Characteristics of e-Cigarette Use Behaviors Among US Youth, 2020

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Key Points

Question

What are the characteristics of current (past 30-day) e-cigarette use among US high school and middle school students in 2020?

Findings

This survey study of 14 531 students found that among the 19.6% of high school students and 4.7% of middle school students who currently used e-cigarettes in 2020, 38.9% of high school users and 20.0% of middle school users self-reported use on 20 to 30 days during the past 30 days, and most reported flavored e-cigarette use.

Meaning

These results suggest that although current e-cigarette use among youth significantly decreased during 2019 to 2020, use prevalence, frequent use, and flavored e-cigarette use remained high.

Abstract

Importance

Comprehensive surveillance of e-cigarette use behaviors among youth is important for informing strategies to address this public health epidemic.

Objective

To characterize e-cigarette use behaviors among US youth in 2020.

Design, Setting, and Participants

The 2020 National Youth Tobacco Survey, a nationally representative, cross-sectional, school-based survey of middle school (grades 6-8) and high school (grades 9-12) students, was conducted from January 16, 2020, to March 16, 2020. A total of 14 531 students from 180 schools participated in the 2020 survey, yielding a corresponding student-level participation rate of 87.4% and school-level participation rate of 49.9%. The overall response rate, a product of the school-level and student-level participation rates, was 43.6%.

Exposures

Current (past 30-day) e-cigarette use.

Main Outcomes and Measures

Self-reported current e-cigarette use behaviors (frequency of use, usual e-cigarette brand, and access source) by school level and flavored e-cigarette use and flavor types among current e-cigarette users by school level and device type. Prevalence estimates were weighted to account for the complex survey design.

Results

Overall, 14 531 students completed the survey, including 7330 female students and 7133 male students with self-reported grade level and sex. In 2020, 19.6% (95% CI, 17.2%-22.2%) of high school students and 4.7% (95% CI, 3.6%-6.0%) of middle school students reported current e-cigarette use. Among them, 38.9% (95% CI, 35.2%-42.6%) of high school users and 20.0% (95% CI, 16.0%-24.8%) of middle school users reported e-cigarette use on 20 to 30 days within the past 30 days. Among current users, JUUL was the most commonly reported usual brand (high school: 25.4%; 95% CI, 18.8%-33.4%; middle school: 35.1%; 95% CI, 27.9%-43.1%). Among current users, the most common source of obtaining e-cigarettes was from a friend (high school: 57.1%; 95% CI, 52.6%-61.4%; middle school: 58.9%; 95% CI, 51.4%-66.1%). Among current users, 84.7% (95% CI, 82.2%-86.9%) of high school students and 73.9% (95% CI, 66.9%-79.8%) of middle school students reported flavored e-cigarette use. Fruit-flavored e-cigarettes were the most commonly reported flavor among current exclusive e-cigarette users of prefilled pods or cartridges (67.3%; 95% CI, 60.9%-73.0%), disposable e-cigarettes (85.8%; 95% CI, 79.8%-90.3%), and tank-based devices (82.7%; 95% CI, 68.9%-91.1%), followed by mint-flavored e-cigarettes.

Conclusions and Relevance

These results suggest that although current e-cigarette use decreased during 2019 to 2020, overall prevalence, frequent use, and flavored e-cigarette use remained high. Continued actions are warranted to prevent and reduce e-cigarette use among US youth.

Abstract

This survey study characterizes e-cigarette use behaviors among US youth in 2020 using data from the 2020 National Youth Tobacco Survey.

Related collections

Most cited references 22

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

Andrea S. Gentzke, MeLisa Creamer, Karen A Cullen … (2019)

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.

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e-Cigarette Use Among Youth in the United States, 2019

Karen A Cullen, Andrea S. Gentzke, Michael D. Sawdey … (2019)

The prevalence of e-cigarette use among US youth increased from 2011 to 2018. Continued monitoring of the prevalence of e-cigarette and other tobacco product use among youth is important to inform public health policy, planning, and regulatory efforts.

