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Centers for Disease Control and Prevention. (2022a, March 10). Tobacco product use and associated factors among middle and high school students - national youth tobacco survey, United States, 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/71/ss/ss7105a1.htm?s_cid=ss7105a1_w

Centers for Disease Control and Prevention. (2022b, November 10). Youth and tobacco use. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

Download Quitstart. smokefree teen. (n.d.). https://teen.smokefree.gov/become-smokefree/quitstart-app

How to keep kids and teens from smoking and vaping. www.heart.org. (2022, June 2). https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/how-to-keep-kids-and-teens-from-smoking-and-vaping

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https://www.cdc.gov/mmwr/volumes/71/ss/ss7105a1.htm?s_cid=ss7105a1_w

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Centers for Disease Control and Prevention

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Tobacco Product Use and Associated Factors Among Middle and...

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The report describes the use of tobacco products among middle school and high school students in the United States.

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Strategies that are successful in the tobacco war against our youth: 

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Strategies that are successful in the tobacco war against our youth: 

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Raising cigarette prices - Most teens and young adults are sensitive to high prices.
Restricting access - The American Heart Association advocates adopting Tobacco 21 laws nationwide, which means setting the minimum age to 21 to legally buy tobacco products.
Limiting tobacco marketing - Regulatory initiatives that ban youth-focused marketing efforts have helped curbed smoking's appeal to youth.
Providing quit smoking programs - Accessible smoking cessation programs can help young smokers quit as well as parents and caregivers who want to model healthier behaviors.

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It reduces the risks of young Americans developing tobacco-use related diseases. It reduces the number of deaths that are attributed to tobacco use. Reduces the risk of youth dying earlier. It also reduces the risk of second-hand exposure.

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How does it improve outcomes/healthy lifestyle?

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How does it improve outcomes/healthy lifestyle?

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Outcomes and lifestyle are improved with increased access to smoking cessation resources because it will decrease the number of young Americans who are smoking. It can also intercept the youth who might try a tobacco product for the first time. It reduces the number of avoidable deaths from tobacco-use.

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The quitSTART app is a free smartphone app that helps you quit smoking with tips, inspirations and challenges (Smokefree.gov, n.d.).

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The quitSTART app is a free smartphone app that helps you quit smoking with tips, inspirations and challenges (Smokefree.gov, n.d.).

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https://teen.smokefree.gov/become-smokefree/quitstart-app

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Smokefree.gov's quitSTART app uses your smoking history to give you custom tips, coaching, and challenges to help you quit smoking for good.

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- Create your own customized tips and materials, and the app can personalize content to fit your needs.
- Check progress and earn badges for smoke-free milestones.
- Get back on track if you have a slip up and smoke.
- Mark times or places that make you want to smoke so you receive encouragement when you need it most.
- Manage cravings and bad moods in healthy ways.
- Distract yourself from cravings with games and challenges.
- Store tips, inspirations, and challenges in your app to look back on later.
- Share your progress and favorite tips through social media.

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Teens and young Americans are always on their phone, so this technological intervention was incorporated as a way to provide a method for smoking cessation. The app also provides interactive continuous support throughout their cessation journey.

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Tobacco use is often started and established primarily during adolescence, so preventing tobacco use among the young is critical to ending the tobacco epidemic (CDC, 2022).

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Tobacco use is often started and established primarily during adolescence, so preventing tobacco use among the young is critical to ending the tobacco epidemic (CDC, 2022).

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Each day in the U.S., roughly 1,600 youth smoke their first cigarette and nearly 200 youth start smoking every day (CDC, 2022). 

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Each day in the U.S., roughly 1,600 youth smoke their first cigarette and nearly 200 youth start smoking every day (CDC, 2022). 

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Nearly 9 out of 10 adults who smoke cigarettes daily, first try smoking by age 18, and 99% try smoking for the first time by the age of 26 (CDC, 2022). 

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Nearly 9 out of 10 adults who smoke cigarettes daily, first try smoking by age 18, and 99% try smoking for the first time by the age of 26 (CDC, 2022). 

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Flavored tobacco makes smoking more appealing to youth, and e-cigarettes have been the most commonly used tobacco product among youth since 2014 (CDC, 2022).

