary

What is already known about this topic?

E-cigarettes remain the most used tobacco product among U.S. youths. The wide availability and growing sales of nicotine pouches has also raised concerns about potential use of these products among youths.

What is added by this report?

During 2023–2024, current e-cigarette use among middle and high school students declined from 7.7% to 5.9%. Current nicotine pouch use (1.8%) did not change significantly during this period.

What are the implications for public health?

Youth e-cigarette use has declined; however, comprehensive tobacco control strategies, regulations, and enforcement remain critical to preventing and reducing e-cigarette and nicotine pouch use among youths.

Related Materials

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).

Investigation and Outcomes

The Food and Drug Administration and CDC analyzed nationally representative data from the 2024 National Youth Tobacco Survey (NYTS), a cross-sectional, school-based, self-administered web-based survey of U.S. students in middle school (grades 6–8) and high school (grades 9–12), which was conducted among 29,861 students from 283 schools during January 22–May 22, 2024. Current (i.e., past–30-day) use of e-cigarettes and nicotine pouches was assessed overall, and by frequency of use, device type used for e-cigarettes, any brand and usual brand used,** and flavor types. Weighted prevalence estimates, 95% CIs, and population totals were calculated using SAS-callable SUDAAN software (version 11.0.4; RTI International).†† Changes in current use since 2023 were evaluated using t-tests; p-values <0.05 were considered statistically significant. The 2023 NYTS data collection methods and estimates have been published (1). This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.§§

In 2024, 5.9% of middle and high school students reported current e-cigarette use, including 7.8% of high school students and 3.5% of middle school students (Table). Among students who currently used e-cigarettes, 38.4% reported frequent use,¶¶ and 26.3% reported daily use. The device types used most often by students reporting current e-cigarette use were disposables (55.6%), followed by prefilled or refillable pods or cartridges (15.6%) and tanks or mod systems*** (7.0%); 21.8% of students currently using e-cigarettes were unsure of the device type used. Among students who currently used e-cigarettes, 36.1% used Elf Bar, followed by Breeze (19.9%), Mr. Fog (15.8%), Vuse (13.7%), and JUUL (12.6%); 87.6% used a flavored product; fruit (62.8%), candy (33.3%), and mint (25.1%) were the flavor types most frequently reported.

In 2024, 1.8% of middle and high school students reported current nicotine pouch use, including 2.4% of high school students and 1.0% of middle school students. Among students who currently used nicotine pouches, 29.3% reported frequent use, and 22.4% reported daily use. Among students reporting current nicotine pouch use, 68.7% used ZYN, followed by on! (14.2%), Rogue (13.6%), Velo (10.7%), and Juice Head ZTN (9.8%); 85.6% used a flavored product: mint (53.3%), fruit (22.4%), and menthol (19.3%) were the flavor types most frequently reported.

From 2023 to 2024, current e-cigarette use declined among middle and high school students overall (from 7.7% to 5.9%; p<0.05) and high school students (from 10.0% to 7.8%; p<0.05). No significant changes were observed for current e-cigarette use among middle school students or for current nicotine pouch use among high school students or middle and high school students overall.

Conclusions and Actions

In 2024, an estimated 1.63 million U.S. middle and high school students currently used e-cigarettes, a significant decline from 2.13 million in 2023. In contrast, from 2023 to 2024, no significant changes occurred in current nicotine pouch use among middle and high school students overall (an estimated 480,000 students in 2024), despite rising sales of nicotine pouches (2).††† Continued surveillance of youth tobacco product use patterns and implementation of comprehensive tobacco control strategies, regulations, and enforcement§§§ are important for preventing and reducing tobacco product use by youths and associated adverse health outcomes, including a potential lifetime of nicotine addiction.

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.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.


* http://dx.doi.org/10.15585/mmwr.ss6812a1

Unlike other smokeless tobacco products, such as snuff and snus, nicotine pouches do not contain any tobacco leaf.

§ E-cigarettes: https://www.fda.gov/tobacco-products/products-ingredients-components/e-cigarettes-vapes-and-other-electronic-nicotine-delivery-systems-ends; nicotine pouches: https://www.fda.gov/tobacco-products/products-ingredients-components/other-tobacco-products.

In 2024, the student-level participation rate was 78.3%, and the school-level participation rate was 42.7%, for an overall response rate of 33.4%.