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Tobacco Product Use and Associated Factors Among Middle and High School Students —  United States, 2019

Teresa Wang, Andrea S. Gentzke, MeLisa Creamer … (2019)

Problem/Condition Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Most tobacco product use begins during adolescence. In recent years, tobacco products have evolved to include various smoked, smokeless, and electronic products. Period Covered 2019. Description of System The National Youth Tobacco Survey (NYTS) is an annual, cross-sectional, school-based, self-administered survey of U.S. middle school (grades 6–8) and high school (grades 9–12) students. A three-stage cluster sampling procedure is used to generate a nationally representative sample of U.S. students attending public and private schools. NYTS is the only nationally representative survey of U.S. middle and high school students that focuses exclusively on tobacco use patterns and associated factors. NYTS is designed to provide national data on tobacco product use and has been conducted periodically during 1999–2009 and annually since 2011. Data from NYTS are used to support the design, implementation, and evaluation of comprehensive tobacco use prevention and control programs and to inform tobacco regulatory activities. Since its inception in 1999 through 2018, NYTS had been conducted via paper and pencil questionnaires. In 2019, NYTS for the first time was administered in schools using electronic data collection methods. CDC’s Office on Smoking and Health, in collaboration with the U.S. Food and Drug Administration’s (FDA’s) Center for Tobacco Products, analyzed data from the 2019 NYTS to assess tobacco product use patterns and associated factors among U.S. middle and high school students. Overall, 19,018 questionnaires were completed and weighted to represent approximately 27.0 million students. On the basis of self-reported grade level, this included 8,837 middle school questionnaires (11.9 million students) and 10,097 high school questionnaires (15.0 million students); 84 questionnaires with missing information on grade level were excluded from school-level analyses. Results In 2019, an estimated 53.3% of high school students (8.0 million) and 24.3% of middle school students (2.9 million) reported having ever tried a tobacco product. Current (past 30-day) use of a tobacco product (i.e., electronic cigarettes [e-cigarettes], cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, and bidis [small brown cigarettes wrapped in a leaf]) was reported by 31.2% of high school students (4.7 million) and 12.5% of middle school students (1.5 million). E-cigarettes were the most commonly cited tobacco product currently used by 27.5% of high school students (4.1 million) and 10.5% of middle school students (1.2 million), followed in order by cigars, cigarettes, smokeless tobacco, hookahs, and pipe tobacco. Tobacco product use also varied by sex and race/ethnicity. Among current users of each tobacco product, the prevalence of frequent tobacco product use (on ≥20 days of the preceding 30 days) ranged from 16.8% of cigar smokers to 34.1% of smokeless tobacco product users. Among current users of each individual tobacco product, e-cigarettes were the most commonly used flavored tobacco product (68.8% of current e-cigarette users). Among students who reported ever having tried e-cigarettes, the three most commonly selected reasons for use were “I was curious about them” (55.3%), “friend or family member used them” (30.8%), and “they are available in flavors, such as mint, candy, fruit, or chocolate” (22.4%). Among never users of each individual tobacco product, curiosity and susceptibility (a construct that can help to identify future tobacco product experimentation or use) was highest for e-cigarettes (39.1% and 45.0%, respectively) and cigarettes (37.0% and 45.9%, respectively). Overall, 86.3% of students who reported contact with an assessed potential source of tobacco product advertisements or promotions (going to a convenience store, supermarket, or gas station; using the Internet; watching television or streaming services or going to the movies; or reading newspapers or magazines) reported exposure to marketing for any tobacco product; 69.3% reported exposure to e-cigarette marketing and 81.7% reported exposure to marketing for cigarettes or other tobacco products. Among all students, perceiving no harm or little harm from intermittent tobacco product use (use on some days but not every day) was 28.2% for e-cigarettes, 16.4% for hookahs, 11.5% for smokeless tobacco products, and 9.5% for cigarettes. Among current users of any tobacco product, 24.7% reported experiencing cravings to use tobacco products during the past 30 days and 13.7% reported wanting to use a tobacco product within 30 minutes of waking. Moreover, 57.8% of current tobacco product users reported they were seriously thinking about quitting the use of all tobacco products and 57.5% reported they had stopped using all tobacco products for ≥1 day because they were trying to quit. Interpretation In 2019, approximately one in four youths (23.0%) had used a tobacco product during the past 30 days. By school level, this represented approximately three in 10 high school students (31.2%) and approximately one in eight middle school students (12.5%). Since 2014, e-cigarettes have been the most commonly used tobacco product among youths. Importantly, more than half of current youth tobacco product users reported seriously thinking about quitting all tobacco products in 2019. However, established factors of use and initiation, including the availability of flavors, exposure to tobacco product marketing, curiosity and susceptibility, and misperceptions about harm from tobacco product use, remained prevalent in 2019 and continue to promote tobacco product use among youths. Public Health Action The continued monitoring of all forms of youth tobacco product use and associated factors through surveillance efforts including NYTS is important to the development of public health policy and action at national, state, and community levels. Everyone, including public health professionals, health care providers, policymakers, educators, parents, and others who influence youths, can help protect youths from the harms of all tobacco products. In addition, the comprehensive and sustained implementation of evidence-based tobacco control strategies, combined with FDA’s regulation of tobacco products, is important for reducing all forms of tobacco product use among U.S. youths.

