• Youth Tobacco Survey Shows Good News, Suggests Work Ahead

    Mixed Results for High School, Middle School Students

    Nov. 22, 2023, News Staff — New research found that e-cigarette use is falling among high-schoolers but more middle-school students are using tobacco products, and the authors called for sustained work through health care interventions and other efforts.

    “Given the negative health consequences of tobacco use and the unique harms associated with adolescent nicotine exposure, prevention of tobacco use by youths is imperative,” the authors wrote in the report, published Nov. 3 in the CDC’s Morbidity and Mortality Weekly Report. Based on the ways youth use tobacco products, they suggested, this could include price increases, smoke-free policies that cover e-cigarettes and clinical interventions.

    The AAFP offers many tools members can incorporate in these interventions to help their patients stop or reduce tobacco use.

    New Findings

    The authors compared 2023 National Youth Tobacco Survey data — from more than 22,000 students at 179 public and private middle and high schools in the United States — with data from the 2022 survey. Participants were asked whether they currently or previously used nine commercial tobacco products (e-cigarettes, cigarettes, cigars, smokeless tobacco, nicotine pouches, hookahs, pipe tobacco, heated tobacco products and other oral nicotine products). Those who used e-cigarettes also were asked about the brand and type of device, and whether they used flavored products.

    According to the analysis, in 2023 10% of all high school and middle school students — about 2.8 million people — reported using a tobacco product at least once in the previously 30 days. Use was higher among females and multiracial, non-Hispanic students. 

    Story Highlights

    More students (7.7%) currently used e-cigarettes than any other tobacco product, and over 89% of e-cigarette users reported using a flavored product. Disposable e-cigarettes were the most common device type. Almost 35% of e-cigarette users reported using e-cigarettes frequently (at least 20 of the previous 30 days), and more than 25% reported using e-cigarettes daily.

    Among high school students, the number who used any tobacco product decreased by more than half a million individuals, from 2.51 million in 2022 to 1.97 million in 2023. There were statistically significant declines among high school students in the current use of

    • any tobacco product (from 16.5% to 12.6%),
    • e-cigarettes (from 14.1% to 10%),
    • cigars (from 2.8% to 1.8%) and
    • any combustible tobacco product (from 5.2% to 3.9%).

    The authors attributed the drop in high school student e-cigarette use by to local, state and national tobacco control efforts, including recent FDA actions aimed at both online and brick-and-mortar retailers, manufacturers and distributors.

    Among middle school students, however, the survey reported statistically significant increases in the current use of any tobacco product (from 4.5% to 6.6%) and multiple tobacco products (from 1.5% to 2.5%). In addition, the percentage of middle students currently using e-cigarettes jumped from 3.3% to 4.6%, although this increase was not statistically significant.

    In discussing the survey results, the authors called youth e-cigarette use “a critical public health concern.”  They noted that about half of students who have ever used e-cigarettes report using them currently, which suggested that many young people who try e-cigarettes continue using them.

    The authors recommended further monitoring to track e-cigarette use in middle school students, as well as continued action to reduce youths’ tobacco use.

    AAFP Resources Help FPs Guide Patients

    Family physicians can rely on several resources from the Academy to help patients reduce or quit tobacco use.

    The AAFP this year updated several components of its longstanding Tar Wars tobacco prevention program, including a newly revised parent information sheet, program guide and PowerPoint presentation. Although the resources are designed to help teachers warn students against smoking or using e-cigarettes, they also can be used as patient educational materials.

    The Academy’s Tobacco Cessation Tools & Resources and Treatment and Cessation webpages offer additional fact sheets, practice manuals and toolkits, including specific guidance for clinicians on e-cigarettes.

    Ask and Act, the AAFP’s tobacco cessation program, has also developed free tobacco cessation resources for members, including several tools that focus on e-cigarettes.

    Clinicians looking for patient-centered information can find a wealth of articles on tobacco, e-cigarettes and smoking at familydoctor.org.

    The Academy is also a longstanding advocate for evidence-based policies to reduce tobacco use and discourage smoking.