# Forecasting Youth Tobacco Use With the National Youth Tobacco Survey Data (2021–2024): Implications for Dental Public Health and Cessation Counseling in the United States

## TL;DR

This study uses national survey data to forecast declining youth tobacco use in the U.S., highlighting the need for targeted dental public health strategies and cessation counseling.

## Contribution

The novelty lies in forecasting future youth tobacco use trends and linking them to actionable dental public health and cessation counseling strategies.

## Key findings

- Youth tobacco use decreased from 9.3% in 2021 to 7.7% in 2024, with significant gender and racial/ethnic disparities.
- Forecasts predict continued decline to 6.95% in 2025 and 6.2% in 2026, suggesting ongoing intervention effectiveness.
- Gender differences in e-cigarette use diminished over time, but tailored approaches remain necessary for sustained reduction.

## Abstract

Background

Youth tobacco use, particularly e-cigarette use, remains a critical public health issue in the United States, with significant implications for oral and systemic health. Although recent regulatory interventions, such as age restrictions and limitations on flavored tobacco products, have been implemented, significant disparities in usage patterns persist across gender and racial/ethnic groups. This study analyzes trends in youth tobacco use to project future patterns and inform targeted dental public health strategies and cessation interventions.

Materials and methods

Data spanning 2021-2024 from a national survey of youth were analyzed to assess overall tobacco use, gender-specific patterns, e-cigarette use by gender, and variations across racial/ethnic groups (non-Hispanic White and Hispanic students). Statistical methods, including chi-square tests, z-tests for proportions, and linear regression, were applied to identify trends. Forecasting models, including simple linear regression and Holt’s exponential smoothing, were applied to estimate tobacco use for 2025 and 2026. To enhance the reliability of the projections, the forecasts generated by both models were averaged using equal weights.

Results

Overall tobacco use decreased from 9.3% in 2021 to 7.7% in 2024, with a statistically significant drop between 2023 and 2024 (p < 0.01). Gender disparities were evident, with females showing higher use in 2023 (11.2% vs. 8.9% in males, p < 0.001), though convergence occurred by 2024. E-cigarette use mirrored this trend, with gender differences diminishing over time. Racial/ethnic analysis revealed higher initial use among non-Hispanic White students in 2021, aligning with Hispanic students by 2024. Forecasts indicate sustained declines, projecting overall use at 6.95% in 2025 and 6.2% in 2026 (p < 0.05).

Conclusion

The consistent reduction in youth tobacco use, including e-cigarette consumption, suggests the potential efficacy of ongoing interventions. However, persistent gender and racial/ethnic differences underscore the necessity for tailored approaches. These findings highlight opportunities for dental professionals to incorporate cessation counseling into practice, mitigating tobacco-related oral health risks, and provide a foundation for proactive public health strategies to further decrease youth tobacco use.