Youth are Using Fewer Cigarette and Smokeless Tobacco Products in Recent Decades

Cigarette end
Cigarette end
Use of e-cigarettes increased among adolescents between 2011 and 2019. However, whether these changes are affecting patterns of use of other tobacco products, especially cigarettes, remains unclear.

A cross-sectional study published in JAMA Network Open found that adolescents were using fewer cigarette and smokeless tobacco products since the late 1990’s.

Data from the Monitoring the Future (MTF) survey was used for this analysis. Students were asked how frequently they used tobacco products during the previous 30 days between 1991 and 2019.

During the past 3 decades, the MTF has surveyed 487,335 8th graders, 447,310 10th graders, and 424,236 12th graders. A total of 215,147 students reported smoking, in which 119,141 smoked daily; and 27,302 reported using smokeless tobacco (7398 daily users).

From 1991 until 1998, any smoking and daily smoking increased among both genders and all 3 grades (12th grade girls 1991-1997 annual precent change [APC], 5.2%; 95% CI, 2.8%-7.7%). After 1998, smoking began to decrease (12th grade girls 1997-2013 APC, -5.8%; 95% CI, -6.4% to -5.2%) and the decrease escalated during recent years (12th grade girls 2013-2019 APC, -15.8%; 95% CI, -19.6% to -11.8%).

The recent decrease in smoking was slightly delayed among boys (12th grade boys 2006-2012 APC, -1.6%; 95% CI, -4.6% to 1.5%) until 2013 (12th grade boys 2012-2019 APC, -17.4%; 95% CI, -19.4% to -15.4%).

No significant gender-based differences in smoking were observed and similar trends were observed across ethnicities.

Boys used more smokeless tobacco than girls. Among 10th grade boys, there was a decreased trend until 2004 (1991-2004 APC, -6.5%; 95% CI, -7.5% to -5.4%) followed by a short-term increase (2004-2012 APC, 3.1%; 95% CI, -0.8% to 7.1%) and a more recent and sharp decline in use (2012-2019 APC, -11.6%; 95% CI, -15.7% to -7.4%).

This study was limited by the self-reporting design and some recall or response bias was likely included.

The study authors concluded that youth cigarette and smokeless tobacco use has been declining over the past few decades. This decline has accelerated since the introduction of electronic cigarettes. However, the authors stated that the popularity of vaping did not appear to reverse the decreased in other tobacco use.


Meza R, Jimenez-Mendoza E, Levy DT. Trends in tobacco use among adolescents by grade, sex, and race, 1991-2019. JAMA Netw Open. Published online December 3, 2021. doi:10.1001/jamanetworkopen.2020.27465