Trump gives Big Tobacco a big gift: He killed the National Youth Tobacco Survey, blinding public, researchers, and policy makers to the effects of changing tobacco industry products and practices
The now-shuttered CDC Office on Smoking and Health (OSH) has conducted the National Youth Tobacco Survey since 1999. The survey provides important surveillance about how youth tobacco use is changing. After Congress created the FDA Center for Tobacco Products, it partnered with CDC to expand the scope and depth of the survey, including increasing details on tobacco product characteristics and even specific brands used. NYTS has informed and driven national and state tobacco policy making over the years, including Congress’ decision to ban flavored cigarettes (except menthol) and FDA actions to limit flavored e-cigarettes and prohibit menthol cigarettes. FDA’s analysis of NYTS data played an important role in the unanimous Supreme Court decision upholding the FDA denying permission to market many flavored e-cigarettes.
Shutting down OSH has been a longstanding tobacco industry goal. Last year, the Republicans in the House zeroed out OSH, but the Dems in the Senate restored it. Now HHS Secretary Robert Kennedy have granted industry’s wish even though doing so directly contradicts his claim that he is “realigning HHS with its core mission: to stop the chronic disease epidemic and Make America Healthy Again.”
Now, Trump has pulled the plug on the NYTS as part of shuttering OSH, suspending the 2025 data collection midstream, effectively blinding the public, national, state and local public health agencies and policy makers about youth tobacco use in this era in which industry is rapidly introducing and promoting new tobacco products.
Use of tobacco products in any form is unsafe, and nearly
all tobacco product use begins during adolescence. CDC and the Food and Drug Administration (FDA) analyzed data from the 2024 National Youth Tobacco Survey to determine tobacco product use among U.S. middle school (grades 6–8) and high school (grades 9–12) students. In 2024, current (previous 30-day) use of any tobacco product was reported by 10.1% of high school students (representing 1.58 million students) and 5.4% of middle school students (representing 640,000 students). Among all students, e-cigarettes were the most commonly reported tobacco product currently used (5.9%), followed by nicotine pouches (1.8%), cigarettes (1.4%), cigars (1.2%), smokeless tobacco (1.2%), other oral nicotine products (1.2%), heated tobacco products (0.8%), hookahs (0.7%), and pipe tobacco (0.5%). During 2023–2024, among all students, the estimated number who reported current use of any tobacco product decreased from 2.80 to 2.25 million students; e-cigarette use decreased (from 2.13 to 1.63 million students); and hookah use decreased (from 290,000 to 190,000 students). Among high school students, current use of any tobacco product decreased from 12.6% to 10.1% of students, and e-cigarette use decreased from 10.0% to 7.8%. Among middle school students, no statistically significant changes occurred. Evidence-based strategies can help prevent initiation and promote cessation of tobacco product use among U.S. youths. [emphasis added]
The NYTS contains much more detailed information. To maximize the value of this information, CDC and FDA continue to do research and publish results in additional publications and FDA uses the results in decision making.
Equally, and perhaps more important, several months after initial publication CDC releases public use datasets with details that might be used to identify specific respondents removed. (The 2024 public use dataset had not been released by the time Trump shut down the Office on Smoking and Health.) Anyone can freely download the public use datasets for their own research and freely public the results. As of April 4, 2025 PubMed listed 302 peer reviewed papers that used the NYTS by a many authors, including us (listed at the end of this post).
The most recent public use data sets have been pulled down
Public use datasets from 2020-2023 are no longer available on the CDC website, but you can download them here. (I had downloaded 2020 and 2021 as Excel files for earlier research [paper1, paper2]) and a UCSF colleague downloaded all formats for 2022 and 2023 after Trump won.) CDC website says “CDC’s website is being modified to comply with President Trump’s Executive Orders.”
The datasets are also available on the Internet Archive and the RestoreCDC website, which was created by independent project.
What should we do next?
The damage done by killing the NYTS can be cited in litigation, the media and political action to reverse Trump’s decision to shutter OSH and restore the cuts and personnel changes at the FDA Center for Tobacco Products. Restoring the NYTS, including details on product characterizes and specific brands, should be part of these efforts.