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Flavored tobacco makes smoking more appealing to youth, and e-cigarettes have been the most commonly used tobacco product among youth since 2014 (CDC, 2022).

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If cigarette smoking continues at the current rate among the youth in this country, 5.6 million of today's Americans younger than 18 will die early from a smoking related illness (CDC, 2022). 

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If cigarette smoking continues at the current rate among the youth in this country, 5.6 million of today's Americans younger than 18 will die early from a smoking related illness (CDC, 2022). 

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https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

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Centers for Disease Control and Prevention

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Youth use of tobacco products in any form is unsafe.
Preventing tobacco product use among youth is critical to reducing tobacco use among the nation's youth.

Tobacco product use is started and established primarily during adolescence.1,2

Nearly 9 out of 10 adults who smoke cigarettes daily first try smoking by age 18.

Flavorings in tobacco products can make them more appealing to youth.4,5

In 2021, 80.2% of high school students and 74.6% of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product during that time.⁶

In 2023, 90.3% of high school students and 87.1% of middle school students who used e-cigarettes in the past 30 days reported using a flavored e-cigarette during that time.⁷

Electronic cigarettes (E-cigarettes)

E-cigarettes have been the most commonly used tobacco product among youth since 2014.

In 2023, about 1 out of every 22 middle school students (4.6%) reported that they had used electronic cigarettes in the past 30 days.7

In 2023, 1 of every 10 high school students (10.0%) reported that they had used electronic cigarettes in the past 30 days.⁷

Cigarettes

Cigars

Smokeless Tobacco

Hookah

Heated Tobacco Products

In 2023, less than 1 of every 100 middle school students (0.8%) and about 1 of every 100 high school students (1.0%) reported using heated tobacco products in the past 30 days.⁷

Heated tobacco products, also known as "heat-not-burn" products, deliver nicotine to the user by heating tobacco leaves rather than a nicotine-containing liquid like e-cigarettes.

Nicotine Pouches

All Tobacco Product Use

Many young people use multiple tobacco products.
Youth who use multiple tobacco products are at higher risk for developing nicotine dependence and might be more likely to continue using tobacco into adulthood. 1, 2

Tobacco Product

Overall

Girls

Boys

Any tobacco product†

12.6%

14.1%

11.2%

Notes:
* "Current use" is determined by respondents indicating that they have used a tobacco product on at least 1 day during the past 30 days.

† In 2023, any tobacco product includes e-cigarettes, cigarettes, cigars, smokeless tobacco (composite), pipe tobacco, bidis (small brown cigarettes wrapped in a leaf), hookahs, heated tobacco products, nicotine pouches, and other oral nicotine products.

Tobacco Product

Overall

Girls

Boys

Any tobacco product†

6.6%

7.5%

5.7%

Factors associated with youth tobacco product use include the following:

Social and physical environments2,10,11

The way mass media show tobacco product use as a normal activity can make young people want to try these products.

Youth are more likely to use tobacco products if they see people their age using these products.

High school athletes are more likely to use smokeless tobacco than those of the same age who are not athletes.¹¹

Young people may be more likely to use tobacco products if a parent uses these products.

Biological and genetic factors1,2,10

There is evidence that youth may be sensitive to nicotine and that teens can feel dependent on nicotine sooner than adults.

Genetic factors may make quitting smoking harder for young people.

Smoking during pregnancy may increase the likelihood that the child will smoke cigarettes regularly in the future.

Mental health: There is a strong relationship between youth smoking and depression, anxiety, and stress.²

Personal views: When young people expect positive things from smoking, such as coping with stress better or losing weight, they are more likely to smoke.2,10

Other influences that affect youth tobacco use include:2,10

Lower socioeconomic status, including lower income or education

Not knowing how to say "no" to tobacco product use

Lack of support or involvement from parents

Accessibility, availability, and price of tobacco products

Doing poorly in school

Low self-image or self-esteem

Seeing tobacco product advertising in stores, on television, the Internet, in movies, or in magazines and newspapers

National, state, and local program activities have been shown to reduce and prevent youth tobacco product use when implemented together.2,12,13 These activities include:

Higher costs for tobacco products (for example, through increased taxes)2,13

Prohibiting smoking in indoor areas of workplaces and public places2,13

Raising the minimum age of sale for tobacco products to 21 years2,12

TV and radio commercials, posters, and other media messages aimed at kids and teens in order to counter tobacco product ads2,13

Community programs and school and college policies that encourage tobacco-free places and lifestyles2,12

Community programs that lower tobacco advertising, promotions, and help make tobacco products less easily available2,13

Some social and environmental factors are related to lower smoking levels among youth. Among these are: ² It is important to keep working to prevent and reduce the use of all forms of tobacco product use among youth.

