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Cited by 181Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesGlobal Public Health Policies and Epidemiology

Flavored tobacco product use among middle and high school students—United States, 2014–2018

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Cullen, Karen A., Liu, Sherry T., Bernat, Jennifer K., Slavit, Wendy I., Tynan, Michael A., King, Brian A., Neff, Linda J.·2019·MMWR. Morbidity and Mortality Weekly Report
DOI 10.15585/mmwr.mm6839a2PMC PMC6776376
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Abstract

The 2009 Family Smoking Prevention and Tobacco Control Act prohibits the inclusion of characterizing flavors (e.g., candy or fruit) other than tobacco and menthol in cigarettes; however, characterizing flavors are not currently prohibited in other tobacco products at the federal level.*Flavored tobacco products can appeal to youths and young adults and influence initiation and establishment of tobacco-use patterns (1).The Food and Drug Administration (FDA) and CDC analyzed data from the 2014-2018 National Youth Tobacco Surveys (NYTS) to determine prevalence of current (past 30-day) use of flavored tobacco products, including electronic cigarettes (e-cigarettes), hookah tobacco, cigars, pipe tobacco, smokeless tobacco, bidis, and menthol cigarettes among U.S. middle school (grades 6-8) and high school (grades 9-12) students.In 2018, an estimated 3.15 million (64.1%) youth tobacco product users currently used one or more flavored tobacco products, compared with 3.26 million (70.0%) in 2014.Despite this overall decrease in use of flavored tobacco products, current use of flavored e-cigarettes increased among high school students during 2014-2018; among middle school students, current use of flavored e-cigarettes increased during 2015-2018, following a decrease during 2014-2015.During 2014-2018, current use of flavored hookah tobacco decreased among middle and high school students; current use of flavored smokeless tobacco, cigars, pipe tobacco, and menthol cigarettes decreased among high school students.Full implementation of comprehensive tobacco prevention and control strategies, coupled with regulation of tobacco products by FDA, can help prevent and reduce use of tobacco products, including flavored tobacco products, among U.S. youths (2,3).NYTS is an annual cross-sectional, school-based, selfadministered, pencil-and-paper questionnaire administered to U.S. middle and high school students.† A three-stage cluster sampling procedure was used to generate a nationally representative sample of U.S. students attending public or private schools in grades 6-12.This report uses data from five NYTS waves (2014)(2015)(2016)(2017)(2018).Sample sizes and response * Family Smoking Prevention and Tobacco Control Act [Pub.L. No. 111-31, H.R.

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  • In the United States, tobacco cigarette use has declined in recent years while e-cigarette use has increased exponentially.

    “Whereas the use of tobacco cigarettes has declined in the United States within recent years, the use of electronic cigarettes (e-cigarettes) has increased exponentially (Cullen et al., 2019; Miech et al., 2019).”

    From Unique, long-term effects of nicotine on adolescent brain. (2020) · cites this paper as Cullen et al., 2019

    The Abstract (page unavailable) reports that, among U.S. high school tobacco-product users, menthol cigarette use decreased and flavored e-cigarette use increased during 2014–2018. It does not establish a decline in cigarette use or an exponential increase in e-cigarette use across the United States generally; the reported e-cigarette increase was from 65.1% to 67.8% in that subgroup. (LLM, conf=0.88)

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  • About 5 million students in grades 6-12 used e-cigarettes within the past 30 days, up from about 3.6 million in 2018.

    “In absolute numbers, the National Youth Tobacco Survey shows that ~5 million students in grades 6–12 have tried e-cigarettes within the past 30 days, an increase from ~3.6 million in 2018 (Cullen et al., 2019).”

    From Unique, long-term effects of nicotine on adolescent brain. (2020) · cites this paper as Cullen et al., 2019

    The 2018 NYTS table (Discussion) estimates 3.64 million current e-cigarette users among middle and high school students, supporting the comparison figure. It estimates 4.92 million current users of any tobacco product—not e-cigarettes—and the paper covers data only through 2018, so it does not support the claimed increase to about 5 million e-cigarette users. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In recent years, cigarette use among teenagers has declined while nicotine vaping has increased substantially.

    “Although there has been a decline in teen use of cigarettes in recent years, there has been a huge increase in nicotine vaping.”

    From Unique, long-term effects of nicotine on adolescent brain. (2020) · cites this paper as Cullen et al., 2019

    The Abstract (page unavailable) reports decreased menthol-cigarette use and increased flavored e-cigarette use among high school tobacco-product users from 2014 to 2018. It does not establish a decline in cigarette use generally or a huge increase in nicotine vaping among teenagers; the reported high-school flavored e-cigarette measure rose from 65.1% to 67.8%, and the middle-school measure was comparable in 2014 and 2018. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The advent of electronic cigarette products has led to a resurgence of nicotine use among adolescents.

    “the advent of electronic cigarette products has led to a resurgence of nicotine use among adolescents [167, 168]”

    From Consequences of adolescent drug use (2023) · cites this paper as [167]

    The Abstract and Discussion report increased flavored e-cigarette use among U.S. high school students during 2014–2018. They do not establish a resurgence of adolescent nicotine use overall or show that the advent of e-cigarettes caused one; the paper also reports an overall decrease in flavored tobacco product use. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Nearly 1 million of these students vape daily.

    “Of these, nearly 1 million are vaping daily.”

    From Unique, long-term effects of nicotine on adolescent brain. (2020) · cites this paper as Cullen et al., 2019

    The table in the Discussion estimates 3.64 million current e-cigarette users among middle and high school students, but the paper defines current use as use on at least one day in the preceding 30 days. A search for daily or every-day vaping found no estimate of how many students vape daily, so the nearly 1 million figure cannot be verified from our copy. (LLM, conf=0.76)

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Authors
Cullen, K. A., Liu, S. T., Bernat, J. K., Slavit, W. I., Tynan, M. A., King, B. A., & Neff, L. J.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Cullen, Karen A.
ORCID
Venue
MMWR. Morbidity and Mortality Weekly Report
Publisher
Centers for Disease Control MMWR Office
Published
2019-10-04
Volume
68
Issue
39
Pages
839-844
ISSN
  • 0149-2195 (ISSN-L)
  • 1545-861X
DOI
10.15585/mmwr.mm6839a2
PMC
PMC6776376
OpenAlex
W2978784026
Cited by
181
References
14
Citations by year
2026: 3 · 2025: 8 · 2024: 10 · 2023: 12 · 2022: 17 · 2021: 23 · 2020: 22 · 2019: 26 · 2018: 17 · 2017: 24 · 2016: 18 · 2015: 1
FWCI
15.08
Type
journal article
Language
en
Open access
Locations
  • MMWR Morbidity and Mortality Weekly Report (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
Keywords
flavored tobacco products, youth tobacco use, electronic cigarettes, hookah tobacco, menthol cigarettes, cigars, pipe tobacco, smokeless tobacco, bidis, tobacco product regulation, Family Smoking Prevention and Tobacco Control Act, junior high school students, high school students, National Youth Tobacco Survey
MeSH terms
Smoking Prevention, Adolescent, Child, Female, Flavoring Agents, Health Surveys, Humans, Male, Schools, Students, Tobacco, Smokeless, United States, United States Food and Drug Administration, Prevalence, Tobacco Products, Tobacco Use, Electronic Nicotine Delivery Systems

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