The U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) have released data from the 2023 National Youth Tobacco Survey (NYTS) that focuses on tobacco product use among U.S. youth.

The findings, which were collected between March and June 2023, show that 10% of U.S. middle and high school students reported current use of any tobacco product.

Among U.S. high school students, current overall tobacco product use declined during 2022-2023 (16.5% to 12.6%). This decline was primarily attributable to reduced e-cigarette use (14.1% to 10%), which translates to 580,000 fewer high school students who reported current use of e-cigarettes in 2023. Among high school students, declines in current use were also observed during 2022-2023 for cigars and overall combustible tobacco smoking, representing all-time lows.

“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,” said Brian King, director of the FDA’s Center for Tobacco Products. “But we can’t rest on our laurels. There’s more work to be done to build on this progress.”

Although a decrease in e-cigarette use was observed among high school students, among middle school students there was an increase in current overall tobacco product use (4.5% to 6.6%) and multiple tobacco product use (1.5% to 2.5%). However, among middle school students overall, no significant change was observed during 2022-2023 for current use of any individual tobacco product type, including e-cigarettes.

E-cigarettes remained the most commonly used tobacco product among both high school and middle school students for the 10th year in a row. Among youth who reported current e-cigarette use, approximately one-quarter reported using e-cigarettes every day. Disposable e-cigarette products were the most common product type used by youth who reported e-cigarette use. However, the most popular brands included both disposable and cartridge-based products.

Among youth who reported current e-cigarette use, nearly all used flavored products (89.4%), with fruit, candy, mint and menthol being the most commonly used flavors. For the first time in NYTS, the 2023 questionnaire asked about use of flavors that included the word “ice” or “iced” in their name, along with other concept flavor names (i.e., names that imply flavor but do not explicitly indicate any particular flavor, such as “island bash”). Accounting for these products provides a more robust picture of flavored tobacco product use among youth, with the results suggesting that flavored tobacco product use among youth might be higher than previously thought.

“The FDA remains concerned about youth tobacco product use, and we cannot and will not let our guard down on this issue,” King said. “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.”

After filing 22 civil money penalty (CMPs) actions in September for the largest amounts sought to date, the FDA announced a new wave of enforcement actions targeting illegal e-cigarettes with alleged youth appeal.

The agency is seeking CMPs for similar amounts against 20 additional retailers for the sale of unauthorized Elf Bar products, the most popular brand among youth according to the 2023 NYTS. The FDA previously issued a warning letter to each of these 20 retailers cautioning them to stop selling unauthorized tobacco products.

Reynolds’ Response

Reynolds released a statement responding to the 2023 NYTS.

“While we look forward to reviewing the underlying data from the National Youth Tobacco Survey that has yet to be released, we are encouraged by the continuous decline in overall youth tobacco use, which is down 11.5% from 2022; and are similarly encouraged that overall cigarette use among youth continues to decline and is at all-time historic lows,” said a Reynolds spokesperson. “We are likewise encouraged to see the dramatic decline in overall youth e-cigarette use, which is down over 18% from 2022, and that among youth who reported using e-cigarettes in the past 30 days, any use of Vuse is down over 12% from 2022.”

The company stated that this is good news, and that it agrees with Dr. King that more work needs to be done.

“Future progress requires regulators — especially FDA — to seriously address the influx of irresponsibly marketed, illegal flavored disposable vapor products. These products account for the vast majority of youth use and are flagrantly sold in youth-appealing flavors such as bubble gum and cotton candy,” the statement continued. “Even worse, FDA has already designated the two most popular brands identified among youth — Elf Bar and Esco Bars — as illegal, yet they remain widely available on the market. This is unacceptable. We call on FDA, in conjunction with state and local authorities, to strongly enforce against these and other illegal disposable products.”

The statement concluded with the following point: “We do not want our products in the hands of youth. Period.”