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Author and article information

Journal

Journal ID (nlm-ta): JAMA Netw Open

Journal ID (iso-abbrev): JAMA Netw Open

Journal ID (pmc): JAMA Netw Open

Title: JAMA Network Open

Publisher: American Medical Association

ISSN (Electronic): 2574-3805

Publication date (Electronic): 7 June 2021

Publication date Collection: June 2021

Publication date PMC-release: 7 June 2021

Volume: 4

Issue: 6

Electronic Location Identifier: e2111336

Affiliations

[1 ]Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia

[2 ]Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland

[3 ]National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

Author notes

Article Information

Accepted for Publication: March 31, 2021.

Published: June 7, 2021. doi:10.1001/jamanetworkopen.2021.11336

Corresponding Author: Teresa W. Wang, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mailstop S107-7, Atlanta, GA 30341 ( yxn7@ 123456cdc.gov ).

Author Contributions: Drs Wang and Park-Lee had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Wang, Gentzke, Neff, Jamal, Park-Lee, King, Hacker.

Acquisition, analysis, or interpretation of data: Wang, Gentzke, Neff, Glidden, Park-Lee, Ren, Cullen.

Drafting of the manuscript: Wang, Gentzke, Neff, Jamal, Park-Lee, Cullen, King, Hacker.

Critical revision of the manuscript for important intellectual content: Wang, Gentzke, Glidden, Park-Lee, Ren, Cullen, King, Hacker.

Statistical analysis: Wang, Gentzke, Glidden, Park-Lee, Ren.

Administrative, technical, or material support: Jamal, Park-Lee, Ren, Cullen, King, Hacker.

Supervision: Wang, Neff, Cullen, King, Hacker.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was funded by the US Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA).

Role of the Funder/Sponsor: The CDC and FDA participated in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The study sponsors were involved in the decision to submit the manuscript for publication but did not have the right to veto the publication or to control the decision regarding to which journal the manuscript was submitted.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC or the FDA. Use of brand names in this publication by CDC and FDA authors does not imply an endorsement by the CDC, FDA, and/or the US Department of Health and Human Services of any product, service, or enterprise.

Article

Publisher ID: zoi210332

DOI: 10.1001/jamanetworkopen.2021.11336

PMC ID: 8185598

PubMed ID: 34097049

SO-VID: 84c2c3ed-5792-4518-be86-8098be17a7ee

License:

This is an open access article distributed under the terms of the CC-BY License.

History

Date received : 26 February 2021

Date accepted : 31 March 2021

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