US Pharm. 2019;44(5):15

In 2019, the FDA and the CDC released data from the 2018 National Youth Tobacco Survey demonstrating that 4.9 million middle school and high school students were using some type of tobacco product in 2018—a 35% increase over the 3.62 million adolescents reported to use these products in 2017. This marked rise was probably due to the increased use of e-cigarettes, which entered the U.S. market in 2007.

Trends in Use: In 2018, among adolescent tobacco-product users, 40% of high school students (1.68 million) and 33% of middle school students (270,000) used two or more types of products. The most common reasons for using these products were use by a friend or family member (39%), the availability of flavors (31%), and the belief that e-cigarettes are less harmful than conventional cigarettes (17.1%). From 2017 to 2018, e-cigarette use increased from 6.6% to 10.4% among 8th-graders, 13.1% to 21.7% among 10th-graders, and 16.6% to 26.7% among 12th-graders.

High School Students: The type of tobacco products used by high school students varied. E-cigarettes were the most frequently used product (20.8%), followed by cigarettes (8.1%), cigars (7.8%), smokeless tobacco (5.9%), hookahs (4.1%), and pipe tobacco (1.1%). Use of any one tobacco product increased from 24.2% (3.69 million students) to 27.1% (4.04 million students) from 2011 to 2018. According to the 2017 Youth Risk Behavior Survey, 42.2% of high school students had ever used an electronic vaping product (EVP). Use of EVPs increased as the students advanced in education level from 9th grade (32.7%) to 10th (41%), 11th (48%), and 12th grade (48.6%). Moreover, 2.4% of all high school students continued to use EVPs on a daily basis. Male students were 3.5 times more likely to be daily users of EVPs compared with female students (3.8% vs. 1.1%).

Middle School Students: Although overall tobacco use did not change significantly from 2011 to 2018, its use increased 28.6% (jumping from 5.6% to 7.2%) from 2017 to 2018. In 2018, among 840,000 middle school students who used tobacco products, e-cigarette use was 4.9% (570,000 students) compared with 0.6% (60,000 students) in 2011, which translates to 1 in 20 students. E-cigarette use in middle school students increased by 48%—from 3.3% to 4.9% of students—from 2017 to 2018. Among middle-schoolers, other types of tobacco products used were cigarettes (1.8%), smokeless tobacco (1.8%), cigars (1.6%), hookahs (1.2%), and pipe tobacco (0.3%). Use of any tobacco product was higher in male students versus female students.

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