Health advocacy groups led by the Campaign for Tobacco Free Kids have a strong record of suing the federal government over tobacco issues and need to jump into this fight, together with their broad network of allied organizations.
We all need to press the Democratic attorneys general to add this battle to the growing list of cases to defend America against Trump.
Our papers using NYTS
To illustrate the breadth of research possible using the NYTS, here are conclusions from 8 papers we have published – 3 in collaboration with OSH scientists (names italicized) — using NYTS data:
2014: E-cigarette use was associated with higher odds of cigarette smoking, including among experimenters.
2015: Current tobacco use is associated with exposure to advertising through perception of peer use, and by exposure to tobacco use depicted on TV and in movies, both directly and through perception of peer use.
2017: Using data through 2014, the introduction of e-cigarettes was not associated with a change in the linear decline in cigarette smoking among youth. E-cigarette-only users would be unlikely to have initiated tobacco product use with cigarettes.
2018: Between 2011 and 2015, in South Korea, where e-cigarettes were extensively regulated, adolescent e-cigarette use remained stable at a low level, whereas in the United States, where e-cigarette regulation has been limited, e-cigarette use increased. Combined e-cigarette and cigarette use in Korea dropped from 13.2% to 8.5% while it increased from 11.3% to 14.0% in the US. The restrictive policies in South Korea likely contributed to lower overall product use.
2018: Adjusting for covariates, state e-cigarette Minimum Legal Age for Sale laws did not affect youth cigarette smoking. Unadjusted for e-cigarette and other tobacco use, these laws were associated with lower cigarette smoking.
2021: Using data through 2017 revealed that the introduction of e-cigarettes was followed by a slowing in the decline in current cigarette smoking, a stall in combined cigarette and e-cigarette use, and an accelerated decline in ever cigarette smoking. Many youth who used e-cigarettes were at low risk of starting nicotine use with cigarettes.
2022: Youth consumed more e-cigarettes on more days and were more addicted following the introduction of Juul e-cigarettes (and copied by others). These may reflect the higher levels of nicotine delivery and addiction liability of modern e-cigarettes that use protonated nicotine to make nicotine easier to inhale.Stronger regulation, including comprehensive bans on the sale of flavored tobacco products, should be implemented.
2022: Ever-smoking youth who used e-cigarettes “to try to quit using other tobacco products, such as cigarettes” had lower odds of having stopped smoking cigarettes than those who did not use e-cigarettes as to try to quit.
(The full citations and abstracts for these papers appear at the end of this blog post.)
OBJECTIVE: To examine e-cigarette use and conventional cigarette smoking.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analyses of survey data from a representative sample of US middle and high school students in 2011 (n = 17 353) and 2012 (n = 22 529) who completed the 2011 and 2012 National Youth Tobacco Survey.
EXPOSURES: Ever and current e-cigarette use.
MAIN OUTCOMES AND MEASURES: Experimentation with, ever, and current smoking, and smoking abstinence.
RESULTS: Among cigarette experimenters (1 puff), ever e-cigarette use was associated with higher odds of ever smoking cigarettes (100 cigarettes; odds ratio [OR] = 6.31; 95% CI, 5.39-7.39) and current cigarette smoking (OR = 5.96; 95% CI, 5.67-6.27). Current e-cigarette use was positively associated with ever smoking cigarettes (OR = 7.42; 95% CI, 5.63-9.79) and current cigarette smoking (OR = 7.88; 95% CI, 6.01-10.32). In 2011, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year (OR = 1.53; 95% CI, 1.03-2.28). Among experimenters with conventional cigarettes, ever use of e-cigarettes was associated with lower 30-day (OR = 0.24; 95% CI, 0.21-0.28), 6-month (OR = 0.24; 95% CI, 0.21-0.28), and 1-year (OR = 0.25; 95% CI, 0.21-0.30) abstinence from cigarettes. Current e-cigarette use was also associated with lower 30-day (OR = 0.11; 95% CI, 0.08-0.15), 6-month (OR = 0.11; 95% CI, 0.08-0.15), and 1-year (OR = 0.12; 95% CI, 0.07-0.18) abstinence. Among ever smokers of cigarettes (100 cigarettes), ever e-cigarette use was negatively associated with 30-day (OR = 0.61; 95% CI, 0.42-0.89), 6-month (OR = 0.53; 95% CI, 0.33-0.83), and 1-year (OR = 0.32; 95% CI, 0.18-0.56) abstinence from conventional cigarettes. Current e-cigarette use was also negatively associated with 30-day (OR = 0.35; 95% CI, 0.18-0.69), 6-month (OR = 0.30; 95% CI, 0.13-0.68), and 1-year (OR = 0.34; 95% CI, 0.13-0.87) abstinence.
