Survey: 2.8 Million Middle, High School Students Use Tobacco Products, Usage Declining


More individuals who used e-cigarettes have reported pulmonary diseases compared with those who never smoked, including asthma.

The FDA and CDC have released results from the 2023 National Youth Tobacco Survey, demonstrating that approximately 2.8 million middle and high school students in the United States reported the current use of any tobacco product.1

Young woman outdoor vaping e-cigarette on modern city buildings background | Image Credit: leszekglasner -

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However, for high school students, there was a decline in overall tobacco products from 2022 to 2023, with 16.5% and 12.6%, respectively.1 The results showed that this was attributed to a reduction in e-cigarette use from 14.1% to 10% in 2022 and 2023, respectively. The authors stated that this was equal to approximately 580,000 fewer high school students using e-cigarettes in 2023.1 Furthermore, there was a decline in current use for cigars and overall combustible tobacco smoking during 2022 to 2023, according to the statement, representing all-time lows in tobacco usage.1

“It’s encouraging to see this substantial decline in e-cigarette use among high schoolers within the past year, which is a win for public health,” Brian King, PhD, MPH, director of the FDA’s Center for Tobacco Products, said in the statement. “But we can’t rest on our laurels. There’s more work to be done to build on this progress.”1

In a 2021 study published in Tobacco Induced Diseases, investigators found that more individuals who used e-cigarettes reported having pulmonary diseases compared with those who never smoked. Further, 9.8% of those who smoked e-cigarettes were diagnosed with asthma compared to 7.2% who never smoked. The proportion of individuals with chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome was also greater for those who smoked e-cigarettes, at 2.1% and 1.5% compared to 1.3% and 0.7%, respectively.3

In the survey, investigators also reported that middle school students had an increase in overall tobacco product usage in 2022 to 2023 at 4.5% and 6.6% as well as multiple tobacco product use at 1.5% to 2.5%, respectively.1 However, the study authors reported that among middle school students overall, there was no significant change for the current use of individual tobacco product type from 2022 to 2023.

E-cigarettes are still the most common tobacco product for both high school and middle school students, with disposable e-cigarette products being the most common type among those who use e-cigarettes. The most common reported brands were Elf Bar at 56.7%, Esco Bars at 21.6%, Vuse at 20.7%, JUUL at 16.5%, and Mr. Fog at 13.6%, according to the survey.1

“The FDA remains concerned about youth tobacco product use, and we cannot and will not let our guard down on this issue,” King said in the statement. “The agency has an array of enforcement tools at our disposal, and we’re committed to using them as appropriate. We will not stand by as bad actors place profit over the health of our nation’s youth.”1


  1. National Survey Shows Drop in E-Cigarette Use Among High School Students. News release. US Food and Drug Administration. November 2, 2023. Accessed November 7, 2023.
  2. Birdsey J, Cornelius M, Jamal A, Park-Lee E, 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. doi:10.15585/mmwr.mm7244a1
  3. Bircan E, Bezirhan U, Porter A, Fagan P, Orloff MS. Electronic cigarette use and its association with asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome among never cigarette smokers. Tob Induc Dis. 2021;19:23. doi:10.18332/tid/132833
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