Nicotine and tobacco product use among US middle and high school students, 2024-25

Based on 2024–2025 National Youth Tobacco Survey data, overall nicotine and tobacco use among US middle and high school students slightly declined, yet the landscape shifted significantly toward increased disposable e-cigarette use, frequent consumption, and dominant preferences for specific brands and flavors.

The Gist

Imagine the world of youth nicotine products as a fast-moving marketplace, like a busy food court where the menu changes every few months. This paper is a snapshot of that food court taken in 2024 and again in 2025, looking at what American middle and high school students are actually "eating" (using).

Here is the story of what happened, explained simply:

1. The Big Picture: The Crowd is Shrinking, But the Menu is Wild

The Good News: Fewer students are using any nicotine or tobacco products in 2025 compared to 2024. It's like the total number of people in the food court dropped slightly.

• The Numbers: About 8 out of 100 students used something in 2024. In 2025, that dropped to about 7 out of 100.
• The Catch: While fewer kids are showing up, the types of things they are buying are changing very fast.

2. The Main Attraction: E-Cigarettes (The "Vapes")

E-cigarettes are still the most popular item on the menu, used by about 5 out of 100 students. But the style of the device has shifted dramatically.

• The "Disposable" Trend: Think of disposable vapes as single-use plastic water bottles. They are cheap, you use them until they're empty, and then you throw them away. In 2024, about 56% of users were drinking from these "plastic bottles." By 2025, that jumped to 67%.
• The "Refillable" Decline: The older style, where you buy a reusable device and refill it (like a reusable metal water bottle), is becoming less popular.
• The Brand Shuffle: The "King of the Hill" brand changed. In 2024, Elf Bar was the superstar. By 2025, Geek Bar took the throne, becoming the most popular brand by a huge margin. It's like if a new burger chain opened up and instantly became more popular than the old favorite, even though people are still eating burgers.

3. The New Contender: Nicotine Pouches

These are small, tobacco-free pouches you put under your lip (like a mint, but with nicotine).

• Steady Popularity: About 1.7% of students use them. The number hasn't changed much, but the flavor has.
• Flavor Shift: In the past, some people used plain, tobacco-flavored pouches. Now, almost everyone is using minty or fruity flavors. It's like a coffee shop where everyone used to drink black coffee, but now 9 out of 10 people are ordering a mint-chocolate latte.
• The Big Brand: ZYN is the undisputed champion here, used by nearly 7 out of 10 pouch users.

4. The "Old School" Stuff: Cigarettes and Cigars

Traditional smoking (lighting a fire and inhaling smoke) is becoming rare.

• The Numbers: Only about 1.7% of students smoke cigarettes.
• The Trend: This is the lowest it has ever been. It's like a classic rock band that used to sell out stadiums but is now playing to a small, empty club. The "combustible" products (things you burn) are fading away.

5. Who is Changing the Most?

The study found a generational split:

• Middle Schoolers: They are the ones driving the decline. Fewer middle schoolers are starting to use these products compared to last year. It's like a new rule at a school gate is successfully keeping younger kids out.
• High Schoolers: Their usage rates stayed about the same. They aren't quitting, but they aren't starting in huge numbers either.

6. The "Flavor" Factor

Almost 90% of e-cigarette users and 88% of pouch users are using flavored products.

• The Metaphor: If nicotine products were ice cream, almost no one is eating the plain vanilla (tobacco flavor). Everyone wants Fruit Punch, Ice Cream, or Candy.
• Why it matters: Flavors are like the "cherry on top" that makes the product appealing to kids. Even though the number of users dropped slightly, the fact that almost everyone is still using flavors suggests that if flavors were banned, the market might shift again, or kids might just switch to a different brand that still has flavors.

The Bottom Line

Think of the youth nicotine market as a chameleon.

• The size of the chameleon (total number of users) is getting slightly smaller, which is good news.
• But the colors (brands, device types, and flavors) are changing rapidly.
• The "disposable" devices are taking over, and new brands are rising to fame overnight.

Why does this matter?
Public health officials are watching closely. If regulations ban one thing (like disposable vapes), the market might just shift to a different type of device or a different brand, rather than kids actually quitting. The study suggests we need to keep our eyes on the menu, because the food court is evolving faster than the rules can keep up.

Technical Summary

1. Problem Statement

While the overall prevalence of youth nicotine and tobacco use in the United States has declined since the mid-1990s, the product landscape is evolving rapidly. New product categories, specifically disposable e-cigarettes and oral nicotine pouches, have emerged, altering usage patterns, brand preferences, and flavor profiles. Existing public health surveillance must adapt to these shifts to understand whether declining overall rates mask the rise of specific high-risk products or if regulatory interventions are effectively curbing initiation. The study addresses the need for timely, product-specific data to inform regulatory policy and public health strategies.

