National Youth Tobacco Survey Research Articles

Socio-psychological risk factors that influence Smoking Prevalence among Youth in the United States of America

The smoking habit among youth is an active problem. In the United States, 11.1% of youths first smoked at age 10 years and below whereas 60.4% of school going children of age 16 year and more reported smoked a full cigarette. Retrospective U.S. national data on smoking prevalence indicates that daily active adult smokers started smoking before the age of 18 years.  A cross-sectional study of 116,637 youths of ages 12-34 years was conducted across US states. Data was also sourced from Centers for Disease Control and Prevention, National Youth Tobacco Survey and U.S. Department of Health and Human Services. The socio-psychosocial risk factors investigated include contemplation of suicide, use of alcohol and drugs, level of strictness of parent or guardian, peer influence, awareness about dangers of smoking and level of self-esteem. Data analysis was done by use of Statistical Software for Social Sciences Version 25.0 Software. A significance level of p of <0.05 was used. Logit model was employed to determine of association between socio-psychosocial risk factors and smoking prevalence among youth in US. The significant psychosocial risk factors that predict smoking initiation among youth in US were identified as use of alcohol and drug, peer influence, awareness influence and self-esteem. A conclusion is therefore made that use of alcohol and drug, peer influence, awareness influence and self-esteem are significant psychosocial risk factors that influence smoking initiation among the youth. There is need for periodic educational awareness programmes for youth regarding use of alcohol and drug. Educational institutions including schools, colleges and rehabilitation centers need to further emphasize in teaching and creating awareness among youth on the dangers associated with smoking. There is also need for counseling sessions in school, churches and community levels for youth who may be facing problems related with low self-esteem. The counseling sessions should gear at identifying the causative factors and devise mechanism to create self-worth among the youth. In addition, parents, guardians, religious leaders and other community members need to work in coordination to identify peer influence among youth and advise accordingly to protect many youth from falling trap to peer influence for lack of awareness.  There is also need to for correctional centers serviced by well-trained social personnel, psychologists to counsel and correct youth who are addicted to smoking. Keywords: Socio-psychological risk factors, Smoking Prevalence, Youth, USA

Patterns of cigarette, hookah and other tobacco product consumption habits among undergraduate students of the University of Sarajevo before the COVID-19 outbreak in Bosnia and Hercegovina, a cross-sectional study.

Tobacco products represent a major health risk factor and a potent way to help transmission of COVID-19. Current data regarding consumption of these products in the region are scarce. The aim of this study was to evaluate patterns of cigarette, hookah and other tobacco products consumption among undergraduate students from the University of Sarajevo before the COVID-19 outbreak in the country. This cross-sectional study based on a National Youth Tobacco Survey (NYTS) was conducted among undergraduate students from the University of Sarajevo in Bosnia and Hercegovina via an online questionnaire from 22nd to 26th of January 2020. Out of 605 students involved in the study, most of them were female (N=429, 70.9%); 363 (60.0%) were enrolled in medical sciences; 159 (26.3%) were attending the 3rd year of their curriculum; 224 (37%) were original from Canton Sarajevo and 514 (84.9%) were living in urban environment. Two hundred thirty five students out of 605 (38.8%) were current smokers and 117 (19.3%) hookah smokers. Being female (OR=0.539, 95% CI 0.368-0.790, p=0.002), in the 1st or 2nd year of study (OR=0.805, 95% CI 0.667-0.972, p=0.024) and living in a rural environment (OR=0.335, 95% CI 0.191-0.585, p<0.001) were associated with reduced risk of cigarette consumption, while older age (22+ years) (OR=1.287, 95% CI 1.122-1.476, p<0.001) increased the same risk. On the other side, being female (OR=0.595, 95% CI 0.380-0.930, p=0.023), of younger age (18-21 years) (OR=0.832, 95% CI 0.743-0.932, p=0.001) and medical science student (OR=0.567, 95% CI 0.328-0.978, p=0.041) were associated with decreased risk of consuming hookah. This study provides an insight in prevalence of smoking among students at the University of Sarajevo. More antismoking efforts are needed, especially in urban environments; and a follow-up study, to be planned in the near future, should determine whether COVID-19 pandemic (and all the modifications of lifestyles connected with it) have eventually changed tobacco consumption patterns among undergraduate students.

