A2.1-1

Appendix 2.1

Sources of Data

Overview A2.1-2

Youth Surveys A2.1-2

National Youth Tobacco Survey A2.1-2

Monitoring the Future Survey A2.1-2

Young Adult and Adult Surveys A2.1-3

National Adult Tobacco Survey A2.1-3

Styles (Also Known as HealthStyles) A2.1-3

Youth, Young Adult, and Adult Surveys A2.1-3

Population Assessment of Tobacco and Health Study A2.1-3

References A2.1-6

List of Tables

Table A2.1-1 Sources of national data on e-cigarette use among youth and young adults A2.1-4
A Report of the Surgeon General

A2.1-2 Appendix 2.1

Overview

Basic methodologic information on national datasets that assess e-cigarette use among youth and young 

adults is presented in Table A2.1-1. The surveys included 

in the table typically assess awareness, ever use, and past30-day use of e-cigarettes. The Population Assessment

of Tobacco and Health (PATH) study assesses the type of

e-cigarette used (e.g., open system vs. closed system),

but the National Youth Tobacco Survey (NYTS), National

Adult Tobacco Survey (NATS), Styles survey (also known

as HealthStyles and Summer Styles), and Monitoring the

Future (MTF) do not. Estimates from these five surveys

are nationally representative and are useful for examining trends across time and co-use with other tobacco

products.

Some of the surveys, however, include an insufficient 

sample of adolescents, young adults, and racial/ethnic 

minorities or other groups of special interest within these 

age categories to allow for more granular analyses that are 

valid and reliable. Further, the youth surveys (NYTS and 

MTF) are school-based and, therefore, exclude youth not 

in school (e.g., dropouts and those missing the survey on 

days of administration). As a result, they may not generalize to the entire population of youth.

Chapter 2 employs cross-sectional data from the 

2011–2015 NYTS, the 2014 and 2015 MTF, the 2013–2014 

NATS, and the 2010–2014 Styles survey. Because the surveys are cross-sectional, temporality and directionality of 

associations cannot be inferred. Unfortunately, data from 

the PATH study were not yet available for inclusion in this 

chapter at the time of its preparation. The longitudinal 

nature of the PATH study will be valuable in the future, as 

the study of e-cigarette use in these populations continues.

Youth Surveys

National Youth Tobacco Survey

The NYTS, which has been administered by the 

Centers for Disease Control and Prevention (CDC) in collaboration with the U.S. Food and Drug Administration 

(FDA) since 2011, provides data on tobacco use among 

youth in order to understand the effect of tobacco control 

interventions and policies. The NYTS is a school-based, selfadministered, paper-and-pencil survey of U.S. middle and 

high school students that examines tobacco use broadly, as 

it includes the use of cigarettes, smokeless tobacco, snus, 

cigars, hookahs, pipes, bidis, and kreteks (beginning in 

2014, kreteks were deleted from the survey). NYTS data have 

been collected periodically since 1999; e-cigarette measures 

were added in 2011. An item to assess the perceived harm 

of e-cigarettes relative to cigarettes was added in 2012, 

while a question on absolute harm was added in 2014. Of 

255 schools selected for the 2015 NYTS, 185 (72.6%) participated, with a sample of 17,711 (87.4%) among 20,259 eligible students; the overall response rate was 63.4%. The 

present report uses data from the 2011–2015 NYTS surveys. 

For additional information on methods used in NYTS surveys conducted prior to 2013–2014, see http://www.cdc.gov/

tobacco/data_statistics/surveys/nyts/.

Monitoring the Future Survey

Administered by the University of Michigan’s 

Institute for Social Research and funded by the National 

Institute on Drug Abuse (NIDA), the purpose of the MTF 

survey is to monitor changes in attitudes, beliefs, and 

behaviors among U.S. adolescents in grades 8, 10, and 12. 

The survey is a school-based, self-administered, paperand-pencil questionnaire with cross-sectional and longitudinal components; an item on e-cigarettes was added in 

2014. The survey assesses the use of cigarettes, smokeless 

tobacco, cigars (large cigars and little cigars/cigarillos), 

and hookahs; questions on e-cigarettes were added in 2014. 

The present report uses data from the 2014 and 2015 MTF 

surveys. More information on methods employed in MTF 

surveys can be found in Bachman and colleagues (2014).
Sources of Data A2.1-3

E-Cigarette Use Among Youth and Young Adults

Young Adult and Adult Surveys

National Adult Tobacco Survey

Administered since 2012 by CDC in collaboration 

with FDA, the purpose of the NATS is to assess the prevalence of tobacco use among U.S. adults and examine the 

factors that promote and protect against tobacco use. The 

NATS is a landline and cell phone survey of noninstitutionalized adults 18 years of age or older residing in the 

50 U.S. states or the District of Columbia. Data on the use 

of cigarettes, smokeless tobacco, cigars (large cigars, cigarillos, and filtered cigars), hookahs, and pipes were collected in 2009–2010 and 2013–2014; measures to assess 

e-cigarette use were added in 2012. For additional information on methods used in NATS surveys conducted 

prior to 2012–2014, see http://www.cdc.gov/tobacco/

data_statistics/surveys/nats/.

