Flavored Tobacco Product Use Among Middle and High School Students—United States, 2014

October 2, 2015 / Vol. 64 / No. 38

MMWR Introduction

Recent analyses of retail sales data suggest that US consumption of non-cigarette flavored tobacco products—including flavored cigars and flavored e-cigarettes—have increased in recent years. There is growing concern that marketed varieties of new and existing flavored tobacco products may appeal to middle and high school students and could contribute to recent increases in the use of tobacco products—including e-cigarette and hookah—among 6th- through 12th-grade students. CDC and the Food and Drug Administration (FDA) analyzed data from the 2014 National Youth Tobacco Survey (NYTS) to determine the prevalence of past 30-day flavored e-cigarette, hookah, cigar, pipe tobacco, or smokeless tobacco product use and menthol cigarette smoking. This includes the proportion of past 30-day tobacco users that have used flavored products among US middle and high school students. An estimated 69.4% of all past 30-day youth tobacco users had used at least 1 flavored tobacco product in the past 30 days. Among past 30-day users of each respective product, 63.3% (1.58 million had used a flavored e-cigarette, 60.6% (1.02 million) had used a flavored hookah, and 63.5% (910,000) had used a flavored cigar. Given the large burden of flavored tobacco product use among young people, it is critical for comprehensive tobacco control and prevention strategies to address all forms of tobacco use—including flavored tobacco products—among US adolescents.

Among all past 30-day tobacco users, the prevalence of flavored product use is generally higher among high school students than middle school students; however, past 30-day use by gender was similar. Among current cigarette smokers, a greater proportion of non-Hispanic blacks reported menthol cigarette use (70.5%) than non-Hispanic whites (51.4%) and Hispanics (52.3%). However, among past 30-day users of other tobacco products, non-Hispanic blacks generally had lower prevalence of flavored product use than non-Hispanic whites. Past 30-day use of at least 1 flavored product was reported by 17.9% of all high school students, whereas 5.8% reported using only non-flavored tobacco products. E-cigarettes (8.8%) were the most commonly used flavored tobacco product among high school students, followed by hookah (6.0%), cigars (5.3%), menthol cigarettes (5.0%), smokeless tobacco (4.1%), and tobacco in pipes (0.7%).

Sustained efforts to carry out proven tobacco control policies and strategies are necessary to prevent all forms of tobacco use—including flavored tobacco products—among US 6th- through 12th-grade students. For example, several local jurisdictions, including New York City, New York; Chicago, Illinois; Providence, Rhode Island; and Santa Clara, California, have carried out flavored tobacco product bans intended to limit or restrict sales of flavored tobacco products in these communities. Additional strategies that may reduce youth tobacco use include raising the minimum age of purchase for all tobacco products to 21 years of age, increasing the price of tobacco products, adopting comprehensive smoke-free laws, and implementing national public education media campaigns.