Massachusetts Youth Tobacco Use Falls as Questions Remain About Flavor Ban

---

Key Points:

• Survey Overview: Newly released 2025 Massachusetts Youth Health Survey results show cigarette experimentation among youth at record lows, while e-cigarette use has declined dramatically from its 2019 peak.

• High School Smoking at Record Lows: In 2025, only 10.4 percent of Massachusetts high school students had ever tried a combustible cigarette, the lowest level recorded and a 31.1 percent decline from 2019.

• Middle School Smoking Remains Low: Only 4 percent of Massachusetts middle school students reported ever trying a combustible cigarette in 2025.

• Youth Vaping Plummets: Current e-cigarette use among Massachusetts high school students fell from 30.9 percent in 2019 to 7.9 percent in 2025, representing a 74.4 percent decline.

• Vaping Experimentation Also Falls: In 2025, 23.5 percent of Massachusetts high school students reported ever trying an e-cigarette, down 54 percent from 51.1 percent in 2019.

• Middle School Vaping Declines: Among middle school students, 10.8 percent reported ever trying an e-cigarette in 2025, a 26.5 percent decline from 14.7 percent in 2019.

• National Trends Mirror Massachusetts: In 2025, 7.1 percent of U.S. high school students currently vaped, compared with 7.9 percent in Massachusetts. National high school vaping declined 74.2 percent from 2019 – nearly identical to Massachusetts' 74.4 percent reduction.

• Flavor Ban Questions Remain: Massachusetts prohibited flavored cigarettes and e-cigarette products in 2020, but similarly dramatic declines in youth vaping occurred nationwide, making it difficult to attribute the state's reductions specifically to the flavor prohibition.

• Young Adult Smoking Concerns: Between 2020 and 2021, smoking among Massachusetts adults aged 18 to 24 increased 8.8 percent, from 6.8 percent to 7.4 percent, while young adult smoking nationally declined by 1.9 percent.

• Young Adult Smoking Remains Higher: In 2024, 6.4 percent of Massachusetts adults aged 18 to 24 smoked cigarettes, compared with 5.9 percent of young adults nationally.

• Fiscal Impact: Following implementation of the flavored cigarette prohibition, Massachusetts cigarette excise tax revenue declined 23.7 percent between 2020 and 2021, substantially exceeding the average annual decline of 5.5 percent between FY2016 and FY2020.

• Adult Harm Reduction: More than 323,700 Massachusetts adults currently use e-cigarettes, part of a national population exceeding 20 million adult users of smoke-free alternatives.

• Balancing Public Health Goals: Massachusetts' historic reductions in youth smoking and vaping are important public health gains, but policymakers should also consider adult access to lower-risk alternatives and potential unintended consequences of broad product restrictions.

• Policy Implications: The similarity between Massachusetts and national youth vaping declines suggests lawmakers should carefully evaluate whether the state's flavor ban itself produced the observed reductions or whether broader national trends played a significant role.

• Bottom Line: Massachusetts youth smoking and vaping have fallen substantially, but the state's progress closely mirrors nationwide declines. Policymakers should examine the flavor ban's full public health and fiscal effects and consider whether more targeted policies can continue protecting youth while preserving lower-risk alternatives for adults who smoke.

---

Youth tobacco and vapor product use continues to decline in the Bay State. The Massachusetts Department of Public Health recently published the 2025 results of the Massachusetts Youth Health Survey (YHS). The biennial survey, conducted in partnership with the Massachusetts Department of Elementary and Secondary Education among middle and high school students in odd-numbered years, measures a variety of student health behaviors, ranging from tobacco and drug use to mental health.

The latest results provide welcome news for policymakers: youth experimentation with combustible cigarettes is at record lows, while use of vapor products continues to decline dramatically from its 2019 peak.

According to the YHS, in 2025, 10.4 percent of Massachusetts high school students reported ever trying a combustible cigarette. This is the lowest level recorded and represents a 31.1 percent decline from 2019. Among middle school students, only 4 percent reported ever trying a cigarette.

In recent years, policymakers have increasingly turned their attention to alternatives to cigarettes, including e-cigarettes and other nicotine products. Here, too, the latest data are encouraging. Vaping among Massachusetts youth – similar to national trends – appears to have peaked in 2019 and has declined substantially since.

In 2025, only 23.5 percent of Massachusetts high school students reported ever trying an e-cigarette, while 7.9 percent were current users, defined as having used the product on at least one occasion in the 30 days prior to the survey. These figures represent dramatic declines from 2019, when more than half (51.1 percent) of students had tried vaping and nearly one-third (30.9 percent) were current users.

Between 2019 and 2025, ever-use of e-cigarettes among Massachusetts high school students declined by 54 percent, while current use fell by 74.4 percent. The YHS asks middle school students only about ever-use of e-cigarettes. In 2025, 10.8 percent reported ever trying a vapor product, a 26.5 percent decline from 2019, when 14.7 percent reported ever-use.

These reductions are significant public health gains in a state that has increasingly restricted adult access to lower-risk alternatives to combustible cigarettes, including through its 2020 prohibition on flavored cigarettes and e-cigarette products. Yet policymakers should also recognize that Massachusetts’ experience broadly mirrors national trends, where youth vaping has declined dramatically even as the marketplace for nicotine products, including e-cigarettes and nicotine pouches, has continued to evolve.

According to the Centers for Disease Control and Prevention’s National Youth Tobacco Survey, in 2025, only 7.1 percent of U.S. high school students reported currently using e-cigarettes – slightly lower than the 7.9 percent reported among Massachusetts high school students in the YHS. Nationally, current high school vaping declined by 74.2 percent from its 2019 peak, when 27.5 percent of high school students reported current use.

Massachusetts’ 2020 flavor ban also warrants examination for possible unintended consequences, particularly among young adults. The CDC annually assesses adult health behaviors through the Behavioral Risk Factor Surveillance System (BRFSS). Between 2020 and 2021, smoking among Massachusetts young adults aged 18 to 24 increased from 6.8 percent to 7.4 percent, an 8.8 percent increase. Nationally, young adult smoking rates declined by 1.9 percent during the same period. More recently, 6.4 percent of Massachusetts young adults were current smokers in 2024, compared with 5.9 percent of U.S. young adults.

The economic effects of the prohibition should also be considered. Following implementation of the flavored cigarette ban, Massachusetts cigarette excise tax revenue declined by 23.7 percent between 2020 and 2021, compared with an average annual decline of 5.5 percent between FY2016 and FY2020. Additional public resources have also been required to enforce the prohibition.

With youth tobacco and nicotine use at historically low levels, Massachusetts policymakers should consider whether the state’s current approach remains appropriately calibrated to both youth prevention and adult harm reduction. E-cigarettes are used by more than 20 million U.S. adults, including more than 323,700 Massachusetts adults, many of whom may otherwise smoke combustible cigarettes.

The 2025 YHS results are welcome news: Massachusetts youth are smoking and vaping at substantially lower rates than they were just a few years ago. But these improvements have occurred alongside similarly dramatic declines nationwide, making it difficult to attribute Massachusetts’ progress specifically to its 2020 flavor prohibition. Rather than treating the existing policy as settled, Bay State lawmakers should examine its public health and fiscal effects, consider potential unintended consequences for adult smokers, and determine whether a more targeted approach could continue protecting youth while preserving access to lower-risk alternatives for adults.

Nothing in this analysis is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101.