Youth and Tobacco Use

What to know

  • Youth use of tobacco products in any form is unsafe.
  • Preventing tobacco product use among youth is critical to reducing tobacco use into adulthood.
  • Review the data about young tobacco use by product type.
Teacher speaking to high school students.

Overview

Youth use of tobacco products in any form is unsafe.

Preventing tobacco product use among youth is critical to reducing tobacco use among the nation's youth.

  • Tobacco product use is started and established primarily during adolescence.12
  • Nearly 9 out of 10 adults who smoke cigarettes daily first try smoking by age 18.
  • Flavorings in tobacco products can make them more appealing to youth.34
    • In 2021, 80.2% of high school students and 74.6% of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product during that time.5
    • In 2023, 90.3% of high school students and 87.1% of middle school students who used e-cigarettes in the past 30 days reported using a flavored e-cigarette during that time.6
Keep Reading: Learn more about trends in tobacco use among youth.

Estimates of current tobacco use among youth

Current Tobacco Use among U.S. High School Students. Any tobacco product 12.6%, E-cigarettes 10%, Cigarettes 1.9%, Cigars 1.8%, Nicotine pouches 1.7%, Smokeless tobacco 1.5%, Other oral nicotine products 1.2%, Hookah 1.1%, Heated tobacco products 1%, Pipes 0.6%
See the breakdown of current tobacco products used by U.S. high school students.

Electronic cigarettes (E-cigarettes)

  • E-cigarettes have been the most commonly used tobacco product among youth since 2014.
  • In 2023, about 1 out of every 22 middle school students (4.6%) reported that they had used electronic cigarettes in the past 30 days.6
  • In 2023, 1 of every 10 high school students (10.0%) reported that they had used electronic cigarettes in the past 30 days.6

Cigarettes

  • In 2023, about 1 of every 100 middle school students (1.1%) reported that they had smoked cigarettes in the past 30 days.6
  • In 2023, nearly 2 of every 100 high school students (1.9%) reported that they had smoked cigarettes in the past 30 days.6

Cigars

  • In 2023, nearly 1 of every 100 middle school students (1.1%) reported that they had smoked cigars in the past 30 days.6
  • In 2023, nearly 2 of every 100 high school students (1.8%) reported that they had smoked cigars in the past 30 days.6

Smokeless tobacco

  • In 2023, nearly 1 of every 100 middle school students (0.7%) reported that they had had used smokeless tobacco in the past 30 days.6
  • In 2023, nearly 2 of every 100 high school students (1.5%) reported that they had had used smokeless tobacco in the past 30 days.6

Hookah

  • In 2023, less than 1 of every 100 middle school students (1.0%) reported that they had smoked hookah in the past 30 days.6
  • In 2023, about 1 of every 100 high school students (1.1%) reported that they had smoked hookah in the past 30 days.6

Heated tobacco products

  • In 2023, less than 1 of every 100 middle school students (0.8%) and about 1 of every 100 high school students (1.0%) reported using heated tobacco products in the past 30 days.6
  • Heated tobacco products, also known as "heat-not-burn" products, deliver nicotine to the user by heating tobacco leaves rather than a nicotine-containing liquid like e-cigarettes.

Nicotine pouches

  • In 2023, about 1 of every 100 high school students (1.7%) reported using nicotine pouches in the past 30 days.6
  • Nicotine pouches are microfiber pouches with flavored nicotine powder that users dissolve in the mouth without spitting. Sales of nicotine pouches have increased rapidly in the U.S.7

All tobacco product use

  • In 2023, more than 6 of every 100 middle school students (6.6%) and about 1 of every 8 high school students (12.6%) reported current use of a tobacco product.6
  • In 2023, nearly 15 of every 100 middle school students (14.7%) and nearly 28 of every 100 high school students (27.9%) said they had ever tried a tobacco product.6

Many young people use multiple tobacco products.

  • In 2023, more than 2 of every 100 middle school students (2.5%) and about 1 of every 30 high school students (3.9%) reported current use of multiple tobacco products in the past 30 days.6
  • In 2023, about 6 of every 100 middle school students (6.1%) and more than 12 of every 100 high school students (12.7%) reported they had ever tried multiple tobacco products.6

Fact‎

Youth who use multiple tobacco products are at higher risk for developing nicotine dependence and might be more likely to continue using tobacco into adulthood.12

Current Tobacco Product Use* Among High School Students in 20236

Tobacco Product Overall Girls Boys
Any tobacco product† 12.6% 14.1% 11.2%
Electronic cigarettes 10.0% 12.2% 8.0%
Cigarettes 1.9% 1.5% 2.3%
Cigars 1.8% 1.4% 2.3%
Smokeless tobacco 1.5% — 2.1%
Hookah 1.1% 1.4% 0.9%
Nicotine Pouches 1.7% — 2.6%
Heated tobacco products 1.0% 0.7% 1.4%
Pipe tobacco 0.6% 0.5% 0.7%

Notes:

*"Current use" is determined by respondents indicating that they have used a tobacco product on at least 1 day during the past 30 days.

