Abstract
Comprehensive surveillance of e-cigarette use behaviors among youth is important for informing strategies to address this public health epidemic. To characterize e-cigarette use behaviors among US youth in 2020. The 2020 National Youth Tobacco Survey, a nationally representative, cross-sectional, school-based survey of middle school (grades 6-8) and high school (grades 9-12) students, was conducted from January 16, 2020, to March 16, 2020. A total of 14 531 students from 180 schools participated in the 2020 survey, yielding a corresponding student-level participation rate of 87.4% and school-level participation rate of 49.9%. The overall response rate, a product of the school-level and student-level participation rates, was 43.6%. Current (past 30-day) e-cigarette use. Self-reported current e-cigarette use behaviors (frequency of use, usual e-cigarette brand, and access source) by school level and flavored e-cigarette use and flavor types among current e-cigarette users by school level and device type. Prevalence estimates were weighted to account for the complex survey design. Overall, 14 531 students completed the survey, including 7330 female students and 7133 male students with self-reported grade level and sex. In 2020, 19.6% (95% CI, 17.2%-22.2%) of high school students and 4.7% (95% CI, 3.6%-6.0%) of middle school students reported current e-cigarette use. Among them, 38.9% (95% CI, 35.2%-42.6%) of high school users and 20.0% (95% CI, 16.0%-24.8%) of middle school users reported e-cigarette use on 20 to 30 days within the past 30 days. Among current users, JUUL was the most commonly reported usual brand (high school: 25.4%; 95% CI, 18.8%-33.4%; middle school: 35.1%; 95% CI, 27.9%-43.1%). Among current users, the most common source of obtaining e-cigarettes was from a friend (high school: 57.1%; 95% CI, 52.6%-61.4%; middle school: 58.9%; 95% CI, 51.4%-66.1%). Among current users, 84.7% (95% CI, 82.2%-86.9%) of high school students and 73.9% (95% CI, 66.9%-79.8%) of middle school students reported flavored e-cigarette use. Fruit-flavored e-cigarettes were the most commonly reported flavor among current exclusive e-cigarette users of prefilled pods or cartridges (67.3%; 95% CI, 60.9%-73.0%), disposable e-cigarettes (85.8%; 95% CI, 79.8%-90.3%), and tank-based devices (82.7%; 95% CI, 68.9%-91.1%), followed by mint-flavored e-cigarettes. These results suggest that although current e-cigarette use decreased during 2019 to 2020, overall prevalence, frequent use, and flavored e-cigarette use remained high. Continued actions are warranted to prevent and reduce e-cigarette use among US youth.
Highlights
During the past decade, e-cigarette use has increased considerably among US youth; this trend was first documented during 2011 to 2012, when the prevalence of current e-cigarette use increased from 1.5% to 2.8% among high school (HS) students and 0.6% to 1.1% among middle school (MS) students.[1]
In 2020, 19.6% of high school students and 4.7% of middle school students reported current e-cigarette use
38.9% of high school users and 20.0% of middle school users reported e-cigarette use on 20 to 30 days within the past 30 days
Summary
E-cigarette use has increased considerably among US youth; this trend was first documented during 2011 to 2012, when the prevalence of current (past 30-day) e-cigarette use increased from 1.5% to 2.8% among high school (HS) students and 0.6% to 1.1% among middle school (MS) students.[1]. Multiple factors have contributed to the surge in e-cigarette use among youth, including e-cigarette advertising exposure, the availability of youth-appealing flavors, and the introduction of concealable devices with high nicotine content into the US marketplace.[9,10,11] earlier versions of e-cigarettes were disposable and resembled conventional cigarettes, these products have since diversified to include rechargeable cartridge-based e-cigarettes known as pod mods. These newer versions of e-cigarettes[12,13] typically deliver nicotine in the form of nicotine salts, instead of the free-base nicotine used in older e-cigarettes and conventional tobacco products, making it easier to inhale higher levels of nicotine with less irritation.[7,14] Youth use of e-cigarettes is a public health concern, given that nicotine is a highly addictive substance that can harm adolescent brain development and prime the brain for addiction to other drugs.[6,9,10,11]
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