In April 2025, as part of its attack on the federal government’s tobacco control efforts, the Trump Administration pulled the plug on data collection for the 2025 National Youth Tobacco Survey (NYTS), a large national survey of middle and high school tobacco use the CDC — later joined by the FDA — had been running since 1999.
In past years, the CDC (later with the FDA) published the topline results in the CDC Morbidity and Mortality Monthy Report (MMWR), then later made a public use dataset available so that independent researchers could do additional analysis to inform tobacco control policymaking and practice.
On March 4, 2026, FDA quietly released the public use dataset for the 2025 NYTS without providing any analysis. The next day, March 5, Atria Client Services (Philip Morris) and the Rutgers University Center for the Assessment of Tobacco Regulations separately released summaries of the results of the 2025 NYTS, with Rutgers releasing more detailed tables on March 26. Neither provided any detailed analysis.
Seeing the vacuum, I downloaded the dataset and did my own analysis, modeled on earlier MMWR reports prepared by CDC and FDA. That analysis, “Tobacco Use Among Middle and High School Students: 2025 National Youth Tobacco Survey,” was accepted by Pediatrics on May 12, 2026 and published on June 30, 2026.
They key observations are:
- Overall youth tobacco use is continuing to decline
- The two most commonly used products are e-cigarettes and nicotine pouches
- The decline in overall tobacco use is manifest across all products, except nicotine pouches, which doubled from 2021 through 2025
- E-cigarette and nicotine pouch users are using them more days per month, indicating growing addiction among current users
- Dual and poly use is common among e-cigarette and, especially, pouch users (figure above)
- Almost all youth use flavored tobacco products, including ice and concept flavors designed to evade flavor bans
Even though we thought it had been killed, a few days before Pediatrics published my paper, Nicotine and Tobacco Research published a paper from the FDA, also titled “Tobacco product use among middle and high school students in the United States: National Youth Tobacco Survey, 2025.” As the table at the end of this post illustrates, the factual findings were similar, but the conclusions about what they mean were very different.
In terms of topics covered, FDA reported data on brands and e-cigarette product types, which I did not discuss, and I explored dual and poly use, which FDA did not address. Dual and poly use are particularly important, because the risks of different tobacco products compound. (For adults, dual use of e-cigarettes and cigarettes is more dangerous than just smoking.) FDA also continues to assume that noncombusted products are substantially safer than combusted products despite the evidence that e-cigarettes carry disease risks approaching or indistinguishable from smoking, including for lung cancer.
While FDA reports that pouch use has been increasing over the years since 2021 when NYTS started collecting data on pouches, they minimize the use as “low” and make the point that there was not a statistically significant increase in pouch use from 2024 to 2025. (They made the same point last year, namely that the change from 2023 to 2024 was not statistically significant.) The problem with doing these year-to-year comparisons is that they do not use all the available data the way a trend analysis does and so can lack the power to detect trends.
Not surprisingly, the FDA’s conclusions supported the agency’s approach to regulating e-cigarettes and pouches. The authors did call for “timely surveillance,” which in the current Administration is a strong recommendation.
My conclusion based on the 2025 NYTS data was quite different:
The widespread use of flavors also questions the 2026 FDA proposed guidance to allow marketing flavored e-cigarettes, perhaps spice, with “lower appeal to youth” because spice e-cigarettes are used by 6.8% of youth. It also questions the wisdom of FDA’s May 5, 2026, decision to authorize the sale of Glas e-cigarettes in “classic” and “fresh” menthol as well as “gold” (mango) and “sapphire” (blueberry) concept flavors. Fruit flavored e-cigarettes are used by 59.1% of youth and menthol by 18.1%. This decision was made despite the fact that the public comment period for FDA’s proposal to allow sales of flavored e-cigarettes was open until May 11, 2026. In addition, on May 8, 2026, FDA announced (without first soliciting public comments) that it would exercise “enforcement discretion” and allow all e-cigarettes, other electronic nicotine delivery systems (ENDS), and nicotine pouches to be sold as long as manufacturers had submitted premarket tobacco authorization applications to FDA, effectively allowing marketing of all these products despite lack of FDA evaluation and authorization.
