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Youth e-cigarette use remains a serious public health concern amid the COVID-19 pandemic. Researchers from the CDC and FDA recently published a research study, Notes from the Field: E-Cigarette Use Among Middle and High School Students—National Youth Tobacco Survey, United States, 2021, where they analyzed national youth tobacco use data to assess e-cigarette use behaviors among middle and high school students.

The study used data from the 2021 National Youth Tobacco Survey (NYTS), a school-based, cross-sectional, self-administered survey of U.S. middle school (grades 6-8) and high school (grades 9-12) students. To accommodate for remote learning settings, data was collected online. The final sample used consisted of 20,413 students from 279 schools. Current e-cigarette use was assessed by frequency of use, device type, flavors and usual brand.

Main Findings

  • Over two million youth were estimated to be current e-cigarette users in 2021.
  • 11.3% of high school students (1.72 million) and 2.8% (320,000) of middle school students reported current use.
      • 43.6% of high school students and 17.2% of middle school students reported using e-cigarettes on ≥20 of the past 30 days.
      • 27.6% of current high school e-cigarette users and 8.3% current middle school e-cigarette users reported daily use.
  • Among youth e-cigarette users, the most commonly used device type was disposables, followed by prefilled or refillable pods or cartridges and tanks or mod systems.
  • Among current youth e-cigarette users overall, 84.7% used flavored e-cigarettes, including 85.8% of high school users and 79.2% of middle school users.
  • Among youth currently using flavored e-cigarettes, the most commonly used flavor types were fruit, followed by candy, desserts or other sweets, mint and menthol.

Researchers state that ongoing efforts to address youth e-cigarette use are critical. As the tobacco product landscape continues to evolve, sustained implementation of comprehensive tobacco control and prevention strategies at the national, state and local levels, coupled with FDA regulation, can reduce and prevent tobacco product initiation and use among youth.


“Notes from the Field” are abbreviated reports intended to advise CDC’s Morbidity and Mortality Weekly Report readers of ongoing or recent events of concern to the public health community, without waiting for development of a Full Report. These reports may contain early unconfirmed information, preliminary results, hypotheses regarding risk factors and exposures, and other similarly incomplete information. No definitive conclusions need be presented in Notes from the Field.