The North Carolina Department of Public Instruction has released the 2023 Youth Risk Behavior Survey (YRBS) results. This biennial study, conducted in coordination with federal agencies, tracks various behaviors of American youth, including dietary habits, physical activity, mental health, and substance use.

The survey brings encouraging news for policymakers: youth vaping is on the decline, and traditional tobacco product use remains low. However, recent years have seen sharp increases in some areas. In 2023, 3.9% of North Carolina high school students reported current use of combustible cigarettes, unchanged from 2021, yet marking a 53% decline since 2019. Frequent cigarette use (20 or more days) has decreased by 47.4% since 2019, despite a 150% increase between 2021 and 2023. Daily cigarette use has decreased by 40% since 2019 but saw a 125% increase between 2021 and 2023.

Meanwhile, e-cigarette use has continued its downward trend from a peak in 2019. From 2019 to 2023, the rate of students who have ever tried e-cigarettes dropped from 52.4% to 36.9%. Current e-cigarette use has decreased by 39.7% since 2019, with 21.4% of high schoolers reporting current use in 2023. Frequent and daily use of e-cigarettes also declined by 29.7% and 19.3%, respectively, over the same period.

Middle school use of combustible cigarettes has seen fluctuations in recent years. In 2023, only 2.7% of North Carolina middle schoolers reported currently using combustible cigarettes, with 0.5% using them daily. From 2019 to 2023, the current use among middle school students fell by 36.6%, though it saw an 8% increase from 2021 to 2023. Daily use of combustible cigarettes has risen by 25% since 2019.

Similarly, the use of e-cigarettes among middle school students has decreased from its peak in 2019, though there was an increase between 2021 and 2023. In 2023, 16.1% of students reported having tried an e-cigarette at least once, a 36.6% decrease from 2019 but an 18.4% increase from 2021. Current e-cigarette use was reported by 9.9% of middle schoolers in 2023, down 31.3% from 2019 but up 28.6% from 2021. Positively, only 0.9% of middle schoolers reported daily e-cigarette use, which represents a 10% decrease from the rates in both 2019 and 2021.

It should be noted that the primary reason North Carolina high school students reported using e-cigarettes in 2023 was curiosity, as indicated by 11.6% of students. Only 1.9% cited the availability of flavors as their reason, representing a 17.4% decrease from 2021—when 2.3% reported flavor as a motivator. Among middle schoolers, curiosity and self-medication for anxiety, depression, or stress were the most cited reasons for using e-cigarettes, reported by 3.9% of students. Flavor was a factor for only 0.2% of middle school students, marking a 60% decline from 2021—when 0.5% used e-cigarettes because of flavors.

As North Carolina policymakers work to regulate e-cigarettes and other tobacco harm-reduction products, it is crucial to balance the needs of adults who use these products to remain smoke-free with the need to address the rising trends in youth tobacco and e-cigarette use. While youth vaping rates are lower than in 2019, the slight increases in recent years and the significant rise in adult e-cigarette use—which increased by 71.7% between 2017 and 2022—highlight the complexities of tobacco regulation aimed at both preventing youth addiction and supporting adult cessation efforts.

Lindsey Stroud is a Visiting Fellow at Independent Womens Forum, a Senior Fellow at the Taxpayers Protection Alliance, and a board member with the American Vapor Manufacturers Association.