[P]rogress continued in reducing youth tobacco use, but a changing market, the 2025 elimination of CDC’s Office on Smoking and Health, and FDA’s 2026 decisions to allow sales of a wide range of flavored e-cigarettes, nicotine pouches, and other electronic nicotine delivery system threaten this progress, This situation increases the importance of state and local tobacco control policies, including comprehensive flavor bans (including menthol and concept flavors), smokefree laws, and consistent higher taxes across all tobacco products. [citations omitted]
Here is the abstract for the Pediatrics paper:
BACKGROUND AND OBJECTIVES: This paper summarizes 2025 findings of the National Youth Tobacco Survey regarding middle and high-school students use of tobacco and compares these findings with historical information on the two most common products used by youth, e-cigarettes and nicotine pouches.
METHODS: Prevalence estimates from the NYTS public use data set accounting for complex survey design.
RESULTS: Tobacco use continued declining through 2025, when 7.2% of youth used tobacco. Only nicotine pouches increased, doubling from 0.8% in 2021 to 1.7% in 2025. Pouches were the second most used tobacco product, after e-cigarettes (5.2%). Most youth used flavored tobacco products. E-cigarette use intensity increased over time, with daily use growing from 9.4% in 2014 to 35.4% in 2025. Dual and poly use is common among e-cigarette and pouch users.
CONCLUSIONS: Although progress continued in reducing overall youth tobacco use, nicotine pouch use doubled. The changing market, elimination of CDC’s Office on Smoking and Health, and pro-tobacco FDA regulatory decision threaten progress in youth tobacco control, increasing the importance of state and local tobacco control policies, including comprehensive flavor bans, smokefree laws, and consistent higher taxes across all tobacco products.
The full citation is: Glantz S. Tobacco Use Among Middle and High School Students: 2025 National Youth Tobacco Survey. Pediatrics (2026) https://doi.org/10.1542/peds.2026-077008
| COMPARISON OF GLANTZ AND FDA ANALYSIS OF 2025 NATIONAL YOUTH TOBACCO SURVEY (Some numerical results, including 95% confidence intervals, and citations have been deleted to improve readability.) | ||
| Topic | Glantz | FDA |
| Overall tobacco use | “Tobacco use continued declining through 2025, when 7.2% of youth used tobacco.” | “7.2% reported current tobacco use” |
| Pouches | “Only pouches increased, doubling from 0.8% in 2021 to 1.7% in 2025. Pouches were the second most used tobacco product, after e-cigarettes (5.2%).” [These numbers refer to all students; high school use is higher.] | “1.7% nicotine pouch use” “Nicotine pouch use increased among high school students from 2022 to 2025; however, use was still low and remained stable over the past year.” |
| “In contrast [to e-cigarettes], between 2021-2025, the most common pattern for pouch users was 1-2 days/month (between 40% and 50%) with daily pouch use increasing from 6.9% to 23.6% and 20-29 day/month use from 4.9% to 11.6%.” [Details on flavor use are in Table 1.] | “Among students currently using nicotine pouches, the majority reported using infrequently on 1–5 days (52.8%; however, 17.6% reported daily use. ZYN was the most reported brand, with 69.2% reporting using ZYN. … Flavored nicotine pouch use was widespread, with 90.8% of youth using nicotine pouches reporting flavored pouch use in the past 30 days. Mint was the most reported nicotine pouch flavor, with more than half endorsing this option (60.9%), followed by fruit (25.0%) and menthol (18.1%). Current use of ice- or iced- flavored nicotine pouches was reported by 18.2% and 11.3% reported use of concept flavors.” | |
| “While the FDA has consistently called pouch use “low” to justify not considering them a threat to youth, the fact is that they are the only tobacco product to see increases between 2021 and 2025, and as of 2024 were the second most common form of youth tobacco use. Dual and poly use, representing around 80% of pouch use [figure above], raises concern that pouches are having the effect of supporting other tobacco product use when using those products is not possible, such as because of smokefree laws and policies.” | ||
