Tobacco Use Drops Among Middle and High School Students

But almost 4 million still use tobacco

closeup of a teen girl's hand holding a lit cigarette

The number of middle and high school students in the US who use tobacco dropped from 4.7 million in 2015 to 3.9 million in 2016 according to a report from the US Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration’s (FDA’s) Center for Tobacco Products. The findings come from students’ answers to questionnaires from the National Youth Tobacco Survey.

Students were counted as tobacco users if they had used a tobacco product in the past 30 days. The 7 tobacco products included in the survey were e-cigarettes, cigarettes, cigars, hookah (a water pipe used to smoke tobacco), smokeless tobacco, pipe tobacco, and bidis (small, flavored cigarettes wrapped in a leaf). The report was published June 15, 2017 in Morbidity and Mortality Weekly Report.

E-cigarettes are still most popular among youth

The decline in use of tobacco products was mostly due to a drop in e-cigarette use among youth from 3 million in 2015 to just under 2.2 million in 2016. However, e-cigarettes remained the most commonly used tobacco product among youth for the third consecutive year. In the survey, 11.3% of high school students and 4.3% of middle school students said they used e-cigarettes.

“Far too many young people are still using tobacco products, so we must continue to prioritize proven strategies to protect our youth from this preventable health risk,” said CDC Acting Director Anne Schuchat, MD.  

Other forms of tobacco

The survey also found that many students use more than one type of tobacco. In 2016, 47.2% of high school tobacco users and 42.4% of middle school tobacco users used 2 or more different types of tobacco products. Using more than one type of tobacco product was found to increase symptoms of nicotine dependence.

After e-cigarettes, the most commonly used tobacco products were:

  • Cigarettes – used by 8% of all high school students and 2.2% of all middle school students
  • Cigars – used by 7.7% of all high school students and 2.2% of all middle school students
  • Smokeless tobacco – used by 5.8% of all high school students and 2.2% of all middle school students
  • Hookah – used by 4.8% of all high school students and 2% of all middle school students
  • Pipe tobacco – used by 1.4% of all high school students and .7% of all middle school students
  • Bidis – used by .5% of all high school students and .3% of all middle school students

Youth tobacco use is risky

Tobacco use is the leading cause of preventable disease and death in the US. Nearly all tobacco use begins during youth and young adulthood. According to the CDC, nearly 9 out of 10 cigarette smokers first tried smoking by age 18, and 99% first tried smoking by age 26. And 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.

What can be done

On Aug. 8, 2016, the FDA began enforcing new federal regulations which, among other things, made it illegal to sell e-cigarettes, cigars, hookah tobacco, and pipe tobacco to anyone under 18 in person and online.

According to the report, tobacco prevention and control strategies at the national, state, and local levels likely have contributed to the reduction in use of certain tobacco products, including e-cigarettes, among youths in recent years. The report says comprehensive and sustained strategies can help prevent and reduce the use of all forms of tobacco products among American youths. They include:

  • smoke-free policies that include e-cigarettes
  • media campaigns warning about the risks of youth tobacco product use
  • increasing the price of tobacco products
  • protections from secondhand smoke and e-cigarette aerosol
  • implementing advertising and promotion restrictions
  • raising the minimum age of purchase for tobacco products to 21 years.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Tobacco Use Among Middle and High School Students—United States, 2011-2016. Published June 15, 2017 in Morbidity and Mortality Weekly Report. First author Ahmed Jamal, MBBS, Centers for Disease Control and Prevention, Atlanta, Ga.


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