2. Methodology

• Study Design: Repeated cross-sectional study utilizing nationally representative data from the National Youth Tobacco Survey (NYTS).
• Data Sources: Publicly available, de-identified data from the 2024 and 2025 NYTS cycles.
• Participants:
  • 2024: 29,678 students (grades 6–12; approx. ages 11–18).
  • 2025: 23,557 students.
  • Sampling: Stratified, three-stage cluster sampling of public and private schools across 50 states and the District of Columbia.
• Exposure: Survey year (2025 vs. 2024).
• Outcomes:
  • Primary: Past 30-day (current) use of 12 specific nicotine/tobacco products (e-cigarettes, nicotine pouches, cigarettes, cigars, hookah, etc.).
  • Secondary: Among current users, characteristics including frequency of use, device type (disposable vs. pod/tank), brand preferences, and flavor profiles.
• Statistical Analysis:
  • Complex survey design accounted for using primary sampling units, strata, and analytic weights.
  • Prevalence Estimates: Weighted percentages with 95% Confidence Intervals (CIs).
  • Comparisons: Design-based Wald tests for unadjusted differences; Adjusted Prevalence Ratios (aPR) with 95% CIs derived from survey-weighted modified Poisson regression (adjusting for school level, sex, and race/ethnicity).
  • Software: R version 4.5.2.

3. Key Contributions

• Latest Surveillance: Provides the first comprehensive analysis of youth nicotine use trends comparing 2024 to 2025, capturing the most recent market shifts.
• Product-Specific Granularity: Moves beyond aggregate "vaping" statistics to detail specific device types (disposable vs. pod), brands (e.g., Geek Bar, ZYN), and flavor categories.
• Market Dynamics: Documents the rapid turnover in brand dominance within the e-cigarette market and the stabilization of nicotine pouch usage, offering insights into how youth adapt to regulatory and market changes.
• Demographic Stratification: Offers distinct prevalence trends for middle school vs. high school students, highlighting age-specific efficacy of current prevention measures.

4. Key Results

A. Overall Prevalence Trends

• Any Nicotine/Tobacco Product: Declined from 8.1% in 2024 to 7.2% in 2025 (aPR 0.89; 95% CI 0.77–1.02).
  • Middle School: Significant decline from 5.5% to 4.2% (aPR 0.76; 95% CI 0.60–0.96).
  • High School: Modest, non-significant decline from 10.1% to 9.5% (aPR 0.93; 95% CI 0.80–1.09).
• E-cigarettes: Remained the most used product, declining from 5.9% to 5.2% (aPR 0.87).
• Nicotine Pouches: Remained stable at 1.7% (vs. 1.8% in 2024).
• Combustible Tobacco: Declined slightly to 2.7% (vs. 3.0% in 2024). Cigarette use specifically dropped to 1.7%, the lowest level recorded by NYTS.
• Oral Nicotine Products (Lozenges/Gums): Marked decline from 1.2% to 0.6% (aPR 0.52).

B. E-Cigarette User Characteristics (2025)

• Device Type: A significant shift toward disposable devices, which increased from 55.8% (2024) to 66.7% (2025). Pod/cartridge use declined from 15.6% to 11.7%.
• Frequency: 40.7% of users reported frequent use (≥20 days), and 27.0% reported daily use.
• Brands:
  • Geek Bar emerged as the dominant brand (61.1%), replacing Elf Bar/EBCreate, which declined from 36.0% to 20.9%.
  • Other top brands: Lost Mary (18.5%), Vuse (15.2%), Breeze (13.8%).
• Flavors: 90.0% of users reported flavored products.
  • Top flavors: Fruit (63.6%), Ice/Iced (53.0%), Mint/Menthol (38.8%).
  • Unflavored use declined significantly (12.1% to 8.8%).

C. Nicotine Pouch User Characteristics (2025)

• Frequency: 26.0% reported frequent use; 17.3% reported daily use (both slightly lower than 2024, though not statistically significant).
• Brands: ZYN remains dominant at 69.4% (stable from 68.3% in 2024).
• Flavors: 88.0% reported flavored use.
  • Mint/Menthol is the leading flavor (70.3%).
  • Tobacco-flavored pouches declined significantly (8.7% to 4.7%).
  • Unflavored use declined sharply (14.3% to 6.4%).

5. Significance and Implications

• Market Evolution: The rapid shift from Elf Bar to Geek Bar and the dominance of disposable devices illustrate the fluidity of the youth e-cigarette market. This suggests that regulatory bans on specific brands may lead to rapid substitution rather than cessation.
• Public Health Trajectory: The continued decline in combustible tobacco and the significant drop in oral nicotine products (lozenges/gums) suggest successful long-term tobacco control. However, the stability of nicotine pouch use and the rise of disposable e-cigarettes indicate that new product forms are sustaining youth nicotine consumption.
• Demographic Insights: The decline in use is concentrated in middle schoolers, suggesting that prevention efforts (e.g., minimum legal sales age, school campaigns) may be more effective at delaying initiation in younger adolescents. High school rates remain stubbornly higher.
• Regulatory Challenges: The high prevalence of flavored products (90% for e-cigarettes, 88% for pouches) and the shift toward disposable devices highlight the need for product-specific regulations. The authors note parallels with the UK, where bans on disposables led to device substitution rather than quitting, emphasizing the need for careful monitoring of unintended consequences.
• Future Surveillance: The study underscores the necessity of continuous, granular surveillance to track brand turnover and emerging product types to inform timely FDA and CDC policy responses.

Limitations Noted: Lower response rate in 2025 (29.7% vs. 33.4% in 2024), potential bias in brand comparisons due to survey design changes (new brands added as options), and reliance on self-reported data.