HomeMy WebLinkAbout _ 9.1(c)--Accept Report and Provide Direction Regarding Tobacco RetailingC IT Y OF
REMDINO�"
AN CITY OF REDDING
REPORT TO THE CITY COUNCIL
MEETING DATE: March 18, 2025
FROM: Jason Gibilisco, Management
ITEM NO. 9.1(c)
Assistant to the City Manager
***APPROVED
BY***
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-i Can Q: "
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jgibilisco@cityofredding.org
btippin@cityofredding.org
SUBJECT: 9.1(c)--Consider accepting report regarding tobacco retailing in the City of
Redding.
Recommendation
Accept the report on tobacco retailing and provide direction to staff regarding next steps.
Fiscal Impact
There is no fiscal impact with accepting this report. If the City Council (Council) would like to
alter the former Council's September 2024 previous direction to staff which was to create a
Tobacco Retail License (TRL) ordinance specific to vape/smoke shops there would be associated
staff time costs with updating the ordinance.
The Redding Police Department (RPD) has received two tobacco use prevention related grants.
The first grant is with the County of Shasta to perform decoy operations through March 15,
2026. The grant consists of five operations a year with each operation consisting of 10 to 12
retailer visits per operation — revenue received per operation is $1,500. The second grant is
through the California Department of Justice that provides $630,569 through October 31, 2027.
This grant funds police officers to administer and conduct enforcement operations that include
retail inspections, decoy operations, shoulder tap, undercover buys, and retailer education.
Alternative Action
The Council could choose to not accept the report or move forward with implementation of a
TRL or provide other direction.
Report to Redding City Council March 12, 2025
Re: 9.1(c)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 2
Background/Analysis
On February 6, 2024, staff presented a report to the Council outlining current California laws and
tobacco enforcement practices in various jurisdictions, including Shasta County. The Council
accepted the report and directed staff to conduct further research on tobacco enforcement
practices in other California municipalities and determine what is and is not working regarding
tobacco enforcement, and any other information as it relates to tobacco retailers.
Staff canvased the municipalities for information related to tobacco retailers and returned to
Council on September 17, 2024 to present this information. Staff analyzed 48 jurisdictions with
28 of them requiring retailers to have a local TRL. This is in addition to the state license that is
required by the California Department of Tax and Fee Administration for any retailers who sell
tobacco products. The cost of the state license is $265 and must be renewed annually. It is
intended to prevent retailers from selling unregulated tobacco products.
Municipalities that require a TRL also require an annual fee in concert with the TRL, and allows
for local control, and enforcement capabilities over tobacco retailers in their jurisdiction. Many
jurisdictions have set their ordinances to go above and beyond what the federal and state law
requires. Jurisdictions that are successfully running a TRL program also provide education,
inspections, and enforcement to their tobacco retailers.
The Council accepted the September 17, 2024 staff report on tobacco retailing and directed staff
to return with a TRL ordinance for vape and smoke shops, and include fee options to fund
enforcement through both code enforcement and law enforcement, for consideration at a future
Council meeting.
Following the September 17, 2024 meeting, staff worked on both a TRL ordinance specific to
vape and smoke shops and worked on fee options to fund the TRL program. The TRL ordinance
specific to vape and smoke shops is still under review and not ready to be presented at this time.
The options to oversee the TRL program could be either RPD or Redding Code Enforcement
(RCE).
If the Council would like to pursue implementing a TRL program, the fee for the TRL will vary
depending on the overseeing department; RPD or RCE. The fee will also vary depending if it is
vape/smoke shop only, or for all tobacco retailers. It was noted at the September 17, 2024
Council meeting, that there are 29 vape/smoke shops and 119 tobacco retailers in the City of
Redding.
RPDs identified resource needs to oversee a TRL program would be one full-time Police Officer
position and a half-time Sergeant position. RPD is currently receiving funding through the
above -mentioned grant for tobacco use prevention related enforcement and education activities.
RCS's identified resource needs to run the TRL program would be one full-time Neighborhood
Preservation Officer and a half-time Admin Assistant. The following are the estimated costs for
RPD and RCE to successfully cover administration and enforcement efforts based on their
identified needs to run a TRL program based off the number of tobacco retailers.
