Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Tobacco Use Among US Middle & HS Students

MMWR; ePub 2017 Jun 16; Jamal, Gentzke, et al

In 2016, approximately 20% of surveyed US high school students and 7% of middle school students reported current tobacco product use, with electronic cigarettes the most commonly used product in both group student groups. This according to data analyzed by the Centers for Disease and Prevention (CDC) and the Food and Drug Administration (FDA) from the 2011-2016 National Youth Tobacco Surveys (NYTS) to determine recent patterns of current use of 7 tobacco product types in US middle school and high school students. Additional findings include:

  • 47.2% of high school students and 42.4% of middle school students who used a tobacco product in the past 30 days used ≥2 tobacco products.
  • During 2015-2016, current use of electronic cigarettes decreased among middle school students and decrease in current use of any tobacco product occurred among high school students.
  • However, decreases in cigarette and cigar use during 2011-2016 were offset by increases in hookah and electronic cigarette use.
  • Electronic cigarettes remained the most commonly used tobacco product among high school (11.3%) and middle school (4.3%) students.


Jamal A, Gentzke A, Hu SS, et al. Tobacco use among middle and high school students — United States, 2011–2016. MMWR Morb Mortal Wkly Rep. 2017;66:597–603. doi:10.15585/mmwr.mm6623a1.


Tobacco use is the leading cause of preventable disease and death in the US, and most tobacco use begins during middle school and high school. Rates of youth smoking have decreased dramatically over the last 15 years, largely as a result of changing societal norms, increased taxes on cigarettes, and educational efforts. What is surprising, though, is the very large increase in use of electronic cigarettes. E-cigarette use among teens and young adults has exploded over the last 5 years, having gone from negligible in 2010 to its current level where it has eclipsed regular tobacco use as the most commonly used tobacco product.1 The use of e-cigarettes and hookahs is not benign.2 A recent Surgeon General report concluded that e-cigarettes contain harmful constituents, including nicotine. Nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain, and the report concluded they are simply unsafe.3 Tobacco use, whether smoked or by e-cigarette or by hookah, should be strongly discouraged. —Neil Skolnik, MD

  1. Krishnan-Sarin S, Morean ME, Camenga DR, Cavallo DA, Kong G. E-cigarette use among high school and middle school adolescents in Connecticut. Nicotine Tob Res. 2015;17(7):810–818. doi:10.1093/ntr/ntu243.
  2. Yıldırım F, Cevik Y, Emektar E, et al. Evaluating ECG and carboxyhemoglobin changes due to smoking narghile. [Published online ahead of print September 12, 2016]. Inhal Toxicol. doi:10.1080/08958378.2016.1224957.
  3. US Department of Health and Human Services. E-cigarette use among youth and young adults: A report of the Surgeon General—executive summary. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016. Accessed December 30, 2016.