Youth Tobacco Use: Results from the National Youth Tobacco Survey

2020 Findings on All Tobacco Use  

The data show youth use of any tobacco product declining, with an estimated 1.73 million fewer youth currently using any tobacco product in 2020 (4.47 million) compared to 2019 (6.20 million). 

The results showed 23.6% of high school and 6.7% of middle school students reported currently using any tobacco product in 2020. In addition, the current use of any combustible tobacco products, multiple tobacco products, e-cigarettes, cigars, and smokeless tobacco decreased among both high and middle school students between 2019 and 2020. Despite these encouraging declines, the survey did not show significant decreases in the use of cigarettes, hookah, pipe tobacco, or heated tobacco products. 

2020 Findings on E-Cigarette Use

In fall 2020, FDA and CDC released findings from the 2020 National Youth Tobacco Survey showing that 1.8 million fewer U.S. youth are currently using e-cigarettes compared to last year. However, youth e-cigarette use has increased dramatically since 2011, and 3.6 million youth still currently use e-cigarettes. Moreover, the data shows an alarming increase in the number of youth who use disposable e-cigarettes and more than 8 out of 10 youth e-cigarette users report the use of flavored products. In addition, almost 40 percent of high school users are using an e-cigarette on 20 or more days out of the month and almost a quarter of them use e-cigarettes every day, indicating a strong dependence on nicotine among youth.

2020 NYTS data shows an alarming uptick in the use of disposable e-cigarettes by youth. Specifically, in 2020, disposable e-cigarettes are being used by 26.5% of high school e-cigarette users (up from 2.4% in 2019) and 15.2% of middle school e-cigarette users (up from 3% in 2019). Furthermore, more than 8 out of 10 youth e-cigarette users report the use of flavored products, with fruit, mint, candy, and menthol among the most commonly used. This is the first year in which the NYTS distinguished between mint and menthol products; in previous years’ surveys, youth were asked questions in which products were identified as “mint/menthol” and not further delineated.

There is work that still needs to be done to curb youth use. Youth use of e-cigarettes remains a public health crisis that is affecting children, families, schools, and communities, and the FDA says that the agency will do everything possible to stop it. The agency says that it is committed to addressing the public health crisis of youth e-cigarette use by, among other things, focusing product review and enforcement on youth-appealing products and investing in campaigns to educate youth about the dangers of e-cigarette use. Additionally, the agency will remain vigilant in monitoring the marketplace, expanding public education efforts, and using regulatory authority – changing course as necessary – to further ensure all tobacco products, and e-cigarettes, in particular, are not marketed to, sold to, or used by kids. If a product is found that is targeted to kids, the agency will not hesitate to target that product.

The premarket review submission deadline has passed in September 2020, which is a milestone for ensuring new tobacco products, including many already on the market, undergo a robust scientific evaluation by the FDA. Scientific review of new products is a critical part of how we carry out our mission to protect the public—especially kids—from the harms associated with tobacco use. Companies must demonstrate that each product meets the applicable statutory criteria for receiving marketing authorization, such as whether marketing the product is appropriate for the protection of public health. In such cases, the FDA may assess, among other things, how particular e-cigarettes or other electronic nicotine delivery systems (ENDS) could help addicted adult smokers seeking to transition away from cigarettes, while also weighing the concerning popularity of these products with young people. The FDA has been working tirelessly to ensure that we are as prepared as possible to receive, process, and review the applications in a timely manner.

In addition to the critical premarket scientific review of tobacco products, taking enforcement actions against those who violate the law remains a vital way public health is protected. Following the September 2020 deadline, the FDA will be prioritizing enforcement against any ENDS product that continues to be sold and for which the agency has not received a product application. Additionally, based on several factors – including the likelihood of youth use or initiation – the FDA will make the best use of agency resources to enforce against any other deemed new tobacco product that does not have the required premarket authorization, though as the result of a court decision, the FDA will not be enforcing this requirement for “premium” cigars.

The FDA has issued warning letters notifying companies who sell or distribute unauthorized ENDS products to remove those products from the market because they do not have the required premarket authorization, or for illegally marketing unauthorized menthol-flavored e-liquids, and/or the labeling and/or advertising of these products also feature cartoon images, such as vampires and kings, that are commonly marketed and/or appeal to youth. The agency is working to ensure these illegally marketed products are no longer sold, and that the products will not be reintroduced on the market until the companies have applied for and if they receive marketing authorization from the FDA.