Teen Tobacco Use in 2019: Vaping Soars as Smoking Hits a Low

Tobacco use is the leading cause of preventable disease, disability and death in the United States, and an estimated 88% of adults who smoke daily first tried a cigarette before 18. Beyond cigarettes, teens now use smokeless tobacco, cigars and, most recently, electronic vapor products such as e-cigarettes. CDC used the 2019 Youth Risk Behavior Survey of high school students to see what they were using.

Use in 2019

• Ever tried: 50.1% had tried an electronic vapor product; 24.1% had tried a cigarette.
• Current use (at least one day in the past 30):

Who used more:

• Boys more than girls: cigarettes, cigars, smokeless tobacco and multiple products.
• 12th graders more than 9th graders, for every product.
• White and Hispanic students more than Black students (vaping, cigarettes, any product, multiple products); white more than Hispanic students for vaping and any product.
• Lesbian, gay or bisexual students more than heterosexual students for cigarettes, cigars, any product and multiple products.

Frequent use (20 or more of the past 30 days) among current users, by product, 2017 and 2019. CDC / MMWR

Trends

From 2017 to 2019, frequent vaping rose among vapers (25.1% to 32.6%), while frequent smoking fell among smokers (30.0% to 22.2%). The surge in vaping, tied to newer devices such as JUUL, has erased earlier gains in youth tobacco use — the U.S. Surgeon General declared youth e-cigarette use an epidemic.

Current use of tobacco products among high school students, by year, 1991–2019. CDC / MMWR

Where they get them

• Vapers 17 and under most often borrowed them from someone else (42.8%) — other social sources, and older students legally able to buy, were also common.
• Vapers 18 and over most often bought them in a store (56.4%).

In 2016, e-cigarettes became regulated as tobacco products, setting a federal minimum purchase age of 18. On December 20, 2019, federal law raised the minimum age for all tobacco products to 21 nationwide. Before it, 19 states, DC, Guam and Palau had already done so — 13 of those laws in 2019 — which may cut off older classmates as a source.

Why any use matters

No tobacco use is safe for young people, however occasional. Even infrequent smoking predicts daily smoking, nearly all tobacco products contain nicotine, and even occasional use is linked to dependence. Using several products is associated with substance use disorders and may raise nicotine exposure.

What works: higher prices, comprehensive smoke-free policies, limits on advertising and promotion, national anti-tobacco media campaigns, restricting youth access to flavored products, and a minimum purchase age of 21 — together with FDA regulation.

Free help to quit

For teens: the National Cancer Institute's teen.smokefree.gov and the Truth Initiative's This is Quitting.

Limits

A 2017 wording change on smokeless tobacco prevents longer-term trends for it, for any tobacco and for multiple products; students could name only one source for vaping products; and the vaping and cigar questions don't rule out marijuana.

Sources

Based on Creamer MR, Everett Jones S, Gentzke AS, Jamal A, King BA, "Tobacco Product Use Among High School Students — Youth Risk Behavior Survey, United States, 2019," MMWR Supplements, volume 69 (as corrected), Centers for Disease Control and Prevention; a work of the United States government in the public domain. The imported copy of the report still carried a sentence on frequent use that CDC's erratum (MMWR 69:1469) corrected; the figures here follow the correction. The report's summary graphic, which includes a stock photograph, is not reproduced.