Pediatrics just published the final version of my paper “Tobacco Use Among Middle and High School Students: 2025 National Youth Tobacco Survey.” 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
This is the final edited version of the paper. To make the results available in a timely manner, Pediatrics published the unedited accepted manuscript on June 30. The blog entry I posted then details the substantial differences with how the FDA interpreted the results in their paper, which supports the FDA’s current permissive policies toward nicotine pouches.
The accompanying editorial, “Nicotine Product Use by Adolescents in the US: Two Million School-Age Students and Counting, by Jonathan Winickoff, goes deeper into how flavors contribute to youth tobacco addiction, the “inconsistent, surprising and inexplicable market authorization of fruit and concept flavors by the FDA,” and how public health advocates and clinicians should respond.
Here is the paper’s abstract:
BACKGROUND AND OBJECTIVES: This paper summarizes 2025 findings of the National Youth Tobacco Survey (NYTS) regarding middle and high school students’ use of tobacco and compares these findings with historical information on the 2 most common products used by youth, e-cigarettes and nicotine pouches.
METHODS: Prevalence estimates from the NYTS public use dataset, accounting for complex survey design, were reviewed.
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.
CONCLUSION: Although progress continued in reducing overall youth tobacco use, nicotine pouch use doubled. The changing market, elimination of Centers for Disease Control and Prevention Office on Smoking and Health, and protobacco Food and Drug Administration regulatory decisions threaten progress in youth tobacco control, increasing the importance of state and local tobacco control policies, including comprehensive flavor bans, smokefree laws, and consistently higher taxes across all tobacco products.
The full citation is: Glantz SA. Tobacco Use Among Middle and High School Students: 2025 National Youth Tobacco Survey. Pediatrics 2026; e2026077008. 10.1542/peds.2026-077008. Published online: 25 Sep 2026 (doi: 10.1542/peds.2026-077008). It is available here.
