Tobacco product use among middle and high school students in the United States

Abstract

INTRODUCTION: Tobacco product use persists among US youth. Continued monitoring of e-cigarettes, nicotine pouches, and other products informs clinical practice, public health policy, and regulatory efforts.

METHODS: Data from the 2025 National Youth Tobacco Survey-a nationally representative sample of 23 630 US students in grades 6-12-were analyzed to estimate current (past 30-day) use of tobacco products. Among those currently using e-cigarettes and nicotine pouches, frequent use (≥20 days), device type (for e-cigarettes only), brand preferences, and flavor preferences were assessed. Changes in current use of any tobacco, any combusted tobacco, e-cigarettes, and nicotine pouches from 2022 to 2025 were assessed using Joinpoint regression.

RESULTS: Among high school (grades 9-12) and middle school (grades 6-8) students, an estimated 2.01 million or 7.2% reported current tobacco use, 5.2% e-cigarette use, 2.6% combusted tobacco use, and 1.7% nicotine pouch use. Among students currently using e-cigarettes, 41.2% reported frequent use, and 66.3% used disposables. Among students currently using nicotine pouches, 26.3% reported frequent use. During 2022-2025, any tobacco use (annual percent change [APC] = -14.5, P < .001), any combusted tobacco use (APC = -11.4, P < .001), and e-cigarette use (APC = -18.1, P < .001) decreased among middle and high school students. Nicotine pouch use increased (APC = 17.3, P = .012) among high school students from 2022 to 2025; however, use was still low and remained stable over the past year.

CONCLUSIONS: Despite a significant decline in the prevalence of any tobacco, any combusted tobacco, and e-cigarette use between 2022 and 2025, students continued using tobacco products, particularly e-cigarettes, with considerable proportions reporting frequent use.

IMPLICATIONS: Despite significant declines in the prevalence of self-reported use of any tobacco product, combusted tobacco products, and e-cigarettes between 2022 and 2025, an estimated 2.01 million youth continued using tobacco products in 2025. In addition, among youth who currently used e-cigarettes and nicotine pouches, persistent frequent use patterns and widespread flavored product use were common. Continued timely surveillance of tobacco products, combined with comprehensive tobacco control and regulatory efforts, enforcement actions, and public education campaigns, remain essential for preventing youth tobacco product use and the harms associated with youth nicotine exposure.