Middle and high school students in the U.S. using flavored tobacco products in 2023

For each respective tobacco product excluding cigarettes, current (past 30-day) users were asked, “Were any of the [tobacco product] that you used in the past 30 days flavored to taste like menthol, mint, clove or spice, alcohol (wine, cognac), candy, fruit, chocolate, or any other flavor?” Response options were “yes,” “no,” or “don’t know.” Those who responded yes were considered flavored tobacco product users.
Reported among respective current (past 30-day) users for each product. Past 30-day use of e-cigarettes was determined by asking, “During the past 30 days, on how many days did you use e-cigarettes?” Past 30-day use of cigarettes was determined by asking, “During the past 30 days, on how many days did you smoke cigarettes?” Past 30-day use of cigars was determined by asking, “During the past 30 days, on how many days did you smoke cigars, cigarillos, or little cigars?” Past 30-day use of smokeless tobacco was determined by asking the following question for use of chewing tobacco, snuff, and dip: “During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip?” Past 30-day use of snus was determined by asking the following question for use of snus: “During the past 30 days, on how many days did you use snus?” Past 30-day use of dissolvable tobacco products was determined by asking the following question for use of dissolvable tobacco products: “During the past 30 days, on how many days did you use dissolvable tobacco products?” Past 30-day use of pipe tobacco was determined by asking the following question for use of pipe tobacco: “During the past 30 days, on how many days did you smoke pipes filled with tobacco?” Past 30-day use of hookahs was determined by asking, “During the past 30 days, on how many days did you smoke tobacco in a hookah or water pipe?” Past 30-day use of heated tobacco products was determined by asking the following question for use of heated tobacco products: “During the past 30 days, on how many days did you use heated tobacco products?” Past 30-day use of nicotine pouches was determined by asking the following question for use of heated tobacco products: “During the past 30 days, on how many days did you use nicotine pouches?”
Any tobacco use includes use of e-cigarettes, cigarettes, cigars (cigars, cigarillos, or little cigars), smokeless tobacco (chewing tobacco, snuff, or dip; snus; dissolvable tobacco products), hookahs, pipe tobacco, bidis (small brown cigarettes wrapped in a leaf), heated tobacco products, and nicotine pouches on ≥1 day during the past 30 days.
Flavored cigarette use refers to menthol cigarette use. Current cigarette smokers were categorized as flavored (menthol) cigarette smokers: if they responded “yes” to the question, “Menthol cigarettes are cigarettes that taste like mint. During the past 30 days, were the cigarettes that you usually smoked menthol?”; or if they indicated “Kool” or “Newport” as a brand they usually smoked in the past 30 days. Usual brand was determined based on responses to two questions: 1) “During the past 30 days, what brands of cigarettes did you smoke? (Select one or more)” and 2) “During the past 30 days, what brand of cigarettes did you usually smoke? (Choose only one answer).” If “Kool” or “Newport” was the only brand selected for the first question, or if multiple brands were selected in the first question and “Kool” or “Newport” was selected for the second question, “Kool” or “Newport” was considered the respondent’s usual brand. Those who selected “some other brand(s) not listed here” could provide a write-in response; write-in responses corresponding to an original response option were recoded. Those who reported “no” or “not sure” to the menthol question or those who did not report “Newport” or “Kool” as their usual brand were categorized as nonmenthol smokers; all other past 30-day cigarette smokers who did not provide any valid response were assigned as missing menthol smoking status.
Flavored tobacco product use was assessed separately among current (past 30-day) users of chewing tobacco, snuff, or dip; snus; and dissolvable tobacco product users. Flavored use was then recoded as a composite among users of any current smokeless tobacco product combined.