Re-Exploring the Early Relationship between Teenage Cigarette and E-Cigarette Use Using Price and Tax Changes

In 2016, the Surgeon General used longitudinal cohort studies to conclude that youth e-cigarette use is strongly associated with cigarette use. We re-evaluate data from the period of time before the writing of the Surgeon General report, using quasi-experimental methods, and reach the opposite conclusion. We study contemporaneous and intertemporal effects of e-cigarette and cigarette price and tax changes. Our price variation comes from 35,000 retailers participating in the Nielsen Retail Scanner data system. We match price and tax variation to survey data on current use of e-cigarettes and cigarettes for over 94,000 students between grades 6 to 12 in the National Youth Tobacco Survey (NYTS) for years 2011 to 2015. We find evidence that e-cigarettes and cigarettes are same-period economic substitutes. Coefficient estimates (while imprecisely estimated) also suggest potentially large positive effects of past e-cigarette prices on current cigarette use, indicating inter-temporal economic substitution. Our findings raise doubts about the conclusion of government-sponsored reports that e-cigarettes and cigarettes are strongly positively associated. We recommend revisiting and possibly amending this conclusion.

Assessment of oral health care practices and smokeless tobacco habit among adults in Odisha: A cross-sectional study

Background: Tobacco chewing is an ancient habit dating back to more than 2000 years. Since then, it has spread with remarkable rapidity, seeping into all sections of the society. Aim: The study was carried out to compare the oral health care practices among the tobacco chewers and nonchewers and to record the tobacco chewing habit among the tobacco chewers of Khordha city, Odisha. Materials and Methods: A cross-sectional descriptive study was conducted from March 2015 to August 2015, among 25–64 years old patients attending the dental out-patient department of Gopabandhu Khordha District Headquarter Hospital. The study sample of 512 subjects (256 tobacco chewers and 256 nonchewers), who were age and sex matched, were then interviewed regarding their oral hygiene practices and tobacco chewing habit using a closed-ended questionnaire, derived from the National Youth Tobacco Survey Questionnaire, 2012 and the WHO Oral Health Questionnaire for Adults, 2013. Data obtained were analyzed using Chi-square test. The significance level was set at P ≤ 0.05. Results: All the study subjects had people at home who had the habit of chewing some or the other form of tobacco. Most (73.4%) of the tobacco chewers felt that tobacco chewing probably makes young people look cool or fit in their peer group. Furthermore, 72.2% never saw a warning label on a smokeless tobacco product and 95.3% never had family or friends talk to them about not using any type of tobacco product. However, 87.1% were willing to quit this habit if proper guidance was provided. Conclusion: Tobacco chewing is a socially and culturally acceptable habit in Khordha city, Odisha. Awareness about the harmful effects of tobacco chewing among the users was very low, emphasizing the need to educate and promote awareness about smokeless tobacco products.

Factors Affecting E-Smoking Behavior in Public Health Students of University Muhammadiyah Kalimantan Timur

Background The trend of using electronic cigarettes (vapor) has developed rapidly among teenagers in the United States, and the largest increase occurred in the United States and Canada in 2018. The increased use of electronic cigarettes occurred from 2011 to 2015 while the decreased use occurred in 2016 and 2017. However, in 2018, the National Youth Tobacco Survey identified the increased use of vapor among adolescents; a 30-day trial of e-cigarette use increased by 20.8% among adolescents, especially students. The results of a survey conducted 2.5% using e-cigarettes. Objectives This study aims to investigate factors that influence the electric smoking behavior of public health students. Methods This study employed quantitative research with a cross-sectional approach to determine the relationship of behavioral factors to e-smoking. This study involved 214 samples selected using simple random sampling. Results Factors that influence smoking behavior are knowledge with a p-value of 0.000 and attitude with a p-value of 0.000. Moreover, this study has found that modern women use e-cigarettes because they consider that it does not violate any rule. Conclusions Factors that influence smoking behavior are knowledge, attitude. Influential factors are knowledge and attitudes so it is necessary to prevent the use of e-cigarettes with health education, regulations

Smoking Behavior Among Secondary School Students - China, 2021.

