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Electronic cigarettes (e-cigarettes) may be on the decline among high school students, but they remain the most popular method of smoking, an analysis of this year's National Youth Tobacco Survey (NYTS) found.

In a nationally representative sample of U.S. students, high school students reporting current use of e-cigarette products declined from 14.1% in 2022 to 10.0% in 2023. This represents an estimated drop from 2.51 million to 1.97 million, respectively, according to Jan Birdsey, MPH, of CDC's Office on Smoking and Health, and colleagues.

Similar to the decline in e-cigarette use, the use of any form of tobacco (16.5% to 12.6%), any type of combustible tobacco (5.2% to 3.9%), and cigar use (2.8% to 1.8%) also decreased since the 2022 survey (P<0.05 for all), the findings in showed.

In contrast, use of tobacco, cannabis, or both had increased among U.S. youths from 2021 to 2022, according to a prior NYTS report.

Birdsey's group suggested that ongoing efforts at the national, state, and local levels to implement tobacco control strategies may be at least partly responsible for the current decrease in e-cigarette use in youth.

However, for middle schoolers, use of any tobacco product (4.5% to 6.6%) and use of multiple tobacco products (1.5% to 2.5%) significantly increased from 2022 to 2023 (P<0.05 for all). Prior research has shown that use of e-cigarettes during early adolescence appeared to increase the odds of any smoking and more frequent tobacco cigarette use in later adolescence.

Study authors stressed the importance of studying and understanding youth tobacco use through these surveys, as well as maintaining existing prevention techniques.

"Given the negative health consequences of tobacco use and the unique harms associated with adolescent nicotine exposure, prevention of tobacco use by youths is imperative," Birdsey's group wrote. "Thus, a continued comprehensive approach to tobacco use prevention is needed to further reduce tobacco use among youths, based on knowledge about youth product use behaviors."

Among student smokers in the 2023 NYTS, e-cigarettes remained the most common form of tobacco product used (7.7%). Traditional cigarettes were the next most favored at 1.6%, followed by cigars at 1.6%, nicotine pouches at 1.5%, smokeless tobacco at 1.2%, other oral nicotine products at 1.2%, hookahs at 1.1%, heated tobacco products at 1%, and lastly, pipe tobacco at 0.5%.

Among both middle and high school students, 22.2% reported ever using any form of tobacco product. Just under half of students, 46.7%, who had reported ever using e-cigarettes were currently using them at the time of the survey, while 25.2% reported daily e-cigarette use, and 34.7% reported smoking e-cigarettes at least 20 or more times in the previous 30 days.

The NYTS began in 1999, and the survey transitioned to a self-administered web-based survey in 2021 as a result of the COVID-19 pandemic.

The present analysis included 22,069 student respondents from 179 schools, yielding a 30.5% response rate. Data were collected from both public and private schools from March 9 through June 6.

New to the annual survey this year was the analysis of flavored tobacco products, including concept flavors and flavors with either "ice" or "iced" in the flavored product's name. Flavors were very popular, with 89.4% of e-cigarette smokers using a flavored product within the prior 30 days. Fruit and candy flavors were the most commonly used among the different kinds of e-cigarette products, while other popular flavors included mint and menthol.

The most common forms of e-cigarettes used were disposable products at 60.7%, followed by prefilled or refillable pods or cartridges at 16.1%, and then devices that had been modified by users to customize the substances, used at 5.9%.

By sex, current use of any tobacco product was reported by 11.2% of girls and 8.9% of boys.

Regardless of sex, current use reached 12.6% of multiracial, 11.7% of Hispanic or Latino, 9.5% of white, 9.3% of Black, and 8.0% of the American Indian or Alaska Native students. In regard to combustible tobacco products, current use was reported by 4.7% of the Black, 3.9% of the Hispanic, 3.7% of the multiracial, and 2.7% of the white or American Indian or Alaska Native students.

Researchers noted that due to the nature of the survey, responses were self-reported and could be subject to bias. Other potential limitations to the study findings include a lower response rate than the previous year, as well as a lack of applicability to students who are home schooled, utilize alternative schooling, have dropped out, or are currently in detention centers.

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