Nicotine and tobacco product use among US youth in 10th and 12th grade, 2023-2025: a repeated cross-sectional study.

BACKGROUND

Youth nicotine/tobacco use has shifted in recent decades. Updated national estimates are essential for policy and practice. We examined changes in youth nicotine/tobacco use in the United States (US) across three annual surveys (2023-2025) and assessed sociodemographic correlates and multi-product co-use patterns in 2025.

METHODS

Self-reported lifetime and past-30-day use of seven nicotine/tobacco products were analyzed among US 10th and 12th graders (2023-2025; n = 47,524; mean age 17.0 years [standard deviation 1.1]; 47.5% female, 48.6% male, 3.8% reported another sex or preferred not to report; 41.0% non-Hispanic White, 22.3% Hispanic, 16.5% Multiracial, 13.7% non-Hispanic Black) in Monitoring the Future's nationally representative cross-sectional survey. Changes in prevalence across the three survey years were examined using survey-weighted log-binomial regression.

FINDINGS: Lifetime nicotine pouch use increased from 3.1% in 2023 to 7.5% in 2025 (average annual prevalence ratio [PR] 1.53, 95% confidence interval [CI] 1.32-1.78, p < 0.0001), and past-30-day use rose from 1.2% to 2.9% (PR 1.45, 95% CI 1.19-1.75, p = 0.0012). Prevalences were largely unchanged for past-30-day cigar/cigarillo, combustible cigarette, e-cigarette, hookah, nicotine candy, and smokeless tobacco use and lifetime cigarette, e-cigarette, and smokeless tobacco use. In 2025, e-cigarettes were the most used product, followed by nicotine pouches. Use of several products was higher among male, rural, non-Hispanic White, and Multiracial youth, and those with lower parental education. Among users, co-use of multiple products was prevalent, with the strongest associations observed for combustible cigarette-e-cigarette co-use and nicotine pouch-smokeless tobacco co-use.

INTERPRETATION: There was little evidence of change in US youth nicotine/tobacco use, except for rising nicotine pouch use. Combustible tobacco use remained at historically low levels. In 2025, use was concentrated in sociodemographic groups and marked by high multi-product use.

FUNDING: National Cancer Institute, National Institute on Drug Abuse, US Food and Drug Administration, and Tobacco-Related Disease Research Program of the University of California.