What is already known about this topic?In 2019, China CDC conducted the National Youth Tobacco Survey among secondary school students, and the prevalence rates of ever, current, and frequent smoking were 17.9%, 5.9%, and 1.8%, respectively.What is added by this report?The prevalence rate of cigarette use in males decreased largely from 2019 to 2021 in China, while it increased in 18 provincial-level administrative divisions (PLADs) for females. The tobacco control situation remains challenging among vocational senior high school (VSHS) students. Significant geographical disparities existed in cigarette use.What are the implications for public health practice?Targeted tobacco control policies aimed at VSHS students are needed, specifically those PLADs with higher smoking rates. Additionally, close attention should be paid to female smokers.

National Trends of Adolescent Exposure to Tobacco Advertisements: 2012-2020.

The objective of the current study is to evaluate the temporal trends in the prevalence of cigarette and electronic cigarette (e-cigarette) advertisement exposure by venue and sociodemographic correlates among US adolescents from 2012 to 2020. We conducted a serial cross-sectional analysis of nationally representative samples of middle and high school youth from the 2012-2020 National Youth Tobacco Survey. Advertisement exposure was defined as self-report of seeing advertisements "sometimes," "most of the time," and "always." The prevalence of cigarette (and other tobacco products) and e-cigarette advertisement exposure, including overall and at specific venues (Internet, press, screen, and retail stores), was estimated by survey year. A total of 139 795 adolescents aged 11 to 19 years old were included in the analysis. The prevalence of exposure to combustible cigarette marketing remained high across all years (any venue ranging from 77.0% [2018] to 91.1% [2014]). An increasing trend for cigarette advertisement exposure was observed from 2017 to 2020 after a drop in 2015 (β2012-2015 = 2.8, P for trend < .001; β2017-2020 = .7, P for trend = .03), driven by retail store-based and Internet-based exposure. A similar increasing pattern in the estimated prevalence of e-cigarette marketing was observed (β2014-2016 = 4.6, P for trend < .001; β2017-2020 = 5.1, P for trend < .001). Given the high estimated prevalence of cigarette and e-cigarette marketing exposure among US adolescents, further regulation efforts for both off-line and online tobacco marketing are needed to mitigate adolescent exposure to content regarding these products, reducing susceptibility to uptake.

Exposure to tobacco and e-cigarette advertisements by sexual identity status among high school students

IntroductionThe literature on tobacco advertising among sexual minorities is relatively scarce. This study examined the association between exposure to tobacco products and e-cigarettes advertisements and sexual identity. MethodsData were from the 2020 National Youth Tobacco Survey (n = 7223). The prevalence of exposure to tobacco marketing through various channels was estimated among high school students and by sexual identity subgroups. Multivariable logistic regressions were used to examine the association between sexual identity status and exposure to tobacco and e-cigarette advertisements. ResultsThe proportion of sexual minority adolescents who reported exposure to tobacco and e-cigarette advertisements was higher than heterosexuals. In multivariable analysis, gay or lesbian youth (aOR 1.45, 95% CI, 1.04–2.02) had higher odds of any exposure to tobacco and e-cigarette advertisement than heterosexuals. Regarding the channel of advertisement exposure, sexual minorities were more likely to be exposed via newspapers/magazines for cigarettes or other tobacco products. Likewise, gay or lesbian youth and those not sure about their sexual identity had higher odds of exposure via newspapers/magazines for e-cigarettes. Analysis stratified by sex showed significant differences, with gay or lesbian males more likely to be exposed to any tobacco and e-cigarette advertisements via the internet, newspapers/magazines, and TV/streaming services. Males not sure about their sexual identity are more likely to be exposed to tobacco and e-cigarette advertisements via newspapers/magazines. ConclusionsOverall, sexual minority adolescents had high exposure to tobacco products and e-cigarette advertisements, especially males. Prevention and intervention efforts targeting this population could help reduce the well-established tobacco use disparities.