Report to Redding City Council March 12, 2025
Re: 9.1(c)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 3
Redding Police
Cost of a Full-time
Estimated Cost of TRL
Estimated Cost
Department
Police Officer and half-
for Vape/ Smoke shops
of TRL for all
time Sergeant
only (29)
Tobacco
Retailers 119)
$379,000
$13,068.96
$3,184.87
Redding Code
Cost of a Full-time
Estimated Cost of TRL
Estimated Cost
Enforcement
Neighborhood
for Vape/ Smoke shops
of TRL for all
Preservation Officer and
only (29)
Tobacco
half-time Admin
Retailers (119)
Assistant
$140,020
$4, 828.27
$1,176.63
The TRL program costs are significantly reduced if requiring all tobacco retailers to be licensed
versus the vape/smoke shops only. TRL program costs are even further reduced with RCE
overseeing the program. The cost of the TRL covers staff time costs to run the TRL program and
includes education, inspections, and enforcement for tobacco retailers. Of course the cost could
be further reduced if the Council wanted to lower the amount of oversight or wished to subsidize
the activity with the General Fund.
At the February 18, 2025, Council meeting, agenda item 12, the Council directed staff to bring
back the TRL item for further direction. If the Council would like to move forward with altering
the previously directed tobacco retail ordinance for vape/smoke shops, staff can further analyze
and update the ordinance to bring back to the Council at a future date for possible adoption. This
process will include necessary outreach with stakeholders, work with the City Attorney's Office
and any other necessary departments.
Environmental Review
This is not a project defined under the California Environmental Quality Act, and no further
action is required.
Council Priority/City Manager Goals
• Public Safety — "Work to improve all aspects of public safety to help people feel secure
and safe where they live, work, and play in the City of Redding."
Attachments
^Tobacco Staff Report February 6, 2024
^Staff Report City Council 9-17-24
^Jurisdictional Data
Tobacco Retailer Licensing is Effective September 2018
California Youth Tobacco Survey -Shasta County Data
California Youth Tobacco Survey 2023 Annual Report
C IT Y OF
REMDINO�"
AN CITY OF REDDING
REPORT TO THE CITY COUNCIL
MEETING DATE: February 6, 2024
FROM: Jason Gibilisco, Management
ITEM NO. 9.1(a)
Assistant to the City Manager
***APPROVED
BY***
.dam , 1s % o anagooac..:t . ims lanl. E,, 1he i ay M8#liiga......... ! Z6!2 24
C't� ,ppi , -i fa. Q: "
jgibilisco@cityofredding.org
btippin@cityofredding.org
SUBJECT: 9. 1 (a) --Accept report regarding tobacco retailing.
Recommendation
Accept the report on tobacco retailing and provide direction to staff regarding next steps.
Fiscal Impact
There is no fiscal impact with accepting the report.
Alternative Action
The City Council (Council) could choose to not accept the report and provide alternate direction
to staff.
Background/Analysis
On October 17, 2023, the Tobacco Education Coalition of Shasta County presented to the
Council. The presentation included information regarding the history of tobacco enforcement in
the County, how kids are targeted, retailer density, youth tobacco use poll data, and public
opinion poll data. On that same evening, the Council directed staff to review the information that
was provided by the Tobacco Education Coalition and present it at a future council meeting for
consideration of potential changes to the City's Ordinance regarding the density of tobacco -
selling businesses.
Staff then began researching what current laws are in place regarding tobacco in California and
in neighboring jurisdictions. Staff met with the Shasta County Health and Human Services
Tobacco & Obesity Prevention Unit and with the Tobacco Use and Prevention Education
Coordinator for the Shasta County Office of Education. They were able to provide information
on state laws, other California city's tobacco regulations, education, and other helpful
information related to youth tobacco use.
Report to Redding City Council January 31, 2024
Re: 9.1(a)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 2
The most recent major California legislation on tobacco is Senate Bill 793 - approved by
Governor Newsom on August 28, 2020. California passed Senate Bill 793 prohibiting the sale of
most flavored tobacco products. These banned tobacco products include flavored e-cigarettes,
menthol cigarettes, flavored little cigars, flavored smokeless tobacco, tobacco flavor enhancers,
and other similar flavored tobacco products. The law does not apply to the retail sale of flavored
loose-leaf pipe tobacco or flavored premium cigars ($12 or more) and flavored shisha or hookah
when sold according to state law. Shortly after passing, a referendum was proposed and qualified
for a ballot measure in the November 2022 election. The law was upheld by the voters and went
into effect on January 1, 2023.
Other California legislation includes that all tobacco retailers throughout the state must obtain a
tobacco retailer license at a current cost of $265 through the California Department of Tax and
Fee Administration to sell tobacco and it must be renewed on an annual basis. The minimum age
required by state and federal law to purchase tobacco is 21. The state accepts customer
complaints and the California Food and Drug Branch conducts random, onsite inspections with a
person under the age of 21 to ensure tobacco retailers do not sell to minors. Retailers who violate
the minimum age of sale law are subject to criminal and civil penalties in fines ranging from
$200 to $1,000. Local enforcement agencies are also authorized to conduct enforcement
activities as necessary.