| “While nicotine pouches can generally be a lower-risk alternative for adults who smoke cigarettes, nicotine pouch use is not risk-free, and its discreet nature could facilitate youth uptake. Following scientific review in accordance with its population health standard, the Food and Drug Administration (FDA) granted marketing authorization for 26 nicotine pouch products as of December 19, 2025.” | ||
| E-cigarettes | [Figure 1 shows e-cigarette use falling over time.] | “e-cigarette use decreased among middle and high school students.” |
| “E-cigarette use intensity increased over time, with daily use growing from 9.4% in 2014 to 35.4% in 2025.” [Note that this comparison is over a longer time horizon (Figure 3) than FDA used, which may account for their failure to detect the long term trend.] | “Despite recent declines in current e-cigarette use prevalence among youth, frequent use patterns have remained stable among current users. From 2022 to 2025, approximately 40% of youth who currently use e-cigarettes reported frequent use, a proportion that has remained consistent (data not shown).” “Among students who report current e-cigarette use, slightly more than a quarter reported daily e-cigarette use (27.5%), and 41.2% reported frequent use (20–30 days per month; Table S3).” | |
| “Among students currently using e-cigarettes, … 66.3% used disposables.” | ||
| Dual and poly use | “Dual and poly use is common among e-cigarette and pouch users.” | |
| “Sole e-cigarette use is the most common pattern among e-cigarette users, although it is falling while poly use is increasing. Most (50%-60%) pouch users are poly product users, with only about 20% being sole pouch users.” | ||
| Flavors | “Most youth used flavored tobacco products. … The distributions among flavors did not vary substantially over time within products, but the most common flavors were different for different products. | |
| “For e-cigarettes fruit and ice (that induces a cooling sensation) were the most common flavors (around 60%), followed by menthol or mint (30-40%), then candy (30%).” | “Approximately 89.4% (95% CI: 86.9%–91.5%) of students who currently use e-cigarettes reported using flavored e-cigarettes in the past 30 days. The most endorsed flavor was fruit (62.1%), followed by candy, desserts, or other sweets (32.8%), and mint (29.8%). Over half of students who currently use e- cigarettes (53.4%) reported using any ice flavor. Use of concept flavors was less common; 18.4% reported using a concept flavor and 32.4% reported being unsure if they had used these types of flavors” | |
| “For pouches, menthol or mint was the most popular flavor (around 60%) followed by fruit and ice (both around 20-30%).” | “Flavored nicotine pouch use was widespread, with 90.8% of youth using nicotine pouches reporting flavored pouch use in the past 30 days. Mint was the most reported nicotine pouch flavor, with more than half endorsing this option (60.9%), followed by fruit (25.0%) and menthol (18.1%). Current use of ice- or iced- flavored nicotine pouches was reported by 18.2%, and 11.3% reported use of concept flavors.” | |
| Brands | “The most commonly used type of e-cigarettes was disposables (66.3%, 95% CI: 62.1%–70.2%) while the most endorsed brand was Geek Bar (64.1%, 95% CI: 60.1%–68.0%), followed by Elf Bar (21.5%, 95% CI: 18.3%–25.0%).” “Notably, the top 4 e-cigarette brands most commonly used by youth in NYTS are among those that lack FDA marketing authorization and have been subject to federal enforcement actions.’ | |
| Sex differences | “Current use of any tobacco product was reported by 7.4% of male, 7.0% of female (Figure 5 and Table S1) youth. Male and female use were similar, except for pouches and smokeless tobacco, where the 95% confidence intervals for males were above females (2.4% [95% CI 1.9%-3.0%] vs. 1.0% [0.8%-1.2%] and 1.5% [1.2%-1.9%] vs. 0.4% [0.3%-0.5%], respectively).” | [Results for sex are reported in Tables 1, S1 and S2.] |