** Brand response options were: blu, Breeze, Elf Bar, Esco Bars, Fume, JUUL, HQD, Kangvape (including Onee Stick), Logic, Mr. Fog, NJOY, SMOK (including NOVO), Suorin (including Air Bar), Vuse, “some other brand(s) not listed here,” and “I don’t know the brand.” Those who selected “some other brand(s) not listed here” could provide a write-in response. Write-in responses were recoded into valid responses. Estimates for Geek Bar and Lost Mary were based on the write-in responses and might be underestimated.

†† Data were weighted to account for complex survey design and to adjust for nonresponse. The weighted proportions of students in each grade matched national population proportions for U.S. public and private schools derived from data from the National Center for Education Statistics (2021–2022 Common Core of Data and 2019–2020 Private School Universe Study) and Market Data Retrieval, Inc. Population number estimates were rounded down to the nearest 10,000 students.

§§ 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

¶¶ Frequent use was defined as use on ≥20 days during the previous 30 days. Daily use was defined as use on all of the previous 30 days. These estimates are not mutually exclusive.

*** An e-cigarette with a tank that the user refills with liquids or a mod system that can be customized by the user with their own combination of batteries or other parts.

††† The scope of the current report examined changes in prevalence from 2023 to 2024. Although outside the scope of this report, a small but statistically significant increase in current nicotine pouch use occurred from 2022 to 2024. The 2022 NYTS methodology report and a copy of the 2022 data file can be found at https://www.cdc.gov/tobacco/about-data/surveys/national-youth-tobacco-survey.html.

§§§ https://www.cdc.gov/tobacco/php/state-and-community-work/guides-for-states.html?CDC_AAref_Val=https://www.cdc.gov/tobacco/stateandcommunity/guides/index.htm; https://www.fda.gov/tobacco-products/ctp-newsroom/fdas-comprehensive-plan-tobacco-and-nicotine-regulation

