Public Health Alerts: E-cigarette and nicotine pouch use among youth, United States, 2025
Jim WappesToday at 12:55 p.m.
Public Health Alerts
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A Public Health Alerts report today reveals that, based on 2025 data, 13.4% of US middle school and high school students had ever used e-cigarettes and 4.1% had ever used nicotine pouches, while 5.2% currently used e-cigarettes and 1.7% currently used nicotine pouches.
Rates were higher in high school students, with 17.9% having ever used e-cigarettes and 7.1% currently using them, compared with 5.7% and 2.3%, respectively, for nicotine pouch use.
“Nearly all youth who used e-cigarettes or nicotine pouches used flavored products, especially fruit-flavored e-cigarettes and mint-flavored nicotine pouches,” wrote the authors, who are from the CDC Foundation and Rutgers University.
Public Health Alerts, a collaboration between NEJM Evidence and CIDRAP, fills a gap in reliable data, offering expert-reviewed reports that translate frontline observations into actionable public health evidence. An NEJM Evidence editorial explains the initiative further. Read all Public Health Alerts reports here.
89% of e-cigarette use involved non-tobacco flavors
The researchers analyzed data from the 2025 National Youth Tobacco Survey, which was conducted among 23,630 students from January 6 to April 4, 2025. Average student response rate was 82.6%.They estimate that 13.4% of US youth in middle school (grades 6 through 8) and high school (9 through 12) had ever used e-cigarettes, corresponding to 3.7 million nationwide. Rates were 17.9% in high school and 7.2% in middle school. Current use was 5.2% overall (1.4 million nationwide), 7.1% in high schoolers, and 2.6% in middle schoolers.
Among those who reported current e-cigarette use, 27.5% used them daily, and 66.3% used disposable versions. Geek Bar was by far the most common brand used in the past 30 days, reported by 64.1% of users.
Among those who currently used e-cigarettes, 89.4% used non-tobacco flavors; 62.1% used fruit flavors, followed by candy, desserts, or other sweets (32.8%); mint (29.7%); and menthol (15.5%).
An estimated 4.1% of youth had ever used nicotine pouches, with the rate rising to 5.7% in high schoolers and dropping to 1.7% in middle schoolers. Current pouch use was 1.7% overall, 2.3% in high school, and 0.9% in middle school. Among youth who used pouches, 90.8% used non-tobacco flavors, most commonly mint (60.9%), fruit (25.0%), and menthol (18.1%).
“Consistent with findings from 2024,” the authors wrote, “flavored e-cigarette use (especially fruit) and nicotine pouch use (especially mint) remain predominant among students who currently use the products. However, top e- cigarette brands did seem to change from 2024 to 2025, underscoring the quickly changing product landscape.”
The researchers noted that Geek Bar’s novel features include a digital screen that animates during use, which may increase its appeal.
No safe tobacco products
The authors write, “Given that there are no safe tobacco products, preventing any tobacco product use among youth is an important public health objective. Nicotine is addictive, and exposure during adolescence can harm brain development.”They conclude, “Continued federal, state, and local infrastructure to support youth tobacco prevention, including surveillance of youth tobacco use behaviors, remains critical in the context of rapid changes in tobacco product availability and use. Strategies that may prevent initiation and reduce use among youth include price increases, comprehensive smoke-free laws that include e-cigarettes, countermarketing campaigns, and comprehensive restrictions on the sale of flavored products.”