CONCLUSIONS AND RELEVANCE: Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. adolescents.
PURPOSE: Youth are exposed to many types of protobacco influences, including smoking in movies, which has been shown to cause initiation. This study investigates associations between different channels of protobacco media and susceptibility to smoking cigarettes, cigarette experimentation, and current tobacco use among US middle and high school students.
METHODS: By using data from the 2012 National Youth Tobacco Survey, structural equation modeling was performed in 2013. The analyses examined exposure to tobacco use in different channels of protobacco media on smoking susceptibility, experimentation, and current tobacco use, accounting for perceived peer tobacco use.
RESULTS: In 2012, 27.9% of respondents were never-smokers who reported being susceptible to trying cigarette smoking. Cigarette experimentation increased from 6.3% in 6th grade to 37.1% in 12th grade. Likewise, current tobacco use increased from 5.2% in 6th grade to 33.2% in 12th grade. Structural equation modeling supported a model in which current tobacco use is associated with exposure to static advertising through perception of peer use, and by exposure to tobacco use depicted on TV and in movies, both directly and through perception of peer use. Exposure to static advertising appears to directly increase smoking susceptibility but indirectly (through increased perceptions of peer use) to increase cigarette experimentation. Models that explicitly incorporate peer use as a mediator can better discern the direct and indirect effects of exposure to static advertising on youth tobacco use initiation.
CONCLUSIONS: These findings underscore the importance of reducing youth exposure to smoking in TV, movies, and static advertising.
BACKGROUND: E-cigarette use is rapidly increasing among adolescents in the United States, with some suggesting that e-cigarettes are the cause of declining youth cigarette smoking. We hypothesized that the decline in youth smoking changed after e-cigarettes arrived on the US market in 2007.
METHODS: Data were collected by using cross-sectional, nationally representative school-based samples of sixth- through 12th-graders from 2004-2014 National Youth Tobacco Surveys (samples ranged from 16614 in 2013 to 25324 in 2004). Analyses were conducted by using interrupted time series of ever (‰¥1 puff) and current (last 30 days) cigarette smoking. Logistic regression was used to identify psychosocial risk factors associated with cigarette smoking in the 2004-2009 samples; this model was then applied to estimate the probability of cigarette smoking among cigarette smokers and e-cigarette users in the 2011-2014 samples.
RESULTS: Youth cigarette smoking decreased linearly between 2004 and 2014 (P = .009 for ever smoking and P = .05 for current smoking), with no significant change in this trend after 2009 (P = .57 and .23). Based on the psychosocial model of smoking, including demographic characteristics, willingness to wear clothing with a tobacco logo, living with a smoker, likelihood of smoking in the next year, likelihood of smoking cigarettes from a friend, and use of tobacco products other than cigarettes or e-cigarettes, the model categorized <25% of current e-cigarette-only users (between 11.0% in 2012 and 23.1% in 2013) as current smokers.
CONCLUSIONS: The introduction of e-cigarettes was not associated with a change in the linear decline in cigarette smoking among youth. E-cigarette-only users would be unlikely to have initiated tobacco product use with cigarettes.
Introduction: In the context of different regulatory environments, different patterns of e-cigarette use have emerged among adolescents worldwide. The United States and South Korea are two examples, the latter of which has maintained much more extensive regulation of e-cigarettes.
Methods: This analysis compares the prevalence of e-cigarette and conventional cigarette use between 2011 and 2015 from the Korean Youth Risk Behavior Web-based Survey and the U.S. National Youth Tobacco Survey, both nationally representative samples of middle and high school students that use similar questions.
