A fewer number of U.S. youths have reported current use of e-cigarettes in 2024 compared with 2023, according to new findings published by Park-Lee et al in the Morbidity and Mortality Weekly Report.
Background
E-cigarettes and nicotine pouches are two categories of tobacco products the U.S. Food and Drug Administration (FDA) and U.S. Centers for Disease Control and Prevention (CDC) are currently monitoring closely—particularly use and appeal among youths.
“Youth use of tobacco products in any form—including e-cigarettes and nicotine pouches—is unsafe,” stressed Deirdre Lawrence Kittner, PhD, MPH, Director of the Office on Smoking and Health at the CDC. "It’s essential that we remain vigilant and committed to public health efforts to ensure all youth can live healthy, tobacco-free lives,” she emphasized.
The National Youth Tobacco Survey is an annual, school-based, self-administered survey of U.S. students in middle (grades 6 to 8) and high school (grades 9 to 12).
Survey Methods and Findings
In the new National Youth Tobacco Survey, researchers asked U.S. youths to answer questions regarding their e-cigarette and nicotine pouch use between January 22 and May 22, 2024.
The researchers found that the proportion of U.S. middle school and high school students who reported current e-cigarette use within the past 30 days decreased from 7.7% (n = 2.13 million) in 2023 to 5.9% (n = 1.63 million) in 2024. The decline was largely driven by reduced e-cigarette use among high school students (1.56 million to 1.21 million), with no statistically significant change in current e-cigarette use among middle school students within the past 1 year. The researchers noted that the number of youths who reported using e-cigarettes in 2024 was approximately one-third of what it was at its peak in 2019, when over 5 million youths reported current e-cigarette use.
Among the youths who currently used e-cigarettes, 26.3% of them reported using e-cigarettes daily. The vast majority of youths who currently used e-cigarettes used flavored products (87.6%)—with fruit (62.8%), candy (33.3%), and mint (25.1%) being the three most commonly used flavors. Disposable e-cigarette products were the most common product type, but the most popular brands included both disposable and cartridge-based products. Further, among youths who currently used e-cigarettes, the most commonly reported brands were Elf Bar (36.1%), Breeze (19.9%), Mr. Fog (15.8%), Vuse (13.7%), and JUUL (12.6%).
The researchers revealed that over the past 1 year, a substantive drop occurred in youths reporting use of e-cigarette products under the Elf Bar brand: from 56.7% in 2023 to 36.1% in 2024. Elf Bar is not authorized by the FDA and has been the subject of focused compliance and enforcement actions by the agency since early 2023, including over 1,000 warning letters and 240 civil money penalties to retailers and other parties involved in the supply chain. The FDA has also issued import alerts that include products under the Elf Bar brand, placing them on the “red list,” which permits the agency to detain products without conducting a full inspection at the time of entry.
Changes in youth nicotine pouch use was not found to be statistically significant, increasing from 1.5% in 2023 to 1.8% in 2024. Among the nearly 500,000 middle school and high school students who reported current nicotine pouch use, 22.4% of them used the products daily. The most commonly reported brands among this group were Zyn (68.7%), on! (14.2%), Rogue (13.6%), Velo (10.7%), and Juice Head ZTN (9.8%). The majority of those who currently used nicotine pouches reported using flavored products (85.6%)—with mint (53.3%), fruit (22.4%), and menthol (19.3%) being the most commonly used flavors.
Conclusions
“The continued decline in e-cigarette use among our nation’s youths is a monumental public health win,” highlighted Brian King, PhD, MPH, Director of the Center for Tobacco Products at the FDA. “This progress is a testament to the relentless efforts by the FDA, CDC, and others, particularly over the past half decade. [However], we can’t rest on our laurels, as there’s still more work to do to further reduce youth e-cigarette use,” he suggested.
Preventing U.S. youths from accessing tobacco products remains a critical issue for the FDA and CDC. As students head back to school, it may be important for educators and parents to communicate with teens about the risks of tobacco product use. The FDA and CDC have free information and resources available to assist youths and other at-risk groups. The FDA provides free science-based lesson plans and materials for educators and parents to promote learning and conversations about youth tobacco product use. The FDA continues to reach approximately 90% of U.S. teens with its tobacco prevention messaging. Additionally, CDC offers resources to help protect youths from the harms of vaping and other tobacco product use.
“While it’s encouraging to see these numbers currently remaining relatively low, the bottom line is that we are concerned about any youth-appealing tobacco product,” Dr. King underscored. “Our guard is up. We are aware of the reported growing sales trends for nicotine pouches and are closely monitoring the evolving tobacco product landscape for threats to public health, particularly when it comes to [youths],” he concluded.
Disclosure: For full disclosures of the survey authors, visit cdc.gov.
