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February 14, 2019

Youth tobacco use is up—reversing decades of declines, CDC finds

Daily Briefing

    Youth tobacco use in 2018 increased by the largest margin ever recorded by CDC in a single year—driven largely by an increase in the number of adolescents who reported using e-cigarettes, according to CDC's Morbidity and Mortality Weekly Report released Monday.

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    For the report, researchers from CDC, FDA, and the National Cancer Institute estimated tobacco product use among U.S. middle- and high-school students by analyzing data from the 2011-2018 National Youth Tobacco Surveys. The researchers defined:

    • Current tobacco users as students who reported using a tobacco product within the 30 days prior to the survey; and
    • Frequent tobacco users as students who reported using a tobacco product for 20 or more days in the 30 days prior to the survey.


    The researchers found the number of U.S. middle- and high-school students who reported being current users of a tobacco product reached about 4.9 million in 2018. The researchers found reported current use of any tobacco product increased from:

    • 19.6% in 2017 to 27.1% in 2018 among high-school students; and
    • 5.6% in 2017 to 7.2% in 2018 among middle-school students.

    Further, the researchers found 40% of high-school students and one-third of middle-school students reported being current users of at least two tobacco products in 2018.

    According to researchers, e-cigarettes primarily drove the increase in tobacco use, and e-cigarettes remained the most popular tobacco product used by high-school students for the fifth year in a row. The researchers found that approximately 3.6 million middle- and high-school students reported that they were current e-cigarette users in 2018, up from 2.1 million in 2017. The researchers found e-cigarette use reached epidemic levels, increasing by:

    • 77.8%, from 11.7% in 2017 to 20.8% in 2018 among high-school students; and
    • 48.5%, from 3.3% in 2017 to 4.9% in 2018 among middle-school students.

    The researchers found no change from 2017 to 2018 in the number of middle- and high-school students who reported using traditional cigarettes or other tobacco products.


    CDC Director Robert Redfield said, "The skyrocketing growth of young people's e-cigarette use over the past year threatens to erase progress made in reducing youth tobacco use." However, he added, "Despite this troubling trend, we know what works and we must continue to use proven strategies to protect America's youth from this preventable health risk. Youth use of any tobacco product, including e-cigarettes, is unsafe."

    Brian King, deputy director for research translation at the National Center for Chronic Disease Prevention and Health Promotion's Office on Smoking and Health, called particular attention to the report's finding that more middle- and high-school students reported using at least two tobacco products. King said the finding supports an emerging body of research that suggests e-cigarette use can lead adolescents to smoke traditional cigarettes. King said,"[T]he most common combination" of tobacco products "is e-cigarettes and cigarettes," which means "[e]-cigarettes could be playing a role in the patterns of use we're seeing among kids in terms of cigarette smoking."

    Anne Schuchat, CDC's principal deputy director, noted tobacco use is the leading cause of preventable deaths and disease in the United States, and nearly all tobacco use begins during adolescence.

    Mitch Zeller, director of FDA's Center for Tobacco Products, said, "From a public health perspective we should be very concerned about what [the report's findings] might mean, especially with the popularity of these pod-based products with incredibly high levels of nicotine in them." He added, "[T]here is nothing good from a public health perspective that comes from more frequent use of any tobacco product."

    FDA Commissioner Scott Gottlieb said the findings could lead to tougher regulations for e-cigarettes. "I fear this trend will continue in 2019, forcing us to make some tough decisions about the regulatory status of e-cigarettes," he said. Gottlieb added, "We'll continue to take a series of escalating regulatory actions to try to address the root causes of this spike in youth e-cigarette use, in particular by ensuring these products are sold in ways that make them less accessible and appealing to youth" (Drage O'Reilly, Axios, 2/11; Hellmann, The Hill, 2/11; Boyles, MedPage Today, 2/11; Siddons, Roll Call, 2/11; CDC's Morbidity and Mortality Weekly Report, 2/11).

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    Ten million individuals nationwide are eligible for lung screening every year—but the average program only screens about 25. Given its potential to increase survival and volumes, lung cancer screening is one of the best opportunities to achieve program cost, quality, and growth goals.

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