Top 5 Takeaways

1. Prevalence of Use: In 2021, 11.3% of high school students and 2.8% of middle school students reported current e-cigarette use.
2. Frequency of Use: Among current users, 43.6% of high school students and 17.2% of middle school students used e-cigarettes on 20 or more of the past 30 days.
3. Device Preferences: Disposable e-cigarettes were the most commonly used device type among both middle and high school students.
4. Flavor Preferences: A significant majority (84.7%) of current youth e-cigarette users used flavored e-cigarettes, with fruit being the most popular flavor.
5. Brand Awareness: A notable percentage of users, 15.6% of high school and 19.3% of middle school students, did not know the brand of e-cigarette they usually used.

Original Article Author and Citation

Corresponding Author

Eunice Park-Lee, Eunice.Park-Lee@fda.hhs.gov, 301-837-7342

Suggested Citation

Park-Lee E, Ren C, Sawdey MD, et al. Notes from the Field: E-Cigarette Use Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Morb Mortal Wkly Rep 2021;70:1387–1389. DOI: http://dx.doi.org/10.15585/mmwr.mm7039a4

Summary

In 2021, the National Youth Tobacco Survey (NYTS) found that 11.3% of high school students and 2.8% of middle school students reported current e-cigarette use. Among these users, a significant portion reported frequent use, with 43.6% of high school and 17.2% of middle school users using e-cigarettes on 20 or more of the past 30 days. Disposable e-cigarettes were the most popular device type, and flavored e-cigarettes, particularly fruit flavors, were highly favored among youth users. The survey also highlighted a lack of brand awareness among a notable percentage of users.

Methods

The 2021 NYTS was a school-based, cross-sectional, self-administered survey conducted from January 18 to May 21, 2021, involving 20,413 students from 279 schools. Due to the COVID-19 pandemic, data collection was conducted online to accommodate remote learning settings. The survey assessed current e-cigarette use, frequency of use, device type, flavors, and usual brand. Weighted prevalence estimates and population totals were calculated. The study was reviewed and approved by the CDC IRB.

Discussion

The findings indicate a significant prevalence of e-cigarette use among middle and high school students, with a substantial number of users engaging in frequent use. The preference for disposable e-cigarettes and flavored products, especially fruit flavors, underscores the appeal of these products to youths. The lack of brand awareness among users suggests potential gaps in understanding the products they consume. The survey’s online administration due to the pandemic may have influenced the results, particularly in terms of underreporting.

Conclusion

Approximately 2.06 million youths were estimated to be current e-cigarette users in 2021. The use of e-cigarettes among youths poses significant health risks, particularly due to nicotine exposure. Ongoing efforts to regulate and prevent youth e-cigarette use are crucial. Comprehensive tobacco control and prevention strategies at various levels, along with FDA regulation, are essential to reduce and prevent tobacco product initiation and use among youths.

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