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HONOLULU -- Use of tobacco, cannabis, or both increased among U.S. youths, according to 2021-2022 data from the CDC's National Youth Tobacco Survey (NYTS).

In 2021, 11% of respondents reported exclusive use of tobacco, 10.8% reported simultaneous use of tobacco and cannabis, 3.4% reported exclusive use of cannabis, and 74% reported no cannabis or tobacco use, while in 2022, there was an increase in use in all three smoker groups:

• 13.6% reported use of both tobacco and cannabis
• 11.7% reported use of tobacco alone
• 4.1% reported use of cannabis alone

Respondents who reported using neither cannabis or tobacco declined to 70.6%, said José de Jesús Méndez Castro, MD, of Dorrington Medical Associates in Houston, during the CHEST annual meeting hosted by the American College of Chest Physicians.

"Why is this important for us? Because, as we have seen in previous sessions and presentations, this is a preventable cause of many, many health issues," he said, noting that the earlier smoking starts, the harder it is to stop.

Kids ages 16 and 17 reported the highest rates of smoking across both years. While the absolute number of smokers among 9-year-olds was low, this age group had the highest proportion of dual use in 2021 and 2022, which was a surprise, Méndez Castro said.

Breaking it down by sex, girls were more likely to be simultaneous users compared with boys, though proportions were similar for cannabis and tobacco use alone.

The survey also asked respondents about their mental health status, particularly anxiety and depression. In 2021, depression was reported by 11.6% of simultaneous cannabis and tobacco users, 4.4% of exclusive cannabis users, and 15.2% of exclusive tobacco users. In 2022, rates increased, with 21.6% of simultaneous users reporting depression, followed by 16% of tobacco users, and 5.1% of cannabis users.

Anxiety followed similar patterns, with 17.2% of simultaneous users reporting feeling anxious, followed by 14.7% of tobacco users, and 4.3% of cannabis users in 2021. In 2022, these proportions were 19.5%, 15.5%, and 4.7%, respectively.

Méndez Castro noted that mental health and smoking, or more precisely, which proceeds the other, can be difficult to understand, likening it to a "chicken and egg" problem.

Looking at grades in school, 23.4% of simultaneous users reported receiving mostly F's in 2021, which increased to 33.5% in 2022, while 11.1% reported receiving mostly B's in 2021, which increased to 13.8% in 2022. Among cannabis-only users, these proportions also increased from 2021 to 2022, with 9.1% reporting that they received mostly F's in 2022. The same was true for tobacco-only users, with 16.5% reporting that they received mostly D's in 2021, which increased to 19.9% in 2022.

The NYTS began in 1999, and the survey transitioned to online in 2021 as a result of the COVID-19 pandemic.

In 2021, 20,413 responses were received from middle and high school students, 51.1% of whom were boys. In 2022, responses went up to 28,291 (51.2% boys).

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