1 in 5 high school students report e-cigarette use

Approximately 1 in 5 high school students and 1 in 20 middle school students report e-cigarette use in 2020, and use of disposable e-cigarettes, in particular, has increased sharply, according to new data from the National Youth Tobacco Survey.

The CDC and FDA analyzed data from the National Youth Tobacco Survey, a cross-sectional, school-based, self-administered survey of U.S. middle and high school students conducted from January to March.

In 2020, 3.02 million (19.6%) high school students in ninth to 12th grade and 550,000 (4.7%) middle school students in sixth to eighth grade reported current use of e-cigarettes. Of those, 38.9% of high school students and 20% of middle school students reported using e-cigarettes on 20 of the past 30 days, and 22.5% of high school students and 9.4% of middle school students reported daily use.

Sharp increase in disposable e-cigarettes

Eighty-three percent of students reported using flavored e-cigarettes (84.7% of high school users; 73.9% of middle school users). The most-used flavor in any e-cigarette device among high school and middle school users, respectively, was fruit (73.1% and 75.6%), followed by mint (55.8% and 46.5%), menthol (37% and 23.5%), and candy, desserts or other sweets (36.4% and 47.2%).

The most commonly used e-cigarette device types were prefilled pods or cartridges (48.5% of high school users; 41.3% of middle school users), followed by disposable e-cigarettes (26.5% and 15.2%) and tanks (14.8% and 21.5%). From 2019 to 2020, use of disposable e-cigarettes increased approximately 1,000%, from 2.4% to 26.5%, among high school users and 400%, from 3% to 15.2%, among middle school users. Again, the most-used flavors in prefilled pods or cartridges and in disposable devices were fruit and mint.

“Although these data reflect a decline in current e-cigarette use since 2019, 3.6 million U.S. youths still currently used e-cigarettes in 2020, and among current users, more than 8 in 10 reported using flavored e-cigarettes,” Teresa W. Wang, PhD, with the Office on Smoking and Health at the National Center for Chronic Disease Prevention and Health Promotion at the CDC, and colleagues wrote in Morbidity and Mortality Weekly Report.

Strategies to reduce use

The researchers noted that strategies to address e-cigarette use in middle and high school students are critical.

“Comprehensive implementation of evidence-based strategies at the national, state and local levels in coordination with FDA regulation can prevent and reduce youth tobacco product use,” Wang and colleagues wrote.

According to Wang and colleagues, in addition to the FDA’s ban on the sale of prefilled pod or cartridge-based e-cigarettes in flavors other than tobacco and menthol, several U.S. states have restricted all flavored e-cigarette sales.

The American Thoracic Society issued a press release after publication of these data. The ATS said it is imperative for the FDA to enact a complete flavorings ban, including menthol and tobacco products, as recently passed in California, and to invest in identifying effective nicotine-cessation treatments.

“Until FDA bans flavors in all tobacco products, they will continue to put our kids at risk,” Ilona Jaspers, PhD, member of the ATS Tobacco Action Committee, said in the press release. “No child wants to inhale tobacco-flavored aerosols. It is the flavors that entice kids to try e-cigarettes. It is the flavors that start kids on a path towards disease and addiction.”

Moreover, “[w]hat is not covered in today’s announcement is that doctors have very few tools to treat kids who are addicted to e-cigarettes. There are no FDA-approved nicotine-cessation products for youth and FDA-cessation products used for adults have not been shown to be effective for youth,” Michelle Eakin, PhD, chair of the ATS Tobacco Action Committee, said in the release.