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
TABLE. Number and percentage of middle and high school students reporting current (past–30-day) e-cigarette use and nicotine pouch use,* overall and by selected characteristics and school level — National Youth Tobacco Survey, United States, 2024Return to your place in the text
Characteristic Overall High school Middle school
Estimated no. of users Weighted % (95% CI) Estimated no. of users Weighted % (95% CI) Estimated no. of users Weighted % (95% CI)
E-cigarette use
Current e-cigarette use among all students 1,630,000 5.9 (5.3–6.6) 1,210,000 7.8 (6.9–8.8) 410,000 3.5 (2.9–4.2)
Among students currently using e-cigarettes
Frequency of use during the previous 30 days§
1–5 days 720,000 44.1 (40.1–48.1) 510,000 42.3 (37.7–47.1) 200,000 49.7 (43.9–55.6)
6–19 days 280,000 17.5 (15.5–19.6) 180,000 15.5 (13.3–18.0) 90,000 23.5 (20.0–27.3)
20–30 days 620,000 38.4 (34.5–42.5) 510,000 42.1 (37.7–46.7) 110,000 26.8 (21.5–32.8)
Daily e-cigarette use§ 430,000 26.3 (23.0–30.0) 360,000 29.7 (25.9–33.8) 60,000 15.6 (11.5–20.7)
Device type most often used
Disposables 870,000 55.6 (52.4–58.8) 690,000 58.7 (54.9–62.4) 180,000 47.0 (41.7–52.4)
Prefilled or refillable pods or cartridges 240,000 15.6 (13.5–18.0) 170,000 15.1 (12.9–17.6) 60,000 17.1 (12.7–22.8)
Tanks or mod systems 110,000 7.0 (5.7–8.6) 80,000 7.0 (5.5–8.9) 20,000 6.6 (4.4–9.8)
Don’t know the type 340,000 21.8 (19.4–24.4) 220,000 19.2 (16.5–22.3) 110,000 29.3 (25.0–34.0)
Any brand**
Elf Bar 560,000 36.1 (32.8–39.6) 380,000 33.2 (29.3–37.3) 170,000 44.4 (39.3–49.6)
Breeze 310,000 19.9 (15.3–25.5) 220,000 19.0 (13.6–26.0) 80,000 21.7 (16.5–28.1)
Mr. Fog 240,000 15.8 (9.6–24.7) 190,000 16.5 (8.9–28.5) 40,000 12.5 (8.9–17.3)
Vuse 210,000 13.7 (10.8–17.2) 160,000 14.2 (10.8–18.4) 40,000 11.3 (7.5–16.5)
JUUL 190,000 12.6 (10.6–14.9) 110,000 10.1 (8.3–12.3) 70,000 19.0 (14.5–24.4)
Esco Bars 160,000 10.2 (8.3–12.4) 100,000 8.9 (6.9–11.4) 50,000 13.0 (9.5–17.4)
Fume 140,000 9.1 (7.2–11.4) 90,000 7.7 (5.8–10.2) 40,000 11.9 (8.1–17.1)
SMOK (including NOVO) 120,000 7.7 (6.2–9.6) 80,000 7.2 (5.6–9.3) 30,000 7.9 (5.4–11.6)
Kangvape (including Onee Stick) 120,000 7.6 (5.9–9.9) 70,000 6.6 (4.7–9.3) 30,000 9.3 (6.7–12.8)
blu 100,000 6.9 (5.6–8.4) 50,000 5.0 (3.8–6.5) 40,000 11.5 (8.6–15.1)
NJOY 90,000 6.1 (4.8–7.7) 60,000 5.5 (4.2–7.3) 20,000 6.7 (4.4–10.0)
Geek Bar†† 90,000 5.8 (4.3–7.8) 70,000 6.5 (4.7–8.9) §§
Suorin (including Air Bar) 80,000 5.2 (4.1–6.6) 40,000 4.3 (3.2–5.7) 20,000 6.9 (4.9–9.8)
HQD 70,000 5.0 (3.9–6.3) 40,000 3.8 (2.9–5.2) 20,000 7.2 (4.7–10.7)
Logic 70,000 4.9 (3.8–6.3) 40,000 3.9 (2.9–5.2) 20,000 6.9 (4.5–10.4)
Lost Mary†† 50,000 3.4 (2.4–4.9) 40,000 3.5 (2.3–5.3)
Some other brand not listed 320,000 20.6 (17.9–23.4) 240,000 20.9 (17.7–24.5) 70,000 18.6 (15.4–22.2)
Not sure or don’t know the brand 490,000 31.1 (28.2–34.2) 350,000 30.6 (27.0–34.4) 120,000 32.6 (28.7–36.8)
Usual brand¶¶
Elf Bar 240,000 15.9 (13.1–19.2) 160,000 14.0 (10.7–18.1) 80,000 22.0 (17.6–27.0)
Breeze 130,000 8.7 (5.2–14.2) 100,000 9.0 (5.0–15.7)
JUUL 50,000 3.2 (2.4–4.4) 20,000 2.5 (1.6–3.8) 20,000 5.4 (3.7–7.8)
Vuse 40,000 3.1 (1.8–5.3)
Fume 20,000 1.8 (1.1–3.0) 20,000 2.1 (1.2–3.7)
Geek Bar†† 20,000 1.5 (0.9–2.3) 10,000 1.7 (1.0–2.7)
Esco Bars 20,000 1.4 (0.9–2.2) 10,000 1.1 (0.6–1.9)
