On November 2, the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) released data from the 2023 National Youth Tobacco Survey (NYTS) on tobacco product use among U.S. youth. The findings—which were collected between March and June 2023 and were published by Birdsey et al in Morbidity and Mortality Weekly Report—showed that 10% of U.S. middle and high school students (2.8 million youth) reported current use of any tobacco product.

Among U.S. high school students, current overall tobacco product use declined during 2022 to 2023 (16.5% to 12.6%). This decline was primarily attributable to reduced e-cigarette use (14.1% to 10%), which translates to 580,000 fewer high school students who reported current use of e-cigarettes in 2023. Among high school students, declines in current use were also observed during 2022 to 2023 for cigars and overall combustible tobacco smoking—representing all-time lows.  

“It’s encouraging to see this substantial decline in e-cigarette use among high schoolers within the past year, which is a win for public health,” said Brian King, PhD, MPH, Director of the FDA’s Center for Tobacco Products. “But we can’t rest on our laurels. There’s more work to be done to build on this progress.”

Although a decrease in e-cigarette use was observed among high school students, among middle school students, there was an increase in current overall tobacco product use (4.5% to 6.6%) and multiple tobacco product use (1.5% to 2.5%). However, among middle school students overall, no significant change was observed during 2022 to 2023 for current use of any individual tobacco product type, including e-cigarettes. 

Use of E-Cigarettes Among Youth

E-cigarettes remained the most commonly used tobacco product among both high school and middle school students for the 10th year in a row. Among youth who reported current e-cigarette use, approximately one-quarter reported using e-cigarettes every day. Disposable e-cigarette products were the most common product type used by youth who reported e-cigarette use. However, the most popular brands included both disposable and cartridge-based products. Among current youth e-cigarette users, the most commonly reported brands were Elf Bar (56.7%), Esco Bars (21.6%), Vuse (20.7%), JUUL (16.5%), and Mr. Fog (13.6%). 

Among youth who reported current e-cigarette use, nearly all used flavored products (89.4%), with fruit, candy, mint, and menthol being the most commonly used flavors. For the first time in the NYTS, the 2023 questionnaire asked about use of flavors that included the word “ice” or “iced” in their name, along with other concept flavor names (ie, names that imply flavor but do not explicitly indicate any particular flavor, such as “island bash”). Accounting for these products provides a more robust picture of flavored tobacco product use among youth, with the results suggesting that flavored tobacco product use among youth might be higher than previously thought.

“The FDA remains concerned about youth tobacco product use, and we cannot and will not let our guard down on this issue,” Dr. King said. “The agency has an array of enforcement tools at our disposal, and we’re committed to using them as appropriate. We will not stand by as bad actors place profit over the health of our nation’s youth.”

Enforcement Actions

After filing 22 civil money penalty (CMPs) actions in September, the FDA is announcing a new wave of enforcement actions targeting illegal e-cigarettes with youth appeal. The agency is seeking CMPs for similar amounts against 20 additional retailers for the sale of unauthorized Elf Bar products. The FDA previously issued a warning letter to each of these 20 retailers cautioning them to stop selling unauthorized tobacco products. During follow-up inspections, the FDA observed that the retailers had not stopped selling the unauthorized products, resulting in the CMP actions. In September, the FDA announced CMP actions against more than a dozen retailers for the sale of unauthorized Elf Bar/EB Design e-cigarettes and sent hundreds more warning letters to retailers for selling the same products. 

Over the past year, the FDA has issued more than 135 warning letters to manufacturers and distributors of unauthorized e-cigarettes—including several distributors of Elf Bar. The FDA has also conducted a series of nationwide retailer inspections; issued more than 400 warning letters to retailers for the sale of unauthorized e-cigarettes; issued import alerts for the detention without physical examination of unauthorized e-cigarettes offered for entry into the U.S. marketplace; filed CMP actions for the largest amounts sought to date against manufacturers of unauthorized e-cigarettes; and filed the first injunctions against manufacturers of unauthorized e-cigarettes.