Re-exploring the early relationship between teenage cigarette and e-cigarette use using price and tax changes.

In 2016, the Surgeon General used longitudinal cohort studies to conclude that youth e-cigarette use is strongly associated with cigarette use. We re-evaluate data from the period of time before the writing of the Surgeon General report, using quasi-experimental methods, and reach the opposite conclusion. We study contemporaneous and intertemporal effects of e-cigarette and cigarette price and tax changes. Our price variation comes from 35,000 retailers participating in the Nielsen Retail Scanner data system. We match price and tax variation to survey data on current use of e-cigarettes and cigarettes for over 94,000 students between grades 6 and 12 in the National Youth Tobacco Survey (NYTS) for years 2011-2015. We find evidence that e-cigarettes and cigarettes are same-period economic substitutes. Coefficient estimates (while imprecisely estimated) also suggest potentially large positive effects of past e-cigarette prices on current cigarette use, indicating intertemporal economic substitution. Our findings raise doubts about the conclusion of government-sponsored reports that e-cigarettes and cigarettes are strongly positively associated. We recommend revisiting and possibly amending this conclusion.

Changing pattern of smoking behavior among Mongolian adolescents: Results from the GYTS (2003-2019)

Abstract Background Tobacco use has become a global health concern. Most part of smokers initiate smoking during their adolescence. This study aims to analyze the changing pattern of cigarette smoking among adolescents in Mongolia. Methods The retrospective data analysis is based on four repeated national cross-sectional Global Youth Tobacco Surveys (GYTS) conducted in 2003, 2007, 2014 and 2019. Data were collected by self-administered questionnaires. The sample represented the students aged 12-16 years. Pearson's chi-squared tests and logistic regression analyses were performed by using IBM SPSS version 24 software. Results Altogether, 17,458 students participated in the four surveys. There was an overall decrease in the prevalence of ever smokers (40.4% in 2003, 21.2% in 2019; p &amp;lt; 0.001), current smokers (9.2% in 2003, 4.4% in 2019), and planning of cessation (84.0% in 2003, 62.9% in 2019; p &amp;lt; 0.001). Smoking related knowledge has been changed, e.g., the prevalence of students who thought smoking helps people feel more comfortable decreased from 28.3% to 7.2%. From the point of the media effects the percentage of students who saw anti-tobacco message in the media significantly decreased (from 84.0% to 62.9%, p &amp;lt; 0.001). Additionally, the percentage of participants who were exposed to tobacco smoke at home decreased from 64.1% to 42.6% (p &amp;lt; 0.001) between 2003 and 2019. The multivariate logistic regression analyses by years showed that males, those who were exposed by smoke at home, who thought that smoking makes people more comfortable were more likely to be current smokers; no association was found with anti-tobacco messages. Conclusions Despite of the implementation of tobacco control policies, smoking is a major problem in the Mongolian population. The findings of GYTSs provide information to the development of an adolescent specific national tobacco control program, which will help to combat the tobacco epidemic. Key messages A positive trend of smoking behavior among adolescents has been demonstrated in Mongolia. The findings help to develop a comprehensive adolescent specific school-based tobacco control program.

Notes from the Field: E-Cigarette Use Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021.

Notes from the Field: E-Cigarette Use Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021.