Styles (Also Known as 

HealthStyles)

The Styles survey, a series of national consumer 

panel surveys of U.S. adults 18 years of age and older, has 

been administered in seasonal waves since 1995. This 

survey is sponsored by CDC and administered by Porter 

Novelli, a multinational public relations firm. Formally 

known as the “Summer Styles” survey, although often 

commonly referred to as HealthStyles, it reaches more 

than 4,000 adults during the summer to examine their 

beliefs and behaviors regarding a variety of health topics. 

The Styles survey assesses sociodemographic characteristics related to tobacco use (cigarettes, smokeless tobacco, 

snus, cigars, and hookahs); e-cigarette measures were 

added in 2009. Styles transitioned to an online-only methodology in 2011; thus, both mail (August–September) and 

web (July–August) versions of Styles were fielded in 2010. 

Only the web version was fielded in 2011 (July–August), 

2012 (June–July), and 2013 (June–July). The present 

report uses data from the 2010–2014 Styles surveys.

Youth, Young Adult, and Adult Surveys

Population Assessment of Tobacco 

and Health Study

The PATH study is sponsored by FDA’s Center for 

Tobacco Products (CTP) and administered by NIDA. The 

purpose of this large, nationally representative, longitudinal survey of tobacco-related knowledge, attitudes, 

beliefs, behaviors and use, and health outcomes among 

U.S. adolescents (12–17 years of age) and adults is to yield 

comprehensive data that can be used to inform CTP’s regulatory activities as well as educate the interested public. 

For adults, biomarkers of exposure are collected as well 

to inform our knowledge of tobacco-related disease processes. Approximately 46,000 persons were included in 

the first wave of the PATH study, which was conducted 

in 2013–2014; follow-up data collection for this initial 

wave and for subsequent waves is ongoing. The in-person, 

computer-assisted interviews include extensive questions 

on cigarettes, e-cigarettes, cigars (traditional large cigars, 

cigarillos, and filtered cigars), pipe tobacco, smokeless 

tobacco, snus, dissolvable tobacco, hookahs, bidis (youth 

only), and kreteks (youth only). Adult participants are also 

asked to contribute buccal cells, urine, and/or blood samples. Original analyses using the PATH study data were 

not available for inclusion in this chapter at the time of 

its preparation, but Table A2.1-1 in this appendix and 

Table  A2.2-2 in Appendix 2.2 include information about 

the PATH study and e-cigarette items on this survey for 

comparison with other national surveys. The survey’s longitudinal design will contribute to the state of the science 

in critical ways. Studies that have appeared in the literature using these data are highlighted where appropriate 

(e.g., Ambrose et al. 2015).
A Report of the Surgeon General

A2.1-4 Appendix 2.1

Table A2.1-1 Sources of national data on e-cigarette use among youth and young adults

NYTS MTF NATS Styles PATH NHIS YRBSS

Sponsoring 

agency or 

organization

Centers for Disease 

Control and 

Prevention and 

Food and Drug 

Administration 

since 2011

National Institute 

on Drug Abuse, 

administered by 

the University 

of Michigan’s 

Institute for Social 

Research

Centers for Disease 

Control and 

Prevention and 

Food and Drug 

Administration since 

2012

Centers for 

Disease Control 

and Prevention, in 

partnership with 

Hollywood, Health 

& Society

Food and Drug 

Administration and 

National Institutes 

of Health

Centers for 

Disease Control 

and Prevention, 

National Center for 

Health Statistics

Centers for 

Disease Control 

and Prevention, 

Division of 

Adolescent and 

School Health

Type of survey Cross-sectional Cross-sectional 

and longitudinal

Cross-sectional Cross-sectional Cross-sectional 

and longitudinal

Cross-sectional Cross-sectional

Years 1999, 2000, 2002, 

2004, 2006, 2009, 

2011–2015

1975–2015 2009–2010, 2012–

2013, 2013–2014

1995–2014 2013–2015 1957–2014 1991–2015

Year e-cigarette 

measures added

2011 2014 2012–2013 2009 2013–2014 2014 2014–2015

Mode of survey 

administration

School-based, 

self-administered 

questionnaire

School-based, 

self-administered 

questionnaire; 

follow-up survey 

by mail

Landline and cell 

phone survey

Postal mail 

surveys/web-based 

surveys

In-person 

interview; 

subsample 

biospecimen 

collection in adults 

only

In-person 

interview

School-based, 

self-administered 

questionnaire 

Response rate 2015: 72.6% for 

schools; 87.4% for 

students; 63.4% 

overall

• 2014: 90% of 8th 

graders; 88% of 

10th graders; 

82% of 12th 

graders

• 2015: 89% of 

8th graders; 

87% of 10th 

graders; 83% of 

12th graders

• 2012–2013: 44.9%

• 2013–2014: 36.1%

• 2013: 66.1%

• 2014: 69%a

Not available 2014: 73.8% for 

households 

2014–2015: 

69% for schools; 

86% for students; 

60% overall
E-Cigarette Use Among Youth and Young Adults

Sources of Data A2.1-5

NYTS MTF NATS Styles PATH NHIS YRBSS

Ages/grades 6th–12th grades 8th and 10th 

graders (since 

1991) and 

12th graders (since 

1975); college 

students; young 

adults

Noninstitutionalized 

adults ≥18 years 

of age residing in 

the 50 states or 

Washington, DC

Adults ≥18 years 

of age

Youth 12–17 years 

of age and adults 

≥18 years of age

Adults, 

18 years of age 

and older, living in 

households across 

the United States

All regular 

publicb and 

privatec schools 

with students in 

at least one of 

grades 9–12 in 

the 50 states and 

the District of 

Columbia

Sample size 2015: 17,711 

students; 

185 schools

• 2014: 41,551 

students; 

377 schools

• 2015: 44,892 

students; 

382 schools

• 2012–2013: 60,192

• 2013–2014: 75,233

• 2013: 4,033

• 2014: 4,269

~46,000 

adolescents and 

adults

36,697 adults 15,624 students

Type of tobacco 

examined (most 

current survey 

available)

Cigarettes, 

smokeless tobacco, 

snus, cigars, 

e-cigarettes, 

hookah, pipes, 

bidis, kreteks 

(kreteks deleted on 

2014 survey)

Cigarettes, 

smokeless tobacco, 

large cigars, little 

cigars or cigarillos, 

e-cigarettes, 

hookah

Cigarettes, 

smokeless tobacco, 

large cigars, 

cigarillos, filtered 

cigars, e-cigarettes, 

hookah, pipes

Cigarettes, 

smokeless tobacco, 

snus, cigars, 

e-cigarettes, 

hookah 

Cigarettes, 

e-cigarettes, 

traditional 

cigars, cigarillos, 

filtered cigars, 

pipe tobacco, 

smokeless tobacco, 

snus, dissolvable 

tobacco, waterpipe 

tobacco, bidis 

(youth only), 

kreteks (youth 

only)

Cigarettes, 

smokeless tobacco, 

large cigars, 

cigarillos, filtered 

cigars, e-cigarettes, 

hookah, pipes

Cigarettes, 

smokeless tobacco, 

cigars, e-cigarettes 

Notes: MTF = Monitoring the Future; NATS = National Adult Tobacco Survey; NHIS = National Health Interview Survey; NYTS = National Youth Tobacco Survey;

PATH = Population Assessment of Tobacco and Health Study; YRBSS = Youth Risk Behavior Surveillance System.

a The Styles survey considers its response rate to be the proportion of those who responded to the survey divided by those who were contacted. This does not fit the 

American Association for Opinion Research (2008) definition of response rate, which considers the number of complete interviews with reporting units divided by the number 

of eligible reporting units in the sample.

b Might include charter schools and public alternative, special education, or vocational schools.

c Might include religious and other private schools, but does not include private alternative, special education, or vocational schools.

Table A2.1-1 Continued
A Report of the Surgeon General

A2.1-6 Appendix 2.1

References

Ambrose BK, Day HR, Rostron B, Conway KP, Borek N, 

Hyland A, Villanti AC. Flavored tobacco product use 

among U.S. youth aged 12–17 years, 2013–2014. JAMA: 

the Journal of the American Medical Association

2015;314(17):1871–3.

American Association for Public Opinion Research.

Standard Definitions: Final Dispositions of Case Codes 

and Outcome Rates for Surveys. 5th ed. Lenexa (KS): 

American Association for Public Opinion Research, 2008.

Bachman JG, Johnston LD, O’Maley PM. Monitoring the 

Future: Questionnaire Responses from the Nation’s 

High School Seniors, 2012. Ann Arbor (MI): University 

of Michigan, 2014; <http://monitoringthefuture.org/

datavolumes/2012/2012dv.pdf>.