City of Redding
The City of Redding currently does not have an ordinance regulating businesses that sell tobacco
or one that controls the density of tobacco retailing in the City and therefore, relies solely on
State law. Currently, the City has approximately 98 tobacco retailers per the California
Department of Tax and Fee Administration website (which includes grocery stores, pharmacies
and other similar retailers). The City's 2045 Draft General Plan incorporates policy language to
reduce the use of tobacco (EJBK) and considers establishing distance requirements for tobacco
retailers from youth -oriented facilities (EJBL).
The Redding Police Department (RPD) finalized a contract with the Shasta County Health and
Human Services to conduct Tobacco Retail Minor Decoy operations. RPD will work with a
person under the age of 21 and perform at least five operations per year with 10-12 retailer visits
per operation. Decoy operations are planned to begin later this month and expire March of 2026.
Funding for the decoy operations is being provided through a Department of Justice grant.
Grants are made available through the Research and Prevention Tobacco Tax Act of 2016
(Proposition 56) and funds assist local law enforcement agencies by providing grants and
tobacco enforcement training.
City of Shasta Lake
The City of Shasta Lake adopted an Interim Zoning Ordinance in August 2023, which requires a
Use Permit for tobacco retailing. The City of Shasta Lake has approximately 8 tobacco retailers
per the California Department of Tax and Fee Administration website.
City of Anderson
The City of Anderson currently does not have a tobacco ordinance more stringent than State law.
The City of Anderson has approximately 18 tobacco retailers per the California Department of
Tax and Fee Administration website.
Report to Redding City Council January 31, 2024
Re: 9.1(a)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 3
Shasta County
Shasta County currently does not have a tobacco ordinance more stringent than state law. In
unincorporated Shasta County, there are approximately 40 tobacco retailers per the California
Department of Tax and Fee Administration website.
Other California Cities
The majority of all California Cities that have adopted tobacco regulations, require tobacco
retailers to be registered with their respective local government. This requires the tobacco retailer
to pay a fee to their respective local government for a license that would be renewed annually.
The fee for the license covers the cost of administration, license program, retailer education,
inspection, and compliance checks. Having a tobacco retail license program assists with
enforcement at the local level. To aid tobacco retail license programs local governments have
adopted various other ordinances to assist in the prevention of youth tobacco use.
Additional ordinances that have been adopted in California include:
• Distance requirements for tobacco retailers such as not being able to operate within 500
feet or 1000 feet of a youth -oriented facility (school, daycare, park, etc);
• Distance requirements for tobacco retailers to not be able to operate within 500 feet or
1000 feet of another tobacco retailer;
• Requirements for pharmacies to cease tobacco retailing;
• Density limits such as limiting the amount of tobacco retailers to operate in a jurisdiction
to one for every 2,500 inhabitants;
• Density limits such as limiting the amount of smoke shops to operate in a jurisdiction to
one shop for every 4,000 inhabitants;
• Requiring a use permit through planning in addition to a tobacco retail license; and
• Prohibiting smoking at all multifamily residential properties unless outside in a
designated smoking area.
The ordinances that are provided in this report are the majority of what California local
governments are adopting in their jurisdictions or variations of, to prevent youth tobacco use. If
the Council would like to provide staff with specific direction on pursuing any potential
ordinances, staff can pursue additional research and report back to Council at a later date. This
can include a report on RPDs progress on the Tobacco Retail Minor Decoy Program.
Environmental Review
This is not a project defined under the California Environmental Quality Act, and no further
action is required.
Council Priority/City Manager Goals
0 This is a routine operational item
C IT Y OF
REMDINO�"
AN CITY OF REDDING
REPORT TO THE CITY COUNCIL
MEETING DATE: September 1.7, 2024
FROM: Jason Gibilisco, Management
ITEM NO. 9.1(a)
Assistant to the City Manager
***APPROVED
BY***
.dam " 1x, % o Ciilftgon,...:I . ims lanl. Sea the i ay M.#tiiga......... ) 8'2024
C't� ,ppi , -i a Q: "
jgibilisco@cityofredding.org
btippin@cityofredding.org
SUBJECT: 9. 1 (a) --Consider report regarding tobacco retailing in the City of Redding.
Recommendation
Accept the report on tobacco retailing and provide direction to staff regarding next steps.
Fiscal Impact
There is no fiscal impact with accepting the report. If the City Council (Council) would like to
pursue drafting an ordinance on tobacco retailing, there would be associated staff time costs.
