ASCO Weighs-In on Widespread Youth Tobacco Use; See the Latest National Youth Tobacco Survey Results

February 14, 2019
Tobacco Product Use Among Middle and High School Students 2011-2018

SOURCE: Tobacco Product Use Among Middle and High School Students — United States, 2011-2018. Morbidity and Mortality Weekly Report (MMWR), February 2019

Approximately 5 million middle and high school students reported currently using a tobacco product, with over 3.6 million currently using e-cigarettes and about half (2.5 million) currently using a combustible tobacco product, according to the latest findings from the National Youth Tobacco Survey (NYTS).

The recently released 2018 Survey was published in a Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention (CDC) and highlights the rapid growth of tobacco use among youth in the U.S.

In response to the dangerous growth in youth tobacco use, ASCO has responded to a Request for Information (Docket No. CDC-2018-0115) from CDC and Department of Health and Human Services (HHS) on Advancing Tobacco Control Practices to Prevent Initiation of Tobacco Use Among Youth and Young Adults, Eliminate Exposure to Secondhand Smoke, and Identify and Eliminate Tobacco-Related Disparities.

In the letter, ASCO noted its efforts in promoting the rapid reduction and ultimate elimination of tobacco products and exposure to environmental tobacco smoke through advancing policy and research. The Society has worked to help the enactment of Tobacco-21 legislation, raising the legal age of purchase of tobacco products to 21 years, which has proven successful at reducing youth tobacco use¹. Thus far, over 430 localities in 22 states have passed such policies, with six of these states and the District of Columbia passing state-wide policies.

The NYTS showed that in the last year alone, from 2017 to 2018, use of any tobacco product increased significantly by 38.3 percent (19.6% to 27.1%) among high school students and by 28.6 percent (5.6% to 7.2%) among middle school students. While e-cigarette use increased by 77.8 percent (11.7% to 20.8%) among high school students and by 48.5 percent (3.3% to 4.9%) among middle school students, frequent e-cigarette use (more than 20 days in the past 30 days), increased significantly by 38.5 percent (20.0% in 2017 to 27.7% in 2018) among high school students who were current e-cigarette users. The Surgeon General recently characterized this increase as an epidemic.

In its comment letter, ASCO also advocates for partnerships between cancer centers and the local school systems in their surrounding communities to target youth for tobacco prevention education through schools—particularly for those in high-risk neighborhoods. ASCO also encourages the CDC to support state and local health departments and their partners—especially in rural areas where the smoking prevalence and high lung cancer rates persist—to provide low-income, uninsured, and underserved current or past tobacco users access to timely cancer screening and diagnostic services.

On November 14, 2018, the Food and Drug Administration (FDA) announced new action to ban the sale of flavored electronic nicotine delivery systems (ENDS) products, including e-cigarettes, sold at in-person locations and online in flavors other than tobacco, mint, and menthol. The ban follows the agency’s September 2018 announcement of its new Youth Tobacco Prevention Plan to address the alarming rates at which children and young adults are using e-cigarettes.

The health effects of ENDS, including e-cigarettes are not yet fully known. A congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine published in January 2018 suggests that e-cigarettes are not without biological effects in humans and the consequences on long-term use on morbidity and mortality are not yet clear.

ASCO is committed to policies that will contribute to the reduced prevalence of tobacco use and prevent the occurrence of cancer and other smoking-caused diseases and commends the FDA for its latest actions. The Society continues to advocate for more research on ENDS and the associated long-term risks along with the next generation of tobacco-related products.

ASCO looks forward to continuing its work with the CDC, FDA, and HHS to protect public health and eliminate tobacco-related diseases. See ASCO’s full comment letter.

Stay up-to-date with the latest tobacco news with ASCO in Action.

Learn more about the FDA’s latest actions.


  1. Schneider, Shari Kessel, et al. "Community reductions in youth smoking after raising the minimum tobacco sales age to 21." Tobacco control 25.3 (2016): 355-359.