†In 2023, any tobacco product included e-cigarettes, cigarettes, cigars, smokeless tobacco (composite), pipe tobacco, bidis (small brown cigarettes wrapped in a leaf), hookahs, heated tobacco products, nicotine pouches, and other oral nicotine products.

Current Tobacco Product Use* Among Middle School Students in 20236

Tobacco Product Overall Girls Boys
Any tobacco product† 6.6% 7.5% 5.7%
Electronic cigarettes 4.6% 5.6% 3.5%
Cigarettes 1.1% 1.1% —
Cigars 1.1% 1.2% 1.0%
Smokeless tobacco 0.7% 0.6% —
Hookah 1.0% — 0.8%
Nicotine Pouches — — —
Heated tobacco products 0.8% 0.8% —
Pipe tobacco 0.4% — —

Factors associated with youth tobacco product use

Factors associated with youth tobacco product use include the following:

  • Social and physical environments289
    • The way mass media show tobacco product use as a normal activity can make young people want to try these products.
    • Youth are more likely to use tobacco products if they see people their age using these products.
    • High school athletes are more likely to use smokeless tobacco than those of the same age who are not athletes.9
    • Young people may be more likely to use tobacco products if a parent uses these products.
  • Biological and genetic factors128
    • There is evidence that youth may be sensitive to nicotine and that teens can feel dependent on nicotine sooner than adults.
    • Genetic factors may make quitting smoking harder for young people.
    • Smoking during pregnancy may increase the likelihood that the child will smoke cigarettes regularly in the future.
  • Mental health: There is a strong relationship between youth smoking and depression, anxiety, and stress.2
  • Personal views: When young people expect positive things from smoking, such as coping with stress better or losing weight, they are more likely to smoke.28
  • Other influences that affect youth tobacco use include:28
    • Lower socioeconomic status, including lower income or education
    • Not knowing how to say "no" to tobacco product use
    • Lack of support or involvement from parents
    • Accessibility, availability, and price of tobacco products
    • Doing poorly in school
    • Low self-image or self-esteem
    • Seeing tobacco product advertising in stores, on television, the Internet, in movies, or in magazines and newspapers
Group of high school students.
Youth are more likely to use tobacco products if they see people their age using these products.

Reducing youth tobacco product use

National, state, and local program activities have been shown to reduce and prevent youth tobacco product use when implemented together.21011 These activities include:

  • Enacting higher costs for tobacco products (for example, through increased taxes)211
  • Prohibiting smoking in indoor areas of workplaces and public places211
  • Raising the minimum age of sale for tobacco products to 21 years210
  • Using TV and radio commercials, posters, and other media messages aimed at kids and teens in order to counter tobacco product ads211
  • Engaging community programs and school and college policies that encourage tobacco-free places and lifestyles210
  • Developing community programs that lower tobacco advertising, promotions, and help make tobacco products less easily available211

Some social and environmental factors are related to lower smoking levels among youth. Among these are:2

  • Being part of a religious group or tradition
  • Racial/ethnic pride and strong racial identity
  • Higher academic achievement

It is important to keep working to prevent and reduce the use of all forms of tobacco product use among youth.

Print
Content Source:
National Center for Chronic Disease Prevention and Health Promotion; Office on Smoking and Health
  1. Corey CG, Ambrose BK, Apelberg BJ, King BA. Flavored tobacco product use among middle and high school students — United States, 2014. MMWR Morb Mortal Wkly Rep 2015;64(38):1066–1070. / U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2014.
  2. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2012.
  3. Corey CG, Ambrose BK, Apelberg BJ, King BA. Flavored tobacco product use among middle and high school students — United States, 2014. MMWR Morb Mortal Wkly Rep 2015;64(38):1066–1070.
  4. Wang TW, Gentzke AS, Neff LJ, et al. Characteristics of e-cigarette use behaviors among US Youth, 2020. JAMA Netw Open. 2021;4(6):e2111336.
  5. Gentzke AS, Wang TW, Cornelius M, et al. Tobacco product use and associated factors among middle and high school students — National Youth Tobacco Survey, United States, 2021. MMWR Morb Mortal Wkly Rep. 2022; 71(No. SS-5):1–29.
  6. Birdsey J, Cornelius M, Jamal A, et al. Tobacco product use among U.S. middle and high school students — National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep. 2023; 72(44);1173–1182.
  7. Gentzke AS, Wang TW, Jamal A, et al. Tobacco product use among middle and high school students — United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(50);1881–1888.
  8. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2000.
  9. Agaku IT, Singh T, Jones SE, et al. Combustible and smokeless tobacco use among high school athletes — United States, 2001–2013. MMWR Morb Mortal Wkly Rep. 2015;64(34):935–939.
  10. Gentzke AS, Glover-Kudon R, Tynan M, Jamal A. Adults' attitudes toward raising the minimum age of sale for tobacco products to 21 years, United States, 2014-2017. Prev Med. 2020;133:106012. Epub ahead of print.
  11. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014. U.S. Dept of Health and Human Services; 2014.