Results: E-cigarette prevalence (past 30 days) among South Korean adolescents decreased from 4.7% in 2011 (95% confidence interval [CI]: 4.4-5.0) to 4.0% (3.7-4.3) in 2015 but increased dramatically among US adolescents from 0.9% (0.7-1.2) to 11.2% (9.9-12.7). Cigarette prevalence (past 30 days) decreased in South Korea from 12.1% (11.6-12.7) to 7.8% (CI: 7.3-8.3) and in the United States from 11.1% (9.5-12.6) to 6.1% (5.1-7.3). Combined prevalence of cigarette and e-cigarette use (adjusting for dual users) decreased in South Korea from 13.2% (12.7-13.8) to 8.5% (8.0-9.1) but increased in the United States from 11.3% (9.7-12.9) to 14.0% (12.4-15.7).
Conclusions: In South Korea, where e-cigarettes are extensively regulated, adolescent e-cigarette use remained stable at a low level, whereas in the United States, where e-cigarette regulation has been limited, e-cigarette use increased. Combined e-cigarette plus cigarette use declined in South Korea whereas it increased in the United States. The restrictive policies in South Korea likely contributed to lower overall product use.
Implications: This paper compared the strength of regulation of South Korea and the United States with the prevalence of adolescents’ e-cigarette and cigarette use and suggests that more restrictive policies likely to contribute to lower e-cigarette use and overall use of e-cigarette and cigarette.
PURPOSE: The purpose of this study was to use individual-level data to examine the relationship between e-cigarette minimum legal sale age (MLSA) laws and cigarette smoking among U.S. adolescents, adjusting for e-cigarette use.
METHODS: In 2016 and 2017, we regressed (logistic) current (past 30-day)
cigarette smoking (from 2009-2014 National Youth Tobacco Surveys [NYTS]) on lagged (laws enacted each year counted for the following year) and unlagged (laws enacted January-June counted for that year) state e-cigarette MLSA laws prohibiting sales to youth aged <18 or <19 years (depending on the state). Models were adjusted for year and individual- (e-cigarette and other tobacco use, sex, race/ethnicity, and age) and state-level (smoke-free laws, cigarette taxes, medical marijuana legalization, income, and unemployment) covariates.
RESULTS: Cigarette smoking was not significantly associated with lagged MLSA laws after adjusting for year (odds ratio [OR]=.87, 95% confidence interval [CI]: .73-1.03; p=.10) and covariates (OR=.85, .69-1.03; p=.10). Unlagged laws were significantly and negatively associated with cigarette smoking (OR=.84, .71-.98, p=.02), but not after adjusting for covariates (OR=.84, .70-1.01, p=.07). E-cigarette and other tobacco use, sex, race/ethnicity, age, and smoke-free laws were associated with cigarette smoking (p<.05). Results unadjusted for e-cigarette use and other tobacco use yielded a significant negative association between e-cigarette MLSA laws and cigarette smoking (lagged: OR=.78, .64-.93, p=.01; unlagged: OR=.80, .68-.95, p=.01).
CONCLUSIONS: After adjusting for covariates, state e-cigarette MLSA laws did not affect youth cigarette smoking. Unadjusted for e-cigarette and other tobacco use, these laws were associated with lower cigarette smoking.
OBJECTIVE: To determine if the declining trend in U.S. youth cigarette smoking changed after e-cigarettes were introduced, and if youth e-cigarette users would have been likely to smoke cigarettes based on psychosocial and demographic predictors of smoking.
METHODS: An interrupted time series analysis was used for cross-sectional data from the 2004 to 2018 National Youth Tobacco Surveys (NYTS) to assess changes in cigarette and e-cigarette use over time. A multivariable logistic regression model used 2004-2009 NYTS data on psychosocial risk factors to predict individual-level cigarette smoking risk from 2011 to 2018. Model-predicted and actual cigarette smoking behavior were compared.
RESULTS: The decline in current cigarette smoking slowed in 2014 (-0.75 [95% CI: -0.81, -0.68] to -0.26 [95% CI: -0.40, -0.12] percentage points per year). The decline in ever cigarette smoking accelerated after 2012 (-1.45 [95% CI: -1.59, -1.31] to -1.71 [95% CI: -1.75, -1.66]). Ever and current combined cigarette and/or e-cigarette use declined during 2011-2013 and increased during 2013-2014 with no significant change during 2014-2018 for either variable. The psychosocial model estimated that 69.0% of current cigarette smokers and 9.3% of current e-cigarette users (who did not smoke cigarettes) would smoke cigarettes in 2018.
