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

To estimate the prevalence of e-cigarette use among US adolescents students in 2019 including frequency of use, brands used, and use of flavored products.

US high school and middle school students participating in the 2019 National Youth Tobacco Survey.

Cross-sectional analyses of a school-based nationally representative sample of 19 018 US students in grades 6 to 12. The National Youth Tobacco Survey was a self-administered questionnaire given from February 15, 2019, to May 24, 2019.

The survey included 10 097 high school students (mean [SD] age, 16.1 [3.0] years; 47.5% female) and 8837 middle school students (mean [SD] age, 12.7 [2.8] years; 48.7% female). The response rate was 66.3%. An estimated 27.5% (95% CI, 25.3% to 29.7%) of high school students and 10.5% (95% CI, 9.4% to 11.8%) of middle school students reported current e-cigarette use. Among current e-cigarette users, an estimated 34.2% (95% CI, 31.2% to 37.3%) of high school students and 18.0% (95% CI, 15.2% to 21.2%) of middle school students reported frequent use, and an estimated 63.6% (95% CI, 59.3% to 67.8%) of high school students and 65.4% (95% CI, 60.6% to 69.9%) of middle school students reported exclusive use of e-cigarettes. Among current e-cigarette users, an estimated 59.1% (95% CI, 54.8% to 63.2%) of high school students and 54.1% (95% CI, 49.1% to 59.0%) of middle school students reported JUUL as their usual e-cigarette brand in the past 30 days. Among current e-cigarette users, 13.8% (95% CI, 12.0% to 15.9%) of high school students and 16.8% (95% CI, 13.6% to 20.7%) of middle school students reported not having a usual e-cigarette brand. Among current exclusive e-cigarette users, an estimated 72.2% (95% CI, 69.1% to 75.1%) of high school students and 59.2% (95% CI, 54.8% to 63.4%) of middle school students used flavored e-cigarettes, with fruit, menthol or mint, and candy, desserts, or other sweets being the most commonly reported flavors.

In 2019, the prevalence of self-reported e-cigarette use was high among high school and middle school students, with many current e-cigarette users reporting frequent use and most of the exclusive e-cigarette users reporting use of flavored e-cigarettes.

Trends of declining youth smoking—achieved after decades of public health policy, educational programs, and activism—have begun to reverse with the growing popularity of e-cigarettes. This study estimates that roughly 60% of current e-cigarette users in high school and middle school use e-cigarettes and no other type of tobacco product. This suggests many young e-cigarette users might never have been drawn to traditional smoking or other tobacco use. Known risks of adolescent nicotine-use, as well as the rising popularity of e-cigarettes, and the largely unknown health consequences of long-term e-cigarette use, suggest a need for educational programs specifically designed to inform students about the manipulative history of tobacco sales and present dangers of e-cigarette use. Previous research has shown adolescents with asthma use e-cigarettes at higher rates than adolescents without asthma, have positive beliefs about e-cigarette products, and experience worsened asthmatic symptoms after exposure to e-cigarette flavoring agents and traditional tobacco products. Thus, the rising prevalence of adolescent e-cigarette use is especially worrisome in asthmatic populations.