Tobacco Product Harm Perceptions Among US Middle and High School Students, 2016-2020.

Purpose: The aim of this study is to examine US youths' harm perceptions toward nondaily use of e-cigarettes, cigarettes, cigars, smokeless tobacco, and hookahs.

Methods: The nationally representative, cross-sectional National Youth Tobacco Survey annually assessed the following: "How much do you think people harm themselves when they [use tobacco products] some days but not every day?" Weighted estimates for 2020 were generated overall (grades 6-12) and by select demographics. Multivariable regression examined linear and quadratic changes during 2016-2020 (excluding cigars).

Results: In 2020, the prevalence of middle and high school students reporting "no" or "little" harm (vs. "some" or "a lot") was 20.1% for e-cigarettes, 17.4% for hookahs, 14.6% for cigars, 13.5% for smokeless tobacco, and 11.0% for cigarettes. During 2016-2020, perceptions of "no" or "little" harm decreased for e-cigarettes, increased for cigarettes and smokeless tobacco, and exhibited nonlinear changes for hookahs.

Discussion: Most youth are aware of tobacco product harms, but opportunities exist to educate youth about the harms of nondaily tobacco product use.