Tobacco Use Among Middle and High School Students - United States, 2011-2016

Abstract

Tobacco use is the leading cause of preventable disease and death in the United States; nearly all tobacco use begins during youth and young adulthood (1,2). Among youths, use of tobacco products in any form is unsafe (1,3). CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2016 National Youth Tobacco Surveys (NYTS) to determine recent patterns of current (past 30-day) use of seven tobacco product types among U.S. middle (grades 6-8) and high (grades 9-12) school students. In 2016, 20.2% of surveyed high school students and 7.2% of middle school students reported current tobacco product use. In 2016, among current tobacco product users, 47.2% of high school students and 42.4% of middle school students used ≥2 tobacco products, and electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among high (11.3%) and middle (4.3%) school students. Current use of any tobacco product did not change significantly during 2011-2016 among high or middle school students, although combustible tobacco product use declined. However, during 2015-2016, among high school students, decreases were observed in current use of any tobacco product, any combustible product, ≥2 tobacco products, e-cigarettes, and hookahs. Among middle school students, current use of e-cigarettes decreased. Comprehensive and sustained strategies can help prevent and reduce the use of all forms of tobacco products among U.S. youths (1-3).

FIGURE 1

Estimated percentage of high school students who currently use any tobacco products, any combustible tobacco products, ≥2 tobacco products, and selected tobacco products — National Youth Tobacco Survey, United States, 2011–2016,, Any tobacco product use is defined as past 30-day use of electronic cigarettes, cigarettes, cigars, hookahs, smokeless tobacco, pipe tobacco and/or bidis. Any combustible tobacco use is defined as use of cigarettes, cigars, hookahs, pipe tobacco, and/or bidis on at least one day in the past 30 days. ≥2 tobacco product use is defined as past 30-day use of two or more of the following tobacco products: electronic cigarettes, cigarettes, cigars, hookahs, smokeless tobacco, pipe tobacco, and/or bidis. ^¶ From 2015 to 2016, a significant decrease in use of any tobacco product, any combustible tobacco product, ≥2 tobacco products, electronic cigarettes, and hookahs was observed (p<0.05). ** During 2011–2016, use of electronic cigarettes and hookahs exhibited a nonlinear increase (p<0.05). Use of cigarettes, cigars, and smokeless tobacco exhibited a linear decrease (p<0.05). Any combustible tobacco use, pipe tobacco, and bidis exhibited a nonlinear decrease (p<0.05). There was a nonlinear change during this time in the use of ≥2 types of tobacco products (p<0.05). No significant trend in current use of any tobacco product was observed during 2011–2016. ^†† Beginning in 2015, the definition of smokeless tobacco included chewing tobacco/snuff/dip, snus, and dissolvable tobacco because of limited sample sizes for individual products; this definition was applied across 2011–2016 for comparability purposes. In previous reports (National Youth Tobacco Survey 2014 and earlier) smokeless tobacco included only chewing tobacco/snuff/dip; snus and dissolvable tobacco were reported as separate products.

FIGURE 2

Estimated percentage of middle school students who currently use any tobacco products, any combustible tobacco product,† ≥2 tobacco products, and selected tobacco products — National Youth Tobacco Survey, 2011–2016,, * Any tobacco product use is defined as past 30-day use of electronic cigarettes, cigarettes, cigars, hookahs, smokeless tobacco, pipe tobacco and/or bidis. Any combustible tobacco use is defined as use of cigarettes, cigars, hookahs, pipe tobacco, and/or bidis on at least one day in the past 30 days. ≥2 tobacco product use is defined as past 30-day use of two or more of the following tobacco products: electronic cigarettes, cigarettes, cigars, hookahs, smokeless tobacco, pipe tobacco, and/or bidis. ^¶ From 2015 to 2016, a significant decrease in use of electronic cigarettes was observed (p<0.05). ** During 2011–2016, electronic cigarette use exhibited a nonlinear increase (p<0.05). Hookah use exhibited a linear increase (p<0.05). Use of any combustible tobacco, cigarettes, cigars, and pipe tobacco exhibited a linear decrease (p<0.05). Bidi use exhibited a nonlinear decrease (p<0.05). Smokeless tobacco use exhibited a nonlinear change over this time period (p<0.05). No change in current use of any product or ≥2 types of products was observed during 2011–2016. ^†† Beginning in 2015, the definition of smokeless tobacco included chewing tobacco/snuff/dip, snus, and dissolvable tobacco because of limited sample sizes for individual products; this definition was applied across 2011–2016 for comparability purposes. In previous reports (National Youth Tobacco Survey 2014 and earlier) smokeless tobacco included only chewing tobacco/snuff/dip; snus and dissolvable tobacco were reported as separate products.