SMOK (including NOVO) 20,000 1.3 (0.8–2.3) 10,000 1.6 (0.9–2.9)
blu 10,000 1.1 (0.7–1.9)
Lost Mary†† 10,000 0.9 (0.5–1.5)
HQD
Kangvape (including Onee Stick)
Logic
Mr. Fog
NJOY
Suorin (including Air Bar)
No usual brand 90,000 6.1 (4.9–7.5) 70,000 6.1 (4.7–7.9) 20,000 6.1 (4.3–8.5)
Some other brand not listed 310,000 20.2 (17.6–23.1) 250,000 21.6 (18.4–25.1) 60,000 16.0 (12.7–19.9)
Not sure or don’t know the brand 420,000 27.1 (24.0–30.5) 310,000 27.3 (23.5–31.5) 100,000 26.7 (22.6–31.2)
Flavored e-cigarette use***
Any flavor other than tobacco-flavored or unflavored 1,430,000 87.6 (85.2–89.7) 1,070,000 88.2 (85.2–90.7) 350,000 85.7 (81.1–89.3)
Exclusive use of tobacco-flavored or unflavored 100,000 6.4 (5.1–7.8) 70,000 6.1 (4.7–7.8) 30,000 7.3 (4.9–10.8)
Unspecified 90,000 6.0 (4.6–7.9) 60,000 5.7 (4.0–8.1) 20,000 7.0 (4.9–9.9)
Flavor type used among students currently using e-cigarettes†††
Fruit 960,000 62.8 (60.0–65.4) 710,000 62.3 (59.0–65.5) 240,000 64.2 (58.6–69.4)
Candy, desserts, or other sweets 510,000 33.3 (30.5–36.3) 360,000 32.2 (28.6–36.0) 140,000 36.4 (32.0–41.0)
Mint 380,000 25.1 (22.3–28.1) 310,000 27.7 (24.2–31.4) 60,000 17.3 (13.5–22.0)
Menthol 230,000 15.1 (12.1–18.7) 190,000 17.0 (13.2–21.6) 30,000 9.5 (6.4–13.9)
Nonalcoholic drinks§§§ 170,000 11.6 (9.9–13.6) 130,000 11.8 (9.9–14.1) 40,000 10.6 (7.8–14.3)
Unflavored 170,000 11.4 (9.6–13.5) 120,000 11.0 (8.8–13.6) 40,000 12.4 (9.2–16.6)
Alcoholic drinks§§§ 130,000 8.9 (7.2–10.9) 90,000 8.6 (6.5–11.2) 30,000 9.2 (6.5–12.9)
Tobacco-flavored 130,000 8.5 (7.0–10.3) 70,000 6.8 (5.4–8.7) 50,000 13.1 (9.5–17.8)
Spice§§§ 90,000 6.4 (5.3–7.8) 60,000 5.9 (4.7–7.4) 20,000 7.2 (4.8–10.7)
Chocolate 80,000 5.8 (4.5–7.4) 50,000 4.7 (3.3–6.4) 30,000 8.1 (5.8–11.3)
Some other flavor 100,000 7.1 (5.7–8.7) 70,000 6.9 (5.3–9.0) 20,000 7.0 (4.7–10.3)
Use of any flavors that included the word “ice” or “iced” (such as “blueberry ice” or “strawberry ice”)¶¶¶
Yes 850,000 54.6 (51.5–57.7) 620,000 53.8 (49.8–57.7) 220,000 56.8 (52.1–61.3)
No 490,000 31.8 (29.2–34.6) 380,000 33.5 (30.2–37.0) 100,000 27.4 (23.8–31.4)
Don’t know 210,000 13.6 (11.8–15.5) 140,000 12.7 (10.8–14.9) 60,000 15.8 (12.4–19.9)
Use of any concept flavors with a name that did not describe a specific flavor (such as “solar,” “purple,” “jazz,” “island bash,” or “fusion”)****
Yes 310,000 20.4 (18.4–22.7) 230,000 20.2 (17.8–22.8) 70,000 20.6 (17.3–24.3)
No 750,000 49.0 (46.0–52.0) 580,000 50.8 (47.1–54.4) 170,000 44.3 (40.2–48.4)
Don’t know 470,000 30.6 (27.7–33.6) 330,000 29.0 (25.5–32.8) 130,000 35.1 (31.4–39.1)
Nicotine pouch use††††
Current nicotine pouch use among all students 480,000 1.8 (1.5–2.1) 360,000 2.4 (2.0–2.9) 110,000 1.0 (0.8–1.2)
Among students currently using nicotine pouches
Frequency of use during the previous 30 days§
1–5 days 250,000 53.7 (47.9–59.3) 190,000 55.2 (48.6–61.6) 50,000 49.9 (37.9–61.9)
6–19 days 80,000 17.1 (13.4–21.5) 50,000 15.0 (10.8–20.5) 20,000 22.6 (15.5–31.7)
20–30 days 140,000 29.3 (24.7–34.3) 100,000 29.8 (24.3–36.0) 30,000 27.5 (18.5–38.8)
Daily nicotine pouch use§ 100,000 22.4 (18.4–27.0) 80,000 22.9 (17.9–28.7) 20,000 20.5 (13.6–29.6)
Any brand use**
ZYN 320,000 68.7 (62.7–74.1) 270,000 77.6 (71.4–82.7) 40,000 39.8 (30.5–50.0)
on! 60,000 14.2 (11.1–17.9) 40,000 13.8 (10.2–18.4) 10,000 14.8 (9.2–23.0)
Rogue 60,000 13.6 (10.5–17.4) 40,000 14.0 (10.4–18.7) 10,000 11.7 (7.0–19.0)
