145: New Youth Tobacco Use Survey

Dr. Andrea Gentzke, a health scientist in the CDC’s Office on Smoking and Health, reviews the findings of the latest National Youth Tobacco Survey; Jack Niedenthal, Secretary of Health and Human Services for the Republic of the Marshall Islands,...

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Dr. Andrea Gentzke, a health scientist in the CDC’s Office on Smoking and Health, reviews the findings of the latest National Youth Tobacco Survey; Jack Niedenthal, Secretary of Health and Human Services for the Republic of the Marshall Islands, explains why his jurisdiction decided to close the borders early during the COVID-19 pandemic; ASTHO plans a webinar this afternoon to introduce its new toolkit to help public health agencies assess cognitive health needs and promote healthy aging; and registration is now open for ASTHO’s second annual Public Health Tech Xpo scheduled for May 10-11 online.

CDC Webpage: Tobacco Product Use and Associated Factors Among Middle and High School Students – National Youth Tobacco Survey, United States, 2021

CDC News Release: Approximately 2.55 Million Students Reported Currently Using a Tobacco Product in 2021

ASTHO Public Health Review Podcast: COVID-19 in the Pacific – What We’ve Learned and Where We’re Going

ASTHO Resource: Needs Assessment Toolkit for Dementia, Cognitive Health, and Caregiving

ASTHO Briefing: Assessing Needs Toolkit

ASTHO Public Health Tech Xpo Webpage

ASTHO logo



This is Public Health Review Morning Edition for Tuesday, March 29th, 2022. I'm Robert Johnson.

Now, today's news from the Association of State and Territorial Health Officials.


More than two and a half million students said they used a tobacco product last year. That's the finding of the CDC's latest National Youth Tobacco Survey. The survey went online because of the pandemic. It found e-cigarettes were the most used tobacco product among middle and high school students. Dr. Andrea Gentzke is with the CDC. She takes us through the report in today's morning conversation.

Explain for us the key findings of this new survey.


Sure. So, we looked at several different topics using data from the 2021 National Youth Tobacco Survey—also known as the NYTS—and this is the only nationally representative survey of youth, specifically middle and high school students, that focuses exclusively on tobacco product use behaviors, knowledge, and attitudes.

So, what we found is that tobacco product use remains a public health concern. In 2021: about 24.1%, or approximately 6.6 million students, reported that they had ever used a tobacco product; and 9.3%, or about 2.5 million students, reported that they currently use tobacco products; and notably, about two-thirds of students who use tobacco products did note that they were seriously thinking about quitting.

We also found that there were disparities in youth tobacco product use. In 2021, the prevalence of use of any tobacco product was higher among students who identified as lesbian, gay, or bisexual than heterosexual, among students who identify as transgender compared to not transgender, and also among students who reported increased symptom severity of psychological distress, which is symptoms of anxiety and depression. We were also troubled that non-Hispanic Black students reported the highest prevalence of use of combustible tobacco products, and specifically cigars, compared to other racial and ethnic groups.

So, our findings really indicated that multiple factors, including flavors, marketing, and misperceptions of harm do continue to promote tobacco product initiation and use among youth.


Considering the latest results, what ought to be our biggest concern?


So, we have a variety of concerns from the study. So first of all, commercial tobacco product use is the leading cause of preventable disease, disability, and death in the United States. And we know that most Tobacco Product Use does begin during youth and young adulthood, and furthermore that nicotine—the addictive drug found in tobacco products—can harm adolescent brain development, which continues throughout the early to mid twenties.

So, currently we know that the minimum age of sale for tobacco products in the U.S is 21 years of age. However, we found over two and a half million youth were currently using tobacco products from our study, which included actually an estimated 860,000 who specifically reported smoking combustible tobacco products. So again, we showed that use of combustible tobacco products—and specifically cigars—is higher among youth who were non-Hispanic Black compared to other racial and ethnic groups; and while use of tobacco products by youth in any form is unsafe, the toll of tobacco-specific disease and death in the U.S. is primarily caused by combustible cigarettes and other forms of combustible tobacco products.

And again, we know that those differences in tobacco product use among certain population subgroups, including students identifying as LGBT or youth that reported increasing symptoms of psychological distress. And this is also concerning given the known relationship between nicotine use and mental health disorders, such as depression and anxiety. So importantly, nicotine withdrawal is commonly accompanied by symptoms of anxiety and depression, and youth who attempt to temporarily relieve those symptoms through use of a nicotine-containing product might actually continue using tobacco.

So all in all, it's really important that we continue monitoring tobacco product use among youth, especially since the various products available on the market continue to evolve.


Read more about the survey using the links in the show notes.


From the early days of the pandemic, public health officials in the Pacific Islands have worked hard to keep COVID-19 out of their jurisdictions. They worried the virus would strain limited resources and spread fast among at-risk populations.

The Republic of the Marshall Islands decided to close its borders in hopes that would keep the virus at bay. Jack Niedenthal is secretary of health and human services.


The goal here was to keep the borders closed until the science caught up with the virus. In other words, we knew there was probably some point going to be really good testing for COVID, and we really knew there was going to be some vaccines at some point, but let's stay closed and stay safe until that happens.

Really radical sort of approach; but we're sitting here two years later living a normal life. We don't have masks, we have gatherings, schools have never closed, kids are given a normal childhood. But we're still, you know, scared that it's going to come, so we're still on edge here.


Hear the full conversation on the latest episode of the Public Health Review podcast, available now everywhere you stream audio and on ASTHO's website at astho.org/communications/podcast. There's a link in the show notes.


Also, ASTHO has released a new toolkit to help public health agencies assess cognitive health needs and promote healthy aging, and you can learn more about it during a webinar set for this afternoon at 1:30 PM Eastern.

ASTHO created the toolkit in partnership with the Alzheimer's Association. Sign up for the webinar and download the tool kit using the links in the show notes.


Finally today, ASTHO's popular Public Health TechXpo is back this year. It's scheduled for May 10th and 11th.

The Xpo is your chance to learn about the latest technology and professional services available to support your public health mission. Get more information by visiting the TechXpo webpage. There's a link in the show notes.


Before we go, we want to remind you to leave us a rating and a review. They help raise our profile, and that makes it easier for new listeners to find us online. Also, if you follow the show, you'll never miss a single report. You can do all of this on the channel you're listening to right now.


That'll do it for today's newscast. We're back tomorrow morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.

Jack Niedenthal

Secretary of Health and Human Services, Republic of Marshall Islands Ministry of Health and Human Services

Andrea Gentzke PhD

Associate Service Fellow, Office on Smoking and Health, CDC