Use frequency and symptoms of nicotine dependence among adolescent E-cigarette users: Comparison of JUUL and Non-JUUL users

ObjectiveNicotine exposure among adolescent e-cigarette users remains a public health concern. JUUL, a popular e-cigarette brand among youth, is particularly alarming given the high nicotine delivery (59 mg/mL). This study compares e-cigarette use frequency and symptoms of nicotine dependence among adolescent JUUL and non-JUUL users. MethodsWe analyzed data from the 2020 National Youth Tobacco Survey. Participants were n = 1713 U.S. middle and high school students who reported past 30-day e-cigarette use. We compared adolescent e-cigarette users who reported JUUL use to those who did not. Outcomes were: (1) symptoms of nicotine dependence (i.e. nicotine cravings; use within 30 min of waking); (2) past 30-day e-cigarette use frequency, categorized as 1–5 days, 6–19 days, and 20–30 days. Covariates were sex, race/ethnicity, other tobacco product use, primary e-cigarette device type (i.e., disposable; pod; mod/tank). ResultsOverall, 49.5% of adolescent e-cigarette users reported using JUUL in the past 30 days, 40.1% reported symptoms of nicotine dependence, and 36.2% reported using an e-cigarette on 20–30 days. JUUL users were 1.77 (95% CI: 1.36–2.31) times as likely to report symptoms of nicotine dependence and 1.43 (95% CI: 1.02–2.01) time as likely to report using e-cigarettes on 20–30 days, compared to 1–5 days, relative to non-JUUL users, controlling for covariates. ConclusionJUUL use was associated with greater odds of nicotine dependence and more frequent e-cigarette use among adolescents. Greater prevention and regulatory efforts should be made to prevent adolescent use of high dose nicotine devices such as JUUL.

Racial Disparities of E-Cigarette Use Among US Youths: 2014‒2019.

Objectives To evaluate disparities in youth e-cigarette use patterns and flavor use by race/ethnicity over time. Methods We used data from the US 2014-2019 National Youth Tobacco Survey (NYTS) to examine trends in dual use (co-use of e-cigarettes and cigarettes or other tobacco products), occasional (≤ 5 days) versus frequent use (≥ 20 days) in the past 30 days, and flavor use among current (past-30-day) e-cigarette users (n = 13 178) across racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, Hispanics/Latinos, and non-Hispanic others). Results Among current e-cigarette users, dual use and occasional use decreased significantly from 2014 to 2019 across racial and ethnic groups except for non-Hispanic Blacks; frequent use and flavored e-cigarette use increased among non-Hispanic Whites, Hispanics/Latinos, and non-Hispanic others but not among non-Hispanic Blacks. In 2019, non-Hispanic Black e-cigarette users were more likely to report dual use (adjusted odds ratio [AOR] = 2.2; 95% confidence interval [CI] = 1.5, 3.2; P < .001) and occasional use of e-cigarettes (AOR = 3.7; 95% CI = 2.3, 5.9; P < .001) but less likely to report frequent use (AOR = 0.2; 95% CI = 0.1, 0.4; P < .001) and flavored e-cigarette use (AOR = 0.4; 95% CI = 0.3, 0.5; P < .001) than their White peers. Conclusions Youth e-cigarette use patterns differed considerably across racial/ethnic groups, and tailored strategies to address disparities in e-cigarette use are needed. (Am J Public Health. 2021;111(11):2050-2058. https://doi.org/10.2105/AJPH.2021.306448).

Characteristics of Past 30–Day Cigar Smoking, U.S. Adolescents, 2020

Data from the 2019 National Youth Tobacco Survey indicated that cigars were the most commonly used combustible tobacco product in the past 30 days among youth. This study uses 2020 National Youth Tobacco Survey data to report the prevalence estimates and characteristics of current cigar use, overall and by cigar type, among middle- and high-school students in the U.S. Weighted prevalence estimates and 95% CIs were calculated in 2020 for overall cigar use and by cigar type. In 2020, current cigar smoking was reported by 3.5% of students (1.5% middle school and 5.0% high school). Cigarillos (44.1%) were the most reported cigar type smoked, followed by regular (33.1%) and little (22.6%) cigars; 21.8% did not know the cigar type. Most cigar smokers were in high school (81.2%) and were male (52.4%), and 42.3% were non-Hispanic White. More than half of cigar smokers reported smoking flavored cigars (58.3%), with fruit (61.5%), candy/desserts/other sweets (34.0%), and mint (30.4%) as the most frequently reported flavor categories. Approximately 1 in 5 current cigar smokers (18.4%) smoked on ≥20 days in the past 30 days, and 78.8% reported multiple tobacco product use. Cigar smoking was highest among non-Hispanic Black and Hispanic youth. More than half of youth cigar smokers reported using flavored cigars, and most were also currently using other tobacco products. Cigarillos were the most reported cigar type used by youth, followed by regular cigars. These findings highlight the continued importance of youth tobacco use reduction strategies and can inform policy development.

