Tobacco Product Use Among High School Students - Youth Risk Behavior Survey, United States, 2019

Abstract

Tobacco product use is the leading cause of preventable disease, disability, and death in the United States. This report used data from the 2019 Youth Risk Behavior Survey to assess the following among U.S. high school students: ever use of cigarettes and electronic vapor products, current use (≥1 day during the 30 days before the survey) of tobacco products, frequent use (≥20 days during the 30 days before the survey) among current users of tobacco products, trends in use over time, and usual source of electronic vapor products among current electronic vapor product users. In 2019, a total of 50.1% of U.S. high school students had ever used electronic vapor products, and 24.1% had ever tried cigarette smoking. Current electronic vapor product use was 32.7%, current cigarette smoking was 6.0%, current cigar smoking was 5.7%, and current smokeless tobacco use was 3.8%. Approximately 36.5% of students were current users of any tobacco product, and 8.2% were current users of two or more tobacco products. Frequent use among users of individual products was 32.6% for electronic vapor products, 28.5% for smokeless tobacco, 22.2% for cigarettes, and 18.4% for cigars. Among current electronic vapor product users who were aged ≤17 years, the most commonly reported source was borrowing them from someone else (42.8%). Significant decreases occurred in current cigarette smoking (1991: 27.5%; 2019: 6.0%), cigar smoking (1997: 22.0%; 2019: 5.7%), and smokeless tobacco use (2017: 5.5%; 2019: 3.8%). However, significant increases occurred in current electronic vapor product use (2015: 24.1%; 2019: 32.7%) and any tobacco product use (2017: 19.5%; 2019: 36.5%). Although current cigarette smoking, cigar smoking, and smokeless tobacco use has decreased among high school students, the increased prevalence of electronic vapor product use among youths is concerning. Continued surveillance for all tobacco product use is warranted for guiding and evaluating public health policy at the local, state, tribal, and national levels.

FIGURE 1

Prevalence of frequent tobacco use* among current users, by type of tobacco product^† — Youth Risk Behavior Survey, United States, 2017 and 2019^§ * Frequent use was defined as use on ≥20 days during the 30 days before the survey. ^† Frequent use was assessed among respondents who reported current use (on ≥1 day during the 30 days before the survey) of each tobacco product. In 2017, among the 13.2% of students nationwide who used electronic vapor products on ≥1 day during the 30 days before the survey; among the 8.8% of students nationwide who smoked cigarettes on ≥1 day during the 30 days before the survey; among the 8.0% of students nationwide who smoked cigars on ≥1 day during the 30 days before the survey; among the 5.5% of students nationwide who used smokeless tobacco on ≥1 day during the 30 days before the survey. In 2019, among the 32.7% of students nationwide who used electronic vapor products on ≥1 day during the 30 days before the survey; among the 6.0% of students nationwide who smoked cigarettes on ≥1 day during the 30 days before the survey; among the 5.7% of students nationwide who smoked cigars on ≥1 day during the 30 days before the survey; among the 3.8% of students nationwide who used smokeless tobacco on ≥1 day during the 30 days before the survey. ^§ Differences from 2017 to 2019 were assessed by t-test (p<0.05): A significant increase occurred in frequent use of electronic vapor products; a significant decrease occurred in frequent use of cigarettes; and no change occurred in frequent use of cigars/cigarillos/little cigars and smokeless tobacco.

FIGURE 2

Prevalence of current tobacco product use, by year — Youth Risk Behavior Survey, United States, 1991–2019* * Logistic regression analyses were used to model linear and quadratic time effects while controlling for sex, grade, and race/ethnicity. Electronic vapor products: significant linear increase (2015–2019); cigarettes: significant linear decrease (1991–2019); significant quadratic trend: increase during 1991–1997, decrease during 1997–2019; cigars/cigarillos/little cigars: significant linear decrease (1997–2019); significant quadratic trend: decrease 1997–2013; decrease 2013–2019 (different rate of decrease). Differences from 2017 to 2019 were assessed by t-test (p<0.05): A significant increase occurred in use of electronic vapor products and any tobacco product; a significant decrease occurred in use of cigarettes, cigars/cigarillos/little cigars and smokeless tobacco; and no change occurred in use of ≥2 products.