Vital Signs: Tobacco Product Use Among Middle and High School Students — United States, 2011–2018

Abstract

Introduction Tobacco use is the leading cause of preventable disease and death in the United States; nearly all tobacco product use begins during youth and young adulthood. Methods CDC, the Food and Drug Administration, and the National Cancer Institute analyzed data from the 2011–2018 National Youth Tobacco Surveys to estimate tobacco product use among U.S. middle and high school students. Prevalence estimates of current (past 30-day) use of seven tobacco products were assessed; differences over time were analyzed using multivariable regression (2011–2018) or t-test (2017–2018). Results In 2018, current use of any tobacco product was reported by 27.1% of high school students (4.04 million) and 7.2% of middle school students (840,000); electronic cigarettes (e-cigarettes) were the most commonly used product among high school (20.8%; 3.05 million) and middle school (4.9%; 570,000) students. Use of any tobacco product overall did not change significantly during 2011–2018 among either school level. During 2017–2018, current use of any tobacco product increased 38.3% (from 19.6% to 27.1%) among high school students and 28.6% (from 5.6% to 7.2%) among middle school students; e-cigarette use increased 77.8% (from 11.7% to 20.8%) among high school students and 48.5% (from 3.3% to 4.9%) among middle school students. Conclusions and Implications for Public Health Practice A considerable increase in e-cigarette use among U.S. youths, coupled with no change in use of other tobacco products during 2017–2018, has erased recent progress in reducing overall tobacco product use among youths. The sustained implementation of comprehensive tobacco control strategies, in coordination with Food and Drug Administration regulation of tobacco products, can prevent and reduce the use of all forms of tobacco products among U.S. youths.

Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents

“…11,13 Prior studies also indicate that risk perception is associated with product use. 10,21 In this study, relative to cigarette-only users, those with a high-risk perception of both products had lower odds of dualuse than those with a low-risk perception of both products. Participants with high perceived risk could be concerned about the possibility of increased nicotine dependence or other risks associated with dual-use.…”

“…Current use was defined as any use within the 30 days prior to the survey. 21 Participants who did not use either product in the previous 30 days were considered nonusers.…”

Electronic cigarettes disrupt lung lipid homeostasis and innate immunity independent of nicotine

“…The electronic nicotine delivery system (ENDS), or e-cigarette, entered the US market in the mid-2000s and rapidly gained popularity among tobacco smokers and never-smokers (1). Currently, an estimated 10 million US adults and over 3 million high school age adolescents are active ENDS users (2,3). Notably, ENDS have become the most commonly consumed tobacco substitute in the adolescent population, fueling concerns over the health-related consequences of ENDS exposure (4).…”

Acute exposure to nicotine vapor causes short-term increases in impulsive choice in rats

“…Relative to traditional cigarettes, e-cigarettes can expose users to different concentrations of nicotine, rates of consumption, and additive chemicals (e.g., propylene glycol, vegetable glycerin), all of which can impact the pulmonary absorption, pharmacodynamics, and health effects of nicotine (Callahan-Lyon, 2014). These differences, along with recent and dramatic increases in e-cigarette use (Gentzke et al, 2019), highlight the need to seek clarity on the effects of nicotine vapor exposure on human health, as well as how the health effects of this novel nicotine delivery system differ from those seen with traditional cigarette use. By doing so, researchers will help address misconceptions regarding the safety of e-cigarettes and improve treatment outcomes for nicotine dependence and e-cigarette related health impairments.…”

“…However, pre-clinical studies linking nicotine vapor consumption from e-cigarettes to changes in the brain and behavior are limited (Javadi-Paydar, Kerr, Harvey, Cole, & Taffe, 2019;Smith et al, 2015). This is concerning, as e-cigarette vaping in adolescents has now surpassed conventional cigarette smoking, with use increasing from 1.5% in 2011 to 20.8% in 2018 (Gentzke et al, 2019). The limited findings that are available thus far suggest that while nicotine vapor may contain fewer toxic additives than nicotine smoke, higher administration rates and chemical constituents associated with e-cigarettes can enhance nicotine's addiction-related behavioral and biological effects (Gilpin et al, 2014;Hall et al, 2014).…”