The percentage of high school students who said they use tobacco products dropped in the past year, primarily due to a decline in electronic cigarette use, according to government data released Thursday.
However, there were more middle school students who said they used any tobacco products, a trend that poses a challenge for regulators and public health officials.
Overall, 540,000 fewer high school students said they use tobacco products, dropping from 2.51 million in 2022 to 1.97 million in 2023, according to findings from the Centers for Disease Control and Prevention’s (CDC) National Youth Tobacco Survey.
The percentage of high schoolers who said they smoke e-cigarettes dropped from 14 percent to 10 percent, which health officials and advocates touted as important progress.
“It is terrific news for our nation’s health that e-cigarette use among high school students fell sharply this year, while use of cigarettes, cigars and other smoked tobacco products are at record lows,” Yolonda C. Richardson, president and CEO of the Campaign for Tobacco-Free Kids said in a statement.
Erika Sward, assistant vice president of national advocacy at the American Lung Association, said it was “absolutely good news” that high school use of tobacco and e-cigarettes dropped. But she said the results of the survey show a "complicated landscape” because there was a significant increase in middle school use of tobacco products.
The number of middle school students who said they use tobacco products increased from 4.5 percent to 6.6 percent. And while fewer high school students said they used e-cigarettes, there was no significant change among middle school students.
For the 10th straight year, e-cigarettes have been the most used tobacco product among both middle and high school students. Altogether, 2.1 million middle and high school students still use e-cigarettes, and nearly 90 percent of them use flavored products.
Deirdre Lawrence Kittner, director of the CDC Office on Smoking and Health, said the report underscores “the threat that commercial tobacco product use poses to the health of our nation’s youth. It is imperative that we prevent youth from starting to use tobacco and help those who use tobacco to quit.”
Among students who had ever used an e-cigarette, almost half said they still use them, and 25 percent of them said they vape daily.
Sward said public health and policy interventions need to start being aimed at younger kids.
“It’s clear that the industry has targeted younger. … Clearly public health interventions need to aim younger,” Sward said.
Disposable products were the most used e-cigarette device type among youth. They are relatively inexpensive, have a high nicotine content and are available in flavors appealing to youths, the CDC said.
However, the most popular brands included a variety of both disposable and cartridge-based products. Among students who used e-cigarettes, the most reported brands were Elf Bar, Esco Bars, Vuse, JUUL, and Mr. Fog.
Electronic cigarettes were first introduced on the market as a “healthier” alternative to smoking traditional tobacco cigarettes, but it began to spread to young people, who were drawn in by sweet and fruit-flavored e-cigarette pods easily accessible in stores.
All flavored e-cigarettes are illegally on the market, but the survey found 63 percent of high schoolers and 66 percent of middle schoolers said they use fruit flavors.
The Food and Drug Administration (FDA) is facing intense scrutiny for its handling of e-cigarette products, which need agency authorization to stay on the market. The agency gave companies until September 2020 to submit applications for approval of each of their vape products, even if they were already on the market. Otherwise, they would be considered illegal.
The FDA said it has received applications for more than 26 million products and has made determinations on 99 percent of them. The agency has denied millions of the applications, but critics say the process has been too slow and is allowing companies to skirt the rules.
The FDA recently told a federal judge in response to a lawsuit from the American Lung Association and other advocacy groups that it will finish reviews by the end of the year.
But anti-tobacco advocates said the government needs to do more than just rid the market of flavored products. Officials also need to step up enforcement of illegal products being shipped from overseas, such as Elf Bar, which comes from China.
In May, the FDA directed customs officials to seize incoming shipments of Elf Bar and EBDesign, two of the company's U.S. brand names. But advocates allege the company has since rebranded in an effort to evade enforcement.