Currently, the Redding Police Department (RPD) is running decoy operations through a grant.
The grant consists of five operations a year with each operation consisting of 10-12 retailer visits
per operation - revenue received per operation is $1,500.
If the Council pursues a Tobacco Retail License (TRL) Program that is to be managed and
enforced by Code Enforcement, staff would need to further examine cost recovery of the
program. In TRL programs, the costs of education, inspections, and enforcement are funded by
the cost of the license, and can be supplemented with grants. The cost of the license could fund a
full time Code Enforcement position and even an administrative position to process the licenses.
Further examination would be required.
Alternative Action
The Council could choose to not accept the report.
Background/Analysis
On February 6, 2024, staff presented to the Council a report regarding what California (State)
laws are in place and what other jurisdictions are doing in regards to tobacco enforcement. Staff
presented a broad scope of what the majority of State jurisdictions are doing in regards to
tobacco enforcement and specifically what the jurisdictions are doing in Shasta County. The
Report to Redding City Council September 12, 2024
Re: 9.1(a)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 2
Council accepted the report and advised staff to further canvas State municipalities to determine
what is and is not working regarding tobacco enforcement, retailer density, how youth are
targeted, and any other information as it relates to tobacco retailers.
Since the previous meeting, the 2023 California Youth Tobacco Use Survey (survey) was
released for Shasta County and there is new legislation, that, if signed by the Governor, will.
increase the fine for selling a tobacco product to youth. The survey was released in March 2024,
and shows Shasta County has the highest rate of tobacco ever used by youth in the State of
California at 41.2 percent'. The report shows that one in three Shasta County Youth report being
able to purchase tobacco directly form a tobacco retailer'. On average, students reported first
using tobacco at age 13 and 82.2 percent of students who have used tobacco reported trying
vapes as their first tobacco product'.
Potential new tobacco enforcement legislation has moved forward to Governor Newsom for
consideration. Senate Bill (SB) 2021 supplements the existing fine that can be issued to an
individual who knowingly sells a tobacco product to a person under 21 years of age. This new
bill allows for a fine to be issued to the retailing businesses or corporation. The fine amount that
can be issued to the business for knowingly selling to a youth is punishable by a fine of $500 for
the first offense, $1,000 for the second offense, and $5,000 for the third offense.
The California Department of Tax and Fee Administration (CDTFA) requires all retailers who
sell cigarettes, or tobacco products, to obtain a cigarette and tobacco retailer's license. The
CDTFA defines a tobacco product on their website as:
• "any product containing, made, or derived from tobacco or nicotine that is intended for
human consumption;"
• "Any electronic smoking or vaping device that delivers nicotine or other vaporized
liquids;" and
• "Any component, part, or accessory of tobacco product, whether or not sold separately."
Data Collection and Benchmarking
Staff analyzed 48 various jurisdictions throughout the State on what types of tobacco ordinances
and enforcement other jurisdictions have in place. Staff specifically asked jurisdictions if they
have a tobacco ordinance, if they enforce their tobacco ordinance, and if the ordinance is
working. Staff also viewed each jurisdiction's municipal code for specifications on tobacco
related ordinances. Staff analyzed if a TRL is required, how many tobacco retailers are in the
jurisdiction, what are the associated fees, population, penalties, and what specific ordinances are
in place. Staff did not hear back from some jurisdictions through phone or email which resulted
in reviewing online ordinances and information.
Of the 48 jurisdictions that were analyzed, 28 of them require retailers to have a local TRL. As of
October 2023, at least 226 municipalities in California require a TRL to sell tobacco products.
Jurisdictions that require a TRL, required them to be renewed annually, allow them to have local
control, and enforcement capabilities of the tobacco retailers in their jurisdiction. This allows the
jurisdiction to set any additional requirements such as limits on how many retailers are operating
in their jurisdiction and general oversight. It makes enforcement more effective and efficient and
gives local governments the ability to intervene when needed. Many jurisdictions have set their
ordinances to go above and beyond of what the federal and state law requires.
Staff found several jurisdictions have adopted tobacco ordinances but currently have no funding
for their tobacco program or for enforcement. These jurisdictions are Butte County, Oroville,
Report to Redding City Council September 12, 2024
Re: 9.1(a)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 3
Hollister, San Benito County, Arroyo Grande, and Merced County. The Cities of Anderson,
Santa Rosa, and Vallejo, stated that they are in the process of working on updating or creating a
TRL program.
The City of Benicia was found to have the most restrictive requirements for tobacco retailers.
Followed by Sonoma County and Sonoma County cities such as Petaluma, Sebastopol, Windsor,
and Sