FDA, CDC: E-Cigarette Use Among Youth Continues to Plummet

According to data from the 2024 National Youth Tobacco Survey (NYTS), half a million fewer US youth are currently using e-cigarettes compared to 2023. This decline accounts for one-third of peak usage reported in 2019, when over 5 million youth reported current e-cigarette use, the FDA said in a release.¹

The nationally representative data appeared in a Morbidity and Mortality Weekly Report from the CDC and includes findings on e-cigarette and nicotine pouch use among US youth. These are 2 tobacco products that the FDA and CDC are closely monitoring due to their popularity among the demographic.

“The continued decline in e-cigarette use among our nation’s youth is a monumental public health win,” said Brian King, PhD, MPH, director of the FDA’s Center for Tobacco Products, in the same release.¹ “This progress is a testament to the relentless efforts by the FDA, CDC, and others, particularly over the past half decade. But we can’t rest on our laurels, as there’s still more work to do to further reduce youth e-cigarette use.”

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The NYTS is an annual, school-based, self-administered survey conducted among US middle and high school students from January 22 to May 22, 2024. The questionnaire showed that the number of youths who reported current e-cigarette use decreased from 2.13 million in 2023 to 1.63 million in 2024.

The decline in e-cigarette use can be primarily attributed to high school students, with the number decreasing from 1.56 million to 1.21 million in this age group. Middle school students did not show a significant change in e-cigarette use during the past year.

Among current e-cigarette users, 26.3% reported daily use. The majority (87.6%) used flavored products, with fruit (62.8%), candy (33.3%), and mint (25.1%) being the most popular.

Disposable e-cigarettes were the most common device, but the most popular brands included both disposable and cartridge-based products. These were Elf Bar (36.1%), Breeze (19.9%), Mr. Fog (15.8%), Vuse (13.7%), and JUUL (12.6%).

The FDA noted that Elf Bar, despite being the most reported e-cigarette brand, has seen a significant decline in popularity, dropping from 56.7% in 2023 to 36.1% in 2024. This decline coincides with increased regulatory scrutiny from the agency, which has issued over 1000 warning letters and 240 civil money penalties to retailers and others in the supply chain since early 2023.¹ The FDA has also issued import alerts targeting Elf Bar products, placing them on the “red list” and allowing for immediate detention without full inspection.

Data from the NYTS further showed that nicotine pouch use among youth remained relatively stable, with a slight increase from 1.5% in 2023 to 1.8% in 2024. Among current nicotine pouch users, 22.4% used them daily. Zyn was the most popular brand (68.7%), followed by on! (14.2%), Rogue (13.6%), Velo (10.7%), and Juice Head ZTN (9.8%). The majority (85.6%) used flavored products, with mint (53.3%), fruit (22.4%), and menthol (19.3%) being the most common.

“Youth use of tobacco products in any form—including e-cigarettes and nicotine pouches—is unsafe,” said Deirdre Lawrence Kittner, PhD, MPH, director of CDC’s Office on Smoking and Health, in the release.¹ “It’s essential that we remain vigilant and committed to public health efforts to ensure all youth can live healthy, tobacco-free lives.”

The FDA and CDC have ramped up efforts to curb youth tobacco use in recent years. Campaigns such as The Real Cost educate young people on tobacco-related harms while also criticizing marketing tactics such as attractive flavors, influencer or celebrity endorsements, and bright packaging used by e-cigarette companies to appeal to the demographic.² According to a 2019 study published in the American Journal of Preventive Medicine, the campaign is estimated to have prevented between 380,000 and 587,000 young people aged 11 to 19 from initiating smoking nationwide.³

In addition to ongoing initiatives such as The Real Cost, late this summer the FDA announced a final rule that will raise the minimum age for certain restrictions on tobacco product sales.⁴ This aligns with a federal law passed in 2019 that increased the minimum age for purchasing tobacco products in the US from 18 to 21 years old.

Effective September 30, retailers will be required to verify the age of anyone under 30 purchasing tobacco products, including e-cigarettes, using photo identification. This age limit has been increased from age 27.

Further, beginning September 30, retailers may not sell tobacco products through vending machines in any facility where individuals under 21 are present or allowed to enter.

These new regulations are expected to further reduce underage tobacco use.

“While it’s encouraging to see these numbers currently remaining relatively low, the bottom line is that we are concerned about any youth-appealing tobacco product,” continued King.¹ “Our guard is up. We are aware of the reported growing sales trends for nicotine pouches and are closely monitoring the evolving tobacco product landscape for threats to public health, particularly when it comes to kids.”

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References

1. Youth e-cigarette use drops to lowest level in a decade. News release. FDA. September 5, 2024. Accessed September 23, 2024. https://www.fda.gov/news-events/press-announcements/youth-e-cigarette-use-drops-lowest-level-decade?utm_medium=email&utm_source=govdelivery

2. Smith MJ, Hilton S. Youth's exposure to and engagement with e-cigarette marketing on social media: a UK focus group study. BMJ Open. 2023;13(8):e071270. doi:10.1136/bmjopen-2022-071270

3. Duke JC, MacMonegle AJ, Nonnemaker JM, et al. Impact of The Real Cost media campaign on youth smoking initiation. Am J Prev Med. 2019;57(5):645-651. doi:10.1016/j.amepre.2019.06.011

4. FDA issues final rule increasing the minimum age for certain restrictions on tobacco sales. News release. FDA. August 29, 2024. Accessed September 23, 2024.