The dramatic rise in electronic cigarette use among middle- and high school students in 2018 is responsible for the largest single year increase in youth tobacco usage ever recorded, reversing a decades-long downward trend in use, the CDC confirms.
Last year, around 4.9 million middle and high school students were current users of tobacco products, up by more than a million users from the previous year.
No increase in cigarette smoking or use of any tobacco product other than e-cigarettes was reported by teens from 2017 to 2018. The new analysis of 2018 data from National Youth Tobacco Surveys was published Monday by the CDC in a Vital Signs report.
In 2018, more than 1 in 4 high school students (27.1% or 4.04 million students) and 1 in 14 middle school students (7.2% or 840,000 students) were current users of any tobacco product.
For the fifth year in a row, e-cigarettes were the most commonly used tobacco product among high school students (20.8%), followed by cigarettes (8.1%), cigars (7.6%), smokeless tobacco (5.9%), hookah (4.1%), and pipe tobacco (1.1%).
"The skyrocketing growth of young people's e-cigarette use over the past year threatens to erase progress made in reducing youth tobacco use," CDC director Robert Redfield, MD, said in a press statement. "Despite this troubling trend, we know what works and we must continue to use proven strategies to protect America's youth from this preventable health risk. Youth use of any tobacco product, including e-cigarettes is unsafe."
In a Monday morning press conference, Brian King, MPH, of the CDC's Office on Smoking and Health noted that while cigarette smoking among youth did not increase in 2018, it did not decline and the popularity of e-cigarettes could be impacting youth smoking rates.
"A very important finding in today's study is that 2 in 5 high school students (reporting tobacco use) are using 2 or more tobacco products and 1 in 3 middle school students are," he said. "Irrespective of whether its middle or high school, the most common combination is e-cigarettes and cigarettes."
King noted that an emerging body of science shows that kids who use e-cigarettes are more likely to smoke conventional cigarettes in the future.
From 2017 to 2018, the frequency of tobacco product use, defined as usage 20 or more days during the past 30 days, also increased by 38.5% among current e-cigarette users in high school, suggesting that e-cigarette users are vaping more often than they have been.
FDA Center for Tobacco Product director Mitch Zeller, JD, called this one of the most disturbing statistics in the report.
"From a public health perspective we should be very concerned about what that might mean, especially with the popularity of these pod-based products with incredibly high levels of nicotine in them. That is not to say that all these kids are becoming addicted, but there is nothing good from a public health perspective that comes from more frequent use of any tobacco product."
In 2018, both FDA Commissioner Scott Gottlieb, MD, and U.S. Surgeon General Jerome Adams, MD, declared the rise in e-cigarette use among youth an "epidemic." Both singled out the huge growth in sales of the e-cigarette brand Juul - introduced to the market in 2015 - as a major contributor to rise in youth e-cigarette use.
Sales of Juul, which is a high nicotine e-cigarette with vaping liquid contained in pods resembling USB devices, increased by approximately 600% during 2016-2017 and increased even further in 2018.
The latest Vital Sign report is the first to reflect the impact of rising sales of Juul and other copycat products.
"If we look at (Juul) sales data, one of the most pronounced sales upticks was during the summer between 2017 and 2018," King said.
He noted that the National Youth Tobacco Survey is conducted in the spring, so the earlier data likely did not reflect this increase.
"If I had my crystal ball I would suspect that we surveyed the kids in 2017 and then they went home for the summer and went to camp or went on YouTube and found out about this hot new product called Juul," he said.
Among the other highlights of the Vital Signs report:
- E-cigarettes were the most commonly used tobacco product among all racial/ethnic groups in 2018, except African American high school students who more often reported using cigars.
- By sex, use of any tobacco product was higher among male high school students than females, including use of two or more tobacco products, such as e-cigarettes, cigarettes, cigars, smokeless tobacco, and pipe tobacco.
- Among high school students, 32.4% of non-Hispanic whites reported current use of any tobacco product in 2018, compared to 21.7% of Hispanics, 18.4% of non-Hispanics of other races, and 17.4% of black students.
- Among middle school students, 6.6% of non-Hispanic white students reported use of any tobacco product in 2018, compared to 9.5% of Hispanic middle school students, 6.8% of blacks, and 3.8% of non-Hispanics of other races.
The researchers declared no relevant relationships with industry related to this report.
Results from 2018, national, youth, tobacco, survey show dramatic increase
Nearly 6 of every 100 high school students (5.9) reported in 2018 that they had used smokeless tobacco in the past 30 daysa decrease from.9 in 2011. CDC, Behavioral Risk Factor Surveillance System, State Tobacco Activities Tracking and Evaluation System, 2016. Products must be under supervision of sales clerk(s) or in sight of the sales clerk. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016 accessed 2019 Feb. Tobacco Use Among Middle and High School hHS Proposes Making EHRs More Portable StudentsUnited States, 2013. Notes from the Field: Use of Electronic esketamine for Depression May Face Uphill Battle at FDA Panel Cigarettes and Any Tobacco Product Among Middle and High School StudentsUnited States. Treatment for...
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