Velo 50,000 10.7 (8.3–13.8) 30,000 8.5 (6.1–11.8) 10,000 17.1 (11.4–24.9)
Juice Head ZTN 40,000 9.8 (7.6–12.5) 30,000 8.9 (6.5–12.0) 10,000 11.9 (7.4–18.7)
Fre 40,000 9.7 (7.1–13.0) 20,000 8.1 (5.4–11.9) 10,000 13.4 (7.6–22.4)
2one 30,000 7.4 (5.3–10.2) 10,000 5.2 (3.2–8.4) 10,000 12.8 (7.6–20.7)
Some other brand not listed 20,000 4.6 (2.9–7.2) <10,000 7.3 (4.3–11.9)
Not sure or don’t know the brand 70,000 15.3 (11.7–19.8) 30,000 10.4 (7.0–15.2) 30,000 29.0 (21.8–37.6)
Usual brand¶¶
ZYN 290,000 62.4 (56.8–67.7) 250,000 72.0 (66.5–77.0) 30,000 33.5 (24.3–44.2)
on! 20,000 4.3 (2.5–7.2)
Rogue 10,000 3.5 (1.9–6.2)
Fre 10,000 3.4 (2.1–5.4)
Juice Head ZTN 10,000 3.1 (1.9–5.2)
Velo 10,000 3.0 (1.9–4.7)
2one <10,000 1.9 (1.1–3.3)
No usual brand 10,000 2.3 (1.3–4.1)
Some other brand not listed
Not sure or don’t know the brand 60,000 13.5 (10.3–17.6) 30,000 9.5 (6.2–14.2) 20,000 26.0 (19.7–33.5)
Flavored nicotine pouch use***
Any flavor other than tobacco-flavored or unflavored 410,000 85.6 (81.5–88.9) 310,000 86.1 (81.1–89.9) 90,000 85.4 (78.6–90.3)
Exclusive use of tobacco-flavored or unflavored 40,000 9.9 (7.2–13.5) 30,000 10.0 (6.8–14.6) 10,000 9.4 (5.5–15.7)
Unspecified 20,000 4.5 (2.9–6.9) 10,000 3.9 (2.1–6.9)
Flavor type used among students currently using nicotine pouches†††
Mint 240,000 53.3 (47.4–59.1) 200,000 58.8 (52.5–64.8) 30,000 36.8 (25.5–49.6)
Fruit 100,000 22.4 (17.9–27.6) 70,000 20.2 (15.1–26.6) 20,000 27.7 (19.9–37.1)
Menthol 80,000 19.3 (15.1–24.3) 70,000 21.1 (16.1–27.2) 10,000 14.7 (9.0–23.1)
Unflavored 60,000 13.3 (10.0–17.5) 40,000 13.8 (9.9–18.9) 10,000 11.8 (7.3–18.5)
Spice§§§ 40,000 10.2 (7.5–13.7) 20,000 8.5 (5.6–12.5) 10,000 16.2 (10.1–25.1)
Candy, desserts, or other sweets 40,000 9.5 (7.3–12.2) 20,000 7.8 (5.6–10.6) 10,000 15.7 (10.0–23.8)
Chocolate 30,000 8.1 (5.9–10.9) 20,000 5.8 (4.0–8.4) 10,000 14.4 (8.6–23.3)
Tobacco-flavored 30,000 8.0 (5.9–10.7) 20,000 7.2 (5.0–10.2) 10,000 11.3 (6.7–18.2)
Nonalcoholic drinks§§§ 30,000 7.5 (5.3–10.5) 20,000 6.6 (4.2–10.4) 10,000 10.5 (6.0–17.7)
Alcoholic drinks§§§ 30,000 6.6 (4.5–9.6) 10,000 5.5 (3.4–8.8) <10,000 9.1 (5.2–15.4)
Some other flavor 40,000 9.6 (7.1–13.0) 20,000 6.6 (4.2–10.1) 10,000 17.1 (11.8–24.1)
Use of any flavors that included the word “ice” or “iced” (such as “blueberry ice” or “strawberry ice”)¶¶¶
Yes 100,000 23.3 (19.8–27.2) 60,000 19.8 (16.0–24.2) 30,000 34.2 (26.0–43.6)
No 250,000 55.9 (50.8–60.9) 210,000 62.0 (56.0–67.7) 40,000 37.7 (29.3–46.9)
Don’t know 90,000 20.8 (16.9–25.2) 60,000 18.2 (13.8–23.7) 30,000 28.0 (20.5–37.0)
Use of any concept flavors with a name that did not describe a specific flavor (such as “solar,” “purple,” “jazz,” “island bash,” or “fusion”)****
Yes 50,000 11.4 (8.5–15.3) 20,000 8.6 (5.5–13.3) 20,000 20.9 (14.3–29.5)
No 290,000 64.4 (59.3–69.2) 230,000 70.2 (64.0–75.8) 40,000 46.2 (37.0–55.8)
Don’t know 100,000 24.1 (20.0–28.8) 70,000 21.2 (16.4–26.8) 30,000 32.9 (25.7–40.9)

* 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).


Suggested citation for this article: Park-Lee E, Jamal A, Cowan H, et al. Notes from the Field: E-Cigarette and Nicotine Pouch Use Among Middle and High School Students — United States, 2024. MMWR Morb Mortal Wkly Rep 2024;73:774–778. DOI: http://dx.doi.org/10.15585/mmwr.mm7335a3.

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