Youth Tobacco Use in 2023: E-Cigarettes Fell Among High Schoolers

Summary

Tobacco use in adolescence raises the risk of lifelong nicotine addiction and its harms. CDC and the Food and Drug Administration (FDA) analyzed the 2023 National Youth Tobacco Survey of middle school (grades 6–8) and high school (grades 9–12) students.

Key findings

• 10.0% of students — 2.80 million — currently used a tobacco product (in the past 30 days); 22.2% (6.21 million) had ever used one.
• Current use among high school students fell by an estimated 540,000, from 2.51 million in 2022 to 1.97 million.
• High school e-cigarette use dropped from 14.1% to 10.0%.
• E-cigarettes remain the most-used product, as they have been since 2014.

What students used (current use, 2023)

By group: current use was 11.2% of girls and 8.9% of boys; 12.6% of multiracial, 11.7% of Hispanic, 9.5% of White, 9.3% of Black and 8.0% of American Indian or Alaska Native students. Combustible tobacco use was highest among Black students (4.7%). Ever use was lowest among Asian students.

How young people vape

• Nearly half (46.7%) of students who had ever tried an e-cigarette still used them.
• 25.2% of current users vaped daily; 34.7% vaped frequently (20 or more of the past 30 days). Among high schoolers who vape, close to 40% used them frequently and 29.9% daily — and 550,000 middle schoolers vaped. Adolescents can show signs of dependence using nicotine just 1–3 days a month.
• Devices: disposables 60.7%, pods or cartridges 16.1%, tanks or mods 5.9%. Disposables are cheap, high in nicotine and come in youth-friendly flavors.
• Brands: Elf Bar (56.7%), Esco Bars (21.6%), Vuse (20.7%), JUUL (16.5%), Mr. Fog (13.6%).
• Flavors: 89.4% used flavored e-cigarettes — fruit (63.4%) and candy (35.0%) most of all; only 6.4% used tobacco flavor. 57.9% used flavors with "ice" in the name. Across all products, 86.9% of young tobacco users used flavors.

Changes from 2022

• High school: significant drops in any tobacco use (16.5% → 12.6%), e-cigarettes (14.1% → 10.0%), cigars (2.8% → 1.8%) and combustible tobacco (5.2% → 3.9%), likely reflecting national, state and local tobacco control, including FDA actions.
• Middle school: significant increases in any tobacco use (4.5% → 6.6%) and use of multiple products (1.5% → 2.5%); e-cigarette use went from 3.3% to 4.6%, not a significant change.
• All students together: no significant change.

What can help

Flavors, marketing and misperceptions of harm keep drawing young people in. Proven measures:

• price increases;
• comprehensive smoke-free policies that include e-cigarettes;
• counter-marketing campaigns;
• health care interventions — plus help for young users to quit.

About the survey: a school-based web survey of 22,069 students at 179 schools, March 9–June 16, 2023, with a 30.5% response rate (down from 45.2% in 2022, adjusted for in the weights). Self-reported, and it misses youths who are home-schooled, out of school, in detention or in alternative schools.

Sources

Based on Jan Birdsey et al., "Tobacco Product Use Among U.S. Middle and High School Students — National Youth Tobacco Survey, 2023," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, with the Food and Drug Administration; published by CDC.