CONCLUSIONS: The introduction of e-cigarettes was followed by a slowing decline in current cigarette smoking, a stall in combined cigarette and e-cigarette use, and an accelerated decline in ever cigarette smoking. Traditional psychosocial risk factors for cigarette smoking suggest that e-cigarette users do not fit the traditional risk profile of cigarette smokers.
IMPORTANCE: As e-cigarettes have become more effective at delivering the
addictive drug nicotine, they have become the dominant form of tobacco use by US adolescents.
OBJECTIVE: To measure intensity of use of e-cigarettes, cigarettes, and other tobacco products among US adolescents and their dependence level over time.
DESIGN, SETTING, AND PARTICIPANTS: This survey study analyzed the cross-sectional National Youth Tobacco Surveys from 2014 to 2021. Confirmatory analysis was conducted using Youth Behavioral Risk Factor Surveillance System from 2015 to 2019. The surveys were administered to national probability samples of US students in grades 6 to 12.
EXPOSURES: Use of e-cigarettes and other tobacco products before and after the introduction of e-cigarettes delivering high levels of nicotine.
MAIN OUTCOMES AND MEASURES: First tobacco product used, age at initiation of use, intensity of use (days per month), and nicotine addiction (measured as time after waking to first use of any tobacco product).
RESULTS: A total of 151 573 respondents were included in the analysis (51.1% male and 48.9% female; mean [SEM] age, 14.57 [0.03] years). Prevalence of e-cigarette use peaked in 2019 and then declined. Between 2014 and 2021, the age at initiation of e-cigarette use decreased, and intensity of use and addiction increased. By 2017, e-cigarettes became the most common first product used (77.0%). Age at initiation of use did not change for cigarettes or other tobacco products, and changes in intensity of use were minimal. By 2019, more e-cigarette users were using their first tobacco product within 5 minutes of waking than for cigarettes and all other products combined. Median e-cigarette use also increased from 3 to 5 d/mo in 2014 to 2018 to 6 to 9 d/mo in 2019 to 2020 and 10 to 19 d/mo in 2021.
CONCLUSIONS AND RELEVANCE: The changes detected in this survey study may reflect the higher levels of nicotine delivery and addiction liability of modern e-cigarettes that use protonated nicotine to make nicotine easier to inhale. The increasing intensity of use of modern e-cigarettes highlights the clinical need to address youth addiction to these new high-nicotine products over the course of many clinical encounters. In addition, stronger regulation, including comprehensive bans on the sale of flavored tobacco products, should be implemented.
PURPOSE: This paper determines the association between youth e-cigarette use “to try to quit using other tobacco products, such as cigarettes” and having stopped smoking cigarettes (defined as an ever cigarette smoker who did not smoke in the past 30 days).
METHODS: This study uses data from the NYTS from 2015 through 2021, focusing on youth who started smoking cigarettes before they started using e-cigarettes. Associations between using e-cigarettes to quit and having stopped smoking were computed using logistic regression accounting for the complex survey design and adjusting for level of nicotine dependence, year, age, gender, and race/ethnicity. Sensitivity analyses allowed for having started cigarettes and e-cigarettes in the same year and without regard for starting sequence.
RESULTS: The primary analytic subsample included 6435 United States middle and high school students (mean age 15.9 years, 55.4% male). Using e-cigarettes to quit was associated with significantly lower odds of having stopped smoking cigarettes (odds ratio, 0.62; 95% confidence interval, 0.45-0.85), controlling for nicotine dependence and demographics. Youth with higher levels of nicotine dependence also had lower odds of having stopped smoking. The results were stable over time. Sensitivity analyses produced similar results.
DISCUSSION: Ever-smoking youth who used e-cigarettes “to try to quit using other tobacco products, such as cigarettes” had lower odds of having stopped smoking cigarettes than those who did not use e-cigarettes as to try to quit. Physicians, regulators, and educators should discourage youth from attempting to use e-cigarettes as a way to stop smoking cigarettes.
Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/
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