| Race/ethnicity | “Current use of any tobacco product was reported by 7.4% of male, 7.0% of female (Figure 5 and Table S1) youth. Male and female use were similar, except for pouches and smokeless tobacco, where the 95% confidence intervals for males were above females (2.4% [95% CI 1.9%-3.0%] vs. 1.0% [0.8%-1.2%] and 1.5% [1.2%-1.9%] vs. 0.4% [0.3%-0.5%], respectively). Multiple tobacco product use was reported by 9.8% of Native Hawaiian/Pacific Islander, 6.0% of American Indian/Alaska Native, 3.9% of multiracial, 3.3% of White, 2.7% of Middle Eastern/North African, 2.6% of Black, 2.1% of Hispanic, and 1.4% of Asian students (Table S2).” | [Results for race/ethnicity are reported in Tables 1, S1 and S2.] |
| Conclusions | “The widespread use of flavors also questions the 2026 FDA proposed guidance to allow marketing flavored e-cigarettes, perhaps spice, with “lower appeal to youth” because spice e-cigarettes are used by 6.8% of youth. It also questions the wisdom of FDA’s May 5, 2026, decision to authorize the sale of Glas e-cigarettes in “classic” and “fresh” menthol as well as “gold” (mango) and “sapphire” (blueberry) concept flavors. Fruit flavored e-cigarettes are used by 59.1% of youth and menthol by 18.1%. This decision was made despite the fact that the public comment period for FDA’s proposal to allow sales of flavored e-cigarettes was open until May 11, 2026. In addition, on May 8, 2026, FDA announced (without first soliciting public comments) that it would exercise “enforcement discretion” and allow all e-cigarettes, other electronic nicotine delivery systems (ENDS), and nicotine pouches to be sold as long as manufacturers had submitted premarket tobacco authorization applications to FDA, effectively allowing marketing of all these products despite lack of FDA evaluation and authorization.” | |
| “In sum, progress continued in reducing youth tobacco use, but a changing market, the 2025 elimination of CDC’s Office on Smoking and Health, and FDA’s 2026 decisions to allow sales of a wide range of flavored e-cigarettes, nicotine pouches, and other electronic nicotine delivery system threaten this progress, This situation increases the importance of state and local tobacco control policies, including comprehensive flavor bans (including menthol and concept flavors), smokefree laws, and consistent higher taxes across all tobacco products.” | “Comprehensive tobacco control and regulatory efforts, including effective tobacco prevention communication campaigns, enforcement of youth access restrictions, and a multi-pronged approach to combat the sale of illegally marketed e-cigarettes remain essential for preventing youth tobacco use. Although nicotine pouch use remained stable in the past year and started from a low baseline, the significant increase among high school students between 2022 and 2025 demonstrates the critical value of sustained monitoring and surveillance of tobacco use patterns and product characteristics. Timely surveillance that informs rigorous premarket review and other tobacco control and regulatory efforts can help prevent a new generation from developing lifelong nicotine addiction and experiencing the serious health consequences associated with tobacco use.” | |
| Role of sponsor | No sponsor | “The study sponsors were involved in the decision to submit the manuscript for publication, but did not have the right to veto the publication or to control the decision regarding the journal to which the manuscript was submitted” |
There are also a few small differences due to the fact that the two papers used different statistical software which may have computed the same things using different algorithms. The remaining differences are likely due to differences in definitions/ variable construction. One example is frequent use, where I include daily use in frequent and FDA doesn’t or how the two papers analyzed write-ins for flavors or how “don’t know” responses were handled for some variables.
Stanton Glantz blog 