Significant Decline in E-cigarette Use Among High School Students Indicates Progress, Yet Challenges Persist in Youth Tobacco Prevention
Statement from Kathy Crosby, Truth Initiative CEO and President
The release of the 2023 National Youth Tobacco Survey (NYTS) marks a notable achievement in the fight against youth tobacco use. The data show a substantial reduction in current (past 30 day) e-cigarette use among high school students, dropping to 10.0% in 2023 versus 14.1% in 2022, the lowest point in almost a decade. As a result, current use of any tobacco product by high school students declined by an estimated 540,000 students, from 2.51 million in 2022 to 1.97 million in 2023.
However, a concerning trend has emerged among middle school students with the significant rise in the use of any tobacco product reaching 6.6% in 2023, up from 4.5% in 2022. Multiple product use among middle school students has also increased with 2.5% of students reporting using more than one tobacco product, up from 1.5% in 2022. This is a troubling finding among the youngest of participants because we know the detrimental effects of nicotine on the developing brain. With e-cigarettes remaining the most commonly used tobacco product among all youth since 2014, the survey also highlights the persistent concern of nicotine dependence. Nearly half (46.7%) of all students ever using e-cigarettes reported using them currently, indicating that many young people who try e-cigarettes remain e-cigarette users. Also deeply concerning, among all students surveyed who currently use e-cigarettes, one in four (25.2%) vape daily.
These indicators of nicotine dependence underscore the importance and critical need for Truth Initiative's free and anonymous text message program, This is Quitting, which has already assisted nearly 660,000 young individuals in their journey to quit vaping nicotine. This first-of-its kind program offers science-based support for young people seeking to break free from e-cigarette use and nicotine addiction. A randomized clinical trial published in JAMA Internal Medicine revealed that young adults aged 18-24 who utilized This is Quitting had nearly a 40% higher likelihood of quitting compared to a control group. This is Quitting, the largest quit vaping program in the country, is not only reaching youth and young adults directly, it has also forged customized partnerships with states and local communities.
The NYTS data emphasize both progress and challenges as any youth e-cigarette use remains a serious public health concern. We are encouraged by the significant decline in e-cigarette use among high school students and attribute this public health victory to the collective impact of policy and sustained youth prevention campaigns designed to change the way that youth think about and act toward tobacco use. For its part, Truth Initiative’s national truth vaping prevention campaign has demonstrated a correlation between truth campaign awareness and reduced e-cigarette use among teens and young adults. Higher awareness of the truth campaign is associated with lower odds of current e-cigarette use.
Also making an impact is Truth Initiative’s free digital curriculum, Vaping: Know the Truth, designed for middle and high school students. The curriculum provides young people with the facts about the risks of e-cigarette use and seamlessly connects them to This is Quitting for those looking to quit vaping by offering a comprehensive resource that has reached more than 860,000 students to date nationwide and is readily available to all schools.
The NYTS data further demonstrate the allure of flavors with 89.4% of youth (9 out of 10) stating their preference for flavored e-cigarettes. Disposable products remain most popular among youth with Elf Bar (56.7%), Esco Bars (21.6%), Vuse (20.7%), JUUL (16.5%), and Mr. Fog (13.6%) topping the list. These findings are consistent with data from the CDC Foundation, which identify disposable products, including Elf Bars, Breeze Smoke, Kangvape, and Esco Bars, among the top 10 brands according to sales. Truth Initiative data echo these findings noting a surge in 2022 with the introduction of 48 disposable e-cigarettes with 6% or greater nicotine strength along with 18 products boasting a 20-milliliter capacity. Products are getting stronger, cheaper and bigger without additional regulation.
We commend the Food and Drug Administration (FDA) for its public education and increased enforcement activities including warning letters, civil monetary penalties, and injunctions against companies that have violated the law. However, the agency must sustain its efforts to protect young people by removing all products without marketing authorization from the market, as the overwhelming majority of these products are flavored and appeal to youth. To date, only 23 e-cigarettes (all of which are tobacco-flavored) have received FDA marketing authorization.
As the tobacco industry continues to flood the market with illicit high-nicotine, cheap and youth-appealing flavored products at the expense of young people’s physical and mental health, retailers bear a pivotal responsibility in curbing youth e-cigarette use in their communities. We urge retailers to protect the children in their communities by taking unauthorized flavored e-cigarettes off their shelves.
The entertainment industry can also contribute to changing this picture. Tobacco products continue to receive unwarranted glorification across screens in popular culture influencing young minds. Truth Initiative's annual While You Were Streaming Report, which analyzes the most popular on-screen entertainment among 15- to 24-year-olds, reveals that in 2023, 25 million young individuals were exposed to tobacco imagery in top television shows, with an additional 25 million encountering such imagery in top box office movies. Established research underscores that smoking in movies prompts young people to initiate tobacco use, and Truth Initiative's published research indicates that exposure to tobacco imagery in episodic streaming entertainment can triple the likelihood of a young person starting to vape nicotine. Continued tobacco depictions on screen jeopardize the younger generation’s future health by putting them at risk for a lifetime of nicotine addiction.
While commendable progress has been made in reducing e-cigarette use among high school students, we have much more work to do. It’s imperative to build on this momentum and accelerate progress with programs, services, and policies we know have impact. It is incumbent upon all stakeholders to do their part. Truth Initiative remains resolute in its commitment to safeguarding the health of young people and will persist in working tirelessly alongside our partners to protect this generation and the next from the harms of tobacco.
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