Prevalence and Factors Associated With Youth Vaping Cessation Intention and Quit Attempts.

This study sought to examine the prevalence and factors associated with youth vaping cessation behaviors. Current (past 30-day) electronic-cigarette (e-cigarette) users from the 2020 National Youth Tobacco Survey (n = 1660, typically aged 11-18 years) were analyzed to examine the prevalence of youth intention to quit vaping, past-year quit attempts, and the frequency of quit attempts. Multivariable logistic or linear regressions were performed to assess the correlates with youth vaping cessation behaviors. In 2020, 53.4% of current e-cigarette users reported intention to quit vaping and 67.4% reported having tried to quit vaping. Intention to quit was lower among female individuals (versus male individuals, adjusted odds ratio [aOR] = 0.7, P = .0004), users of a modifiable system (versus disposable e-cigarettes, aOR = 0.4, P = .0204), and dual or poly users (versus sole e-cigarette use, aOR = 0.7, P = .0144). e-cigarette harm perception was positively associated with intention to quit (aOR = 2.2, P < .0001) and past-year quit attempts (aOR = 1.6, P = .0037). Reasons for e-cigarette use were related to cessation behaviors. Adolescents who vaped because of curiosity had higher odds of past-year quit attempts (aOR = 1.4, P = .0306), whereas users to disguise vaping had a lower likelihood of intention to quit (aOR=0.4, P < .0001) and past-year quit attempts (aOR = 0.7, P = .0126). The average number of past-year quit attempts was 5.3, and it was lower among female individuals (versus male individuals), users of e-cigarettes with prefilled pods or cartridges (versus disposable e-cigarettes), and those with nicotine cravings (versus no nicotine craving). Intention to quit vaping and past-year quit attempts are prevalent among US adolescent e-cigarette users. The study findings inform the development of multifaceted vaping cessation programs to take sex, e-cigarette devices, vaping reasons and patterns, harm perception, and nicotine dependence into account.

Tobacco Craving, Nicotine Dependence, and Quit Intentions among LGB and Non-LGB High School Students: A Quasi-Experimental Analysis.

There is evidence of higher tobacco use among lesbian or gay and bisexual (LGB) populations. However, a limited number of studies have examined whether there are differences in potential indicators of future tobacco cessation behaviors between LGB and non-LGB populations. This study examined whether sexual identity is associated with craving, nicotine dependence, and quit intentions among high school students. Data were drawn from the 2020 National Youth Tobacco Survey (n = 1642). A propensity score matching (PSM) technique was used to address covariate imbalance among sexual identity groups. Additionally, subgroup analyses were performed for both males and females. The PSM results showed higher odds of craving among students who were gay or lesbian (aOR, 1.70; 95% CI = 1.13–2.55) and bisexual (aOR, 1.89; 95% CI = 1.23–2.92) compared to heterosexual (straight) students. In the sex-based subgroup analyses, we found that gay or lesbian (aOR, 1.92; 95% CI = 1.10–3.34) and bisexual (aOR, 3.12; 95% CI, 1.46–6.66) male students had significantly higher odds of craving when compared to heterosexual/straight male adolescents. However, the association was not significant in female students. Additionally, female bisexuals had significantly lower odds for quit intention (aOR, 0.48; 95% CI = 0.29–0.81) when compared to heterosexual/straight female adolescents. Results also showed no significant differences between LGB and non-LGB students for nicotine dependence. Sexual minority adolescents, especially male adolescents, were more likely to have tobacco cravings and bisexual females had lower odds of quit intention than heterosexual peers. Prevention efforts targeting this subpopulation may be beneficial.