Being part of a religious group or tradition

Racial/ethnic pride and strong racial identity

Higher academic achievement

1. Flavored Tobacco Product Use Among Middle and High School Students-United States, 2014U.S. Department of Health and Human Services. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2019 Feb 28].

2. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012 [accessed 2019 Feb 28].

3. Substance Abuse and Mental Health Services Administration. 2018 National Survey on Drug Use And Health: Detailed Tables. Substance Abuse and Mental Health Data Archive [accessed 4 Dec 2019].

4. Centers for Disease Control and Prevention. Flavored Tobacco Product Use Among Middle and High School Students-United States, 2014. Morbidity and Mortality Weekly Report, 2015;64(38):1066-70 [accessed 2019 Feb 28].

5. Wang TW, Gentzke AS, Neff LJ, et al. Characteristics of e-Cigarette Use Behaviors Among US Youth, 2020. JAMA Netw Open. 2021;4(6):e2111336. doi:10.1001/jamanetworkopen.2021.11336

6. Gentzke AS, Wang TW, Cornelius M, Park-Lee E, Ren C, Sawdey MD, Cullen KA, Loretan C, Jamal A, Homa DM. Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021. Morbidity and Mortality Weekly Report, 2022; 71(No. SS-5):1-29.

7. Birdsey J, Cornelius M, Jamal A, et al. Tobacco Product Use Among U.S. Middle and High School Students - National Youth Tobacco Survey, 2023. MMWR Morb Mortal Wkly Rep 2023; 72(44);1173-1182.

8. Gentzke AS, Wang TW, Jamal A, Park-Lee E, Ren C et al. Tobacco Product Use Among Middle and High School Students, United States, 2020. Morbidity and Mortality Weekly Report 2020;69(50);1881-1888 [accessed 2020 Dec 17].

9. Marynak KL, Wang X, Borowiecki M, et al. Nicotine Pouch Unit Sales in the US, 2016-2020. JAMA. 2021;326(6):566-568. doi:10.1001/jama.2021.10366

10. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000 [accessed 2019 Feb 28].

11. Centers for Disease Control and Prevention. Combustible and Smokeless Tobacco Use Among High School Athletes-United States, 2001-2013. Morbidity and Mortality Weekly Report, 2015;64(34):935-9 [accessed 2019 Feb 28].

12. Gentzke AS, Glover-Kudon R, Tynan M, Jamal A. Adults' attitudes toward raising the minimum age of sale for tobacco products to 21 years, United States, 2014-2017. Prev Med. 2020 Feb 3;133:106012. doi: 10.1016/j.ypmed.2020.106012. Epub ahead of print. PMID: 32027916.

13. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs-2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2019 Feb 28].

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Smoking and smokeless tobacco use are almost always initiated and established during adolescence. Adolescent smokeless tobacco users are more likely than nonusers to become adult cigarette smokers.

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How does it enhance accessibility of care?

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How does it enhance accessibility of care?

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Putting emphasis on the identified strategies can intercept the youth and provide accessible resources to provide education and smoking cessation tips. Mobile apps have been created as a tool to quit smoking, and provide support and encouragement along the journey.

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I included the link for the SmokefreeUS instagram. Instagram is a social media app that is frequently used among young Americans. Following their page can offer posts that encourage cessation, where to seek help and begin a smoking cessation journey.

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NYTS is the only nationally representative survey of U.S. middle and high school students that focuses exclusively on tobacco use patterns and associated factors. NYTS provides data to support the design, implementation, and evaluation of comprehensive youth tobacco use prevention and control programs and to guide tobacco regulatory activities (CDC, 2022).