More than 6 million middle and high school students were currently using tobacco product in 2019, according to National Youth Tobacco Survey data released Thursday by the US Centers for Disease Control and Prevention.
The survey found that 1 in 3 high school students and around 1 in 8 middle school students are current tobacco users, meaning they had used the product at least once in the 30 days.
For the sixth year in a row, e-cigarettes were the most commonly used tobacco product among high school and middle school students. More than 55% of students reported using e-cigarettes only. Other tobacco products used by students included cigars, cigarettes, smokeless tobacco, hookahs and pipe tobacco.
More than 53% of high school students and more than 23% of middle school students reported ever trying a tobacco product.
"Our Nation's youth are becoming increasingly exposed to nicotine, a drug that is highly addictive and can harm brain development," CDC Director Dr. Robert R. Redfield said in a statement. "Youth use of any tobacco product, including e-cigarettes, is unsafe."
Around a third of the students were also using more than two tobacco products. Cigars were the second most-used product, and the one used most in combination with e-cigarettes.
Among youth, symptoms of nicotine dependence increase in those who use a combination of products, compared to those who only use one.
In 2019, more than half of current tobacco product users reported seriously thinking about quitting all tobacco products. Increasing successful quit attempts "could complement prevention efforts to reduce tobacco product use among youths," the report said.
Why young people try tobacco
The report identified two of the largest factors in young people trying and continuing to use tobacco products -- tobacco product advertising and flavored tobacco products.
This year, nearly 9 in 10 of middle and high school students reported exposure to such advertisements from at least one source.
More than half of the students who reported trying e-cigarettes said they did so because they were curious. Witnessing their family or friends try e-cigarettes and interest in flavors were other reasons.
Among current tobacco product users, flavored tobacco use was 72.8% among high schoolers and 59.6% among middle schoolers.
Nearly 30% of the students perceived little to no harm from intermittent use of e-cigarettes, and more than 16% saw little to no harm in using hookahs.
Though current use of flavored tobacco products was slightly higher in males, females were slightly more susceptible to general e-cigarette use, the report found.
Preventing youth tobacco use
Given the increases in youth tobacco use, the report says that "comprehensive, sustained, evidence-based tobacco control strategies, combined with FDA regulation of tobacco products, are important for preventing and reducing youth tobacco product use."
On September 11, President Donald Trump said the US Food and Drug Administration would put out some "very strong recommendations" regarding the sale of flavored e-cigarettes. At the time, US Health and Human Services Secy. Alex Azar said the policy would require e-cigarette companies to take non-tobacco-flavored products off the market, including mint and menthol.
A policy has not yet been announced.
"We are fully committed to preventing children from using harmful tobacco products, including e-cigarettes, and will continue to develop policies that will achieve that objective as soon as possible," acting FDA Commissioner Dr. Brett Giroir, HHS assistant secretary for health, said in a statement about the new report.