Tobacco Product Use and Associated Factors Among Middle and High School Students — United States, 2019
Authors: Teresa W. Wang, Andrea S. Gentzke, MeLisa R. Creamer, Karen A. Cullen, Enver Holder-Hayes, Michael D. Sawdey, Gabriella M. Anic, David B. Portnoy, Sean Hu, David M. Homa, Ahmed Jamal, Linda J. Neff
Journal: MMWR Surveillance Summaries (2019)

Problem/Condition: Tobacco use is the leading cause of preventable disease, disability, and death in the United States.Most tobacco product use begins during adolescence.In recent years, tobacco products have evolved to include various smoked, smokeless, and electronic products.Period Covered: 2019. Description of System:The National Youth Tobacco Survey (NYTS) is an annual, cross-sectional, school-based, self-administered survey of U.S. middle school (grades 6-8) and high school (grades 9-12) students.A three-stage cluster sampling procedure is used to generate a nationally representative sample of U.S. students attending public and private schools.NYTS is the only nationally representative survey of U.S. middle and high school students that focuses exclusively on tobacco product use patterns and associated factors.NYTS is designed to provide national data on tobacco product use and has been conducted periodically during 1999-2009 and annually since 2011.Data from NYTS are used to support the design, implementation, and evaluation of comprehensive tobacco use prevention and control programs and to inform tobacco regulatory activities.Since its inception in 1999 through 2018, NYTS had been conducted via paper and pencil questionnaires.In 2019, NYTS for the first time was administered in schools using electronic data collection methods.CDC's Office on Smoking and Health, in collaboration with the U.S. Food and Drug Administration's (FDA's) Center for Tobacco Products, analyzed data from the 2019 NYTS to assess tobacco product use patterns and associated factors among U.S. middle and high school students.Overall, 19,018 questionnaires were completed and weighted to represent approximately 27.0 million students.On the basis of self-reported grade level, this included 8,837 middle school questionnaires (11.9 million students) and 10,097 high school questionnaires (15.0 million students); 84 questionnaires with missing information on grade level were excluded from school-level analyses. Results:In 2019, an estimated 53.3% of high school students (8.0 million) and 24.3% of middle school students (2.9 million) reported having ever tried a tobacco product.Current (past 30-day) use of a tobacco product (i.e., electronic cigarettes [e-cigarettes], cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, and bidis [small brown cigarettes wrapped in a leaf ]) was reported by 31.2% of high school students (4.7 million) and 12.5% of middle school students (1.5 million).E-cigarettes were the most commonly cited tobacco product currently used by 27.5% of high school students (4.1 million) and 10.5% of middle school students (1.2 million), followed in order by cigars, cigarettes, smokeless tobacco, hookahs, and pipe tobacco.Tobacco product use also varied by sex and race/ethnicity.Among current users of each tobacco product, the prevalence of frequent tobacco product use (on ≥20 days of the preceding 30 days) ranged from 16.8% of cigar smokers to 34.1% of smokeless tobacco product users.Among current users of each individual tobacco product, e-cigarettes were the most commonly used flavored tobacco product (68.8% of current e-cigarette users).Among students who reported ever having tried e-cigarettes, the three most commonly selected reasons for use were "I was curious about them" (55.3%), "friend or family member used them" (30.8%), and "they are available in flavors, such as mint, candy, fruit, or chocolate" (22.4%).Among never users of each individual tobacco product, curiosity and susceptibility (a construct that can help to identify future tobacco product experimentation or use) was highest for e-cigarettes (39.1% and 45.0%, respectively) and cigarettes (37.0% and 45.9%, respectively).Overall, 86.3% of students who reported contact with an assessed potential source of tobacco product advertisements or promotions (going to a convenience store, supermarket, or gas station; using the Internet; watching television or streaming services or going to the movies; or reading newspapers or magazines) reported exposure to marketing for any tobacco product; 69.3% reported exposure to e-cigarette marketing and 81.7% reported exposure to marketing for cigarettes or other tobacco products.Among all students, perceiving no harm or little