Trends in Nicotine Product Use Among US Adolescents, 1999-2020

With increasing e-cigarette use among US adolescents and decreasing use of other tobacco products, it is unclear how total use of nicotine products, and its long-term health risks, have changed. The Centers for Disease Control and Prevention's standard measure-any tobacco product use in the past 30 days-considers neither frequency of use nor product risk implications. To investigate how nicotine product use, including frequency of use, and its associated risks have changed among middle school and high school students since 1999. This cross-sectional study used data from the 1999-2020 National Youth Tobacco Survey, an in-school survey of a nationally representative sample of students in grades 6 through 12; each survey recruited between 15 000 and 36 000 participants. Nicotine product use in the past 30 days. Use of nicotine products assessed by nicotine product days (NPDs), the number of days that the average student consumed these products in the past 30 days. Risk-adjusted NPDs account for differential long-term health risks of various products. This study included 16 years of cross-sectional survey data. Each survey recruited between 15 000 and 36 000 participants in grades 6 through 12 (male students: mean, 50.4% [minimum, 48.5%; maximum, 58.4%]; mean age, 14.5 years [minimum, 14.0 years; maximum, 14.7 years]). Nationally representative cross-sectional data for high school students showed that NPDs decreased steadily from 5.6 days per month in 1999 (95% CI, 5.0-6.2 days per month) to 2.2 days per month in 2017 (95% CI, 1.9-2.6 days per month), increased to 4.6 days per month in 2019 (95% CI, 4.1-5.1 days per month), and then decreased to 3.6 days per month in 2020 (95% CI, 3.0-4.1 days per month). For a risk weight of 0.1 for e-cigarettes, compared with combustible products, risk-adjusted NPDs decreased from 2.5 days per month in 2013 (95% CI, 2.2-2.9 days per month) (prior to the popularity of e-cigarettes) to 2.0 days per month in 2019 (95% CI, 1.6-2.5 days per month) and 1.4 days per month in 2020 (95% CI, 1.0-1.8 days per month). However, with a risk weight of 1.0 for e-cigarettes (identical to that of combustible products), risk-adjusted NPDs increased to 5.3 days per month in 2019 (95% CI, 4.4-6.2 days per month) and 3.9 days per month in 2020 (95% CI, 3.1-4.7 days per month). Similar trends were found for middle school students. This study suggests that NPDs represent an improvement, albeit an imperfect one, compared with any 30-day tobacco product use by incorporating the frequency of use of various products. By distinguishing products, NPDs permit consideration of the health consequences associated with different mixes of products over time. Health risks of adolescent nicotine product use could have decreased during vaping's popularity if assessment of the long-term risks associated with vaping compared with those of smoking is low. There is a need to closely monitor youth nicotine and tobacco product use patterns.

Tobacco Cessation Behaviors Among U.S. Middle and High School Students, 2020

PurposeThe landscape of youth tobacco product use has changed dramatically in recent years; however, little is known about current youth cessation behaviors. This study aims to assess prevalence and correlates of quit intentions and past-year quit attempts among U.S. middle and high school students who report current use of any tobacco product, cigarettes, and e-cigarettes. MethodsData came from the 2020 National Youth Tobacco Survey, a nationally representative cross-sectional school-based survey of students in grades 6–12. Weighed prevalence estimates of quit intentions and past-year quit attempts among users of any tobacco product, cigarettes, and e-cigarettes are presented. Multivariable-adjusted logistic regression with predictive marginals was used to assess sociodemographic correlates of quit intentions and quit attempts for each tobacco product user group. ResultsQuit intentions were reported by 62.5% of current users of any tobacco product, 68.1% of cigarette smokers, and 63.9% of e-cigarette users. Similarly, past-year quit attempts were reported by 65.4% of current users of any tobacco product, 65.8% of cigarettes smokers, and 67.4% for e-cigarette users. Harm perceptions toward tobacco, nicotine dependency, and the use of ≥2 tobacco products were significantly correlated with quit intentions, quit attempts, or both among different tobacco product user groups. ConclusionsMost students who use tobacco products want to quit and have attempted to do so. Development of youth-focused cessation interventions, particularly those addressing the most commonly used products, could potentially accelerate progress in a comprehensive approach to youth tobacco prevention and control.

Has increased youth e-cigarette use in the USA, between 2014 and 2020, changed conventional smoking behaviors, future intentions to smoke and perceived smoking harms?

IntroductionAn increase in electronic cigarette (EC) use among US youth has raised concerns that their use may increase conventional cigarette smoking. MethodsRepeated cross-sectional data from two large nationally representative samples of US youth were drawn from the National Youth Tobacco Survey (NYTS) and Monitoring the Future (MTF). Students from grade 6–12 of the NYTS (N = 98,454–132,003) and students from grade 12 of the MTF (N = 17,870–30,981) were included in the analyses. Trends in smoking behavior, intention to smoke in the future and perceived smoking harms among youth who do and do not use ECs were estimated from 2014 to 2020 using weighted multinomial logistic regression and predicted marginal probabilities. ResultsThe prevalence for regular smoking decreased among youth who regularly use ECs. For example, among regular EC users, smoking prevalence decreased from 27.8% to 6.7% (−21%; 99.67% CI:[−32.3%, −9.9%]) in the NYTS between 2014 and 2020 and from 31.8% to 10.6% (−21.2%, 99.67% CI:[−35.0%, −7.3%]) in the MTF between 2014 and 2018. Intent to smoke in the future and perceiving smoking as harmless decreased or remained unchanged during the same period. For example, among regular EC users, there was no significant change in intention to smoke next year in the NYTS between 2014 and 2018; intention to smoke in the next 5 years decreased significantly from 30.7% to 11.2% (−19.5%, 99.67% CI:[−37.7%, −1.3%]) in the MTF. ConclusionsIn two national samples of US youth, smoking prevalence declined by a sizeable relative percentage. Intent to smoke in the future and harm perceptions of smoking declined or remained unchanged while EC use increased. Results provide little evidence that EC use has increased conventional cigarette smoking among youth.

Alternative Tobacco Product Use and Smoking Quit Attempts Among Teenagers in the United States: A Cross-Sectional Study.

BackgroundPublic health interventions have heightened awareness of risk factors and ill effects of tobacco use. Though sales of conventional tobacco products have been steadily declining, there is the advent of a new generation of alternative tobacco products marketed with claims of reduced harms and smoking cessation aids. These products are increasing in prevalence and popularity among adolescents.AimThe aim of this study is to assess the prevalence of tobacco quit attempts in adolescents in the United States and examine its relationship to the use and self-reported awareness of two alternative tobacco products: e-cigarettes and heated tobacco products (HTPs).MethodsThis is a cross-sectional analysis of data (2,271) from the 2019 National Youth Tobacco Survey (NYTS) of middle and high school students in the United States. Logistic regression analysis was employed to determine the odds of tobacco quit attempts adjusting for age, race, gender, school type, and household tobacco exposure.ResultsThe overall prevalence of tobacco quit attempts among e-cigarette users and HTP users was 52.50% and 5.20%, respectively. Results of multivariate regression analyses identified age (OR=0.74, 95% CI:0.57-0.96), race (OR=1.41, 95% CI:1.14-1.75), and household tobacco smoke exposure (OR=1.19, 95% CI:1.01-1.39) as the main factors that are significantly associated with tobacco quit attempts adjusting for all other covariates.ConclusionThis study did not show a statistically significant association between the awareness and use of e-cigarettes, and heated tobacco products and tobacco smoking quit attempts. Race, age, and exposure to household tobacco smoking were positively associated with quit attempts. Further studies are needed to clarify whether the use and awareness of e-cigarettes and HTPs are associated with tobacco smoking quit attempts within the US adolescent population.