The factors for rapid increases in the e-cigarettes among the youth include its mouth watering flavours, advertising and the introduction of new gadget with prefilled pods and high nicotine levels.  After the research from National Youth Tobacco Survey (NYTS), the data shows high and middle school students inhale e-cig lesser than 2019 but still data shows 19.6% of high school students (3.02 million) and 4.7% of middle school students (550,000) reported current e-cigarette use in 2020 — 1.8 million less than in 2019. However, e-cig among the youth remains prominent and the devices are evolving causing challenge to public health.

To generate a nationally representative sample of USA student from grade 6 to grade 8 also known as middle school student and grade 9 to grade 12 high school student, the National Youth Tobacco Survey (NYTS) was conducted. This cross-sectional, school-based electronic survey uses a stratified, three-stage, cluster-sampling design (across countries, schools, and classrooms).  From February 15 to May 24, 2019, among 19,018 respondents (overall response rate, 66.3%) data collection for the 2019 NYTS took place. Similarly for 2020, data collection for the NYTS took place from January 16 to March 16, 2020, among 14,531 respondents (overall response rate, 43.6%).  According to school level, weighted evaluations of gadgets type–specific use were assessed among current e-cig users and overall students.

Among the sixth to eighth grade students (middle school) currently using any type of e-cigarette, the one-time e-cigarette use rate reported in 2019 is 3.0% (95% confidence interval [CI], 1.7 to 5.4), which is equivalent to 30,000 students, and increase by 15.2% (95% CI, 9.1 to 24.1) in 2020, equivalent to 80,000 students. Among students in grades 9-12 (high school) currently using any type of e-cigarette, the reported use rate of disposable e-cigarettes in 2019 was 2.4% (95% CI, 1.6 to 3.7) (90,000 students) and 26.5% (2020 95% CI for the year, 20.0 to 34.2) (790,000 students). Among all high school students, the use rate of disposable e-cigarettes in 2019 was 0.3% (95% CI, 0.2 to 0.6), and in 2020 it was 0.7% (95% CI, 0.4 to 1.2); in 2019 and 2020, all 0.7% (95% CI, 0.4 to 1.0) and 5.1% (95% CI, 3.9 to 6.8) of high school students respectively reported using disposable electronic products. Pre-filled capsules or cartridges remained the most widely used type of equipment in 2020 (220,000 middle school students and 1.45 million high school students).

According to the device type, it is consistent with retail sales data, indicating that the sales of disposable e-cigarettes for young people have grown very high. The Food and Drug Administration focused on enforcement of certain unapproved flavor-enhancing e-cigarette cartridges in January and July 2020 and issued warning letters to 10 organizations to stop trading or selling disposable e-cigarettes and attract young people’s belongings. During the 2019 and 2020 NYTS data collection period, the Covid19 pandemic did not affect the survey or its national representation. The survey results show the fast and dynamic nature of e-cigarettes and the general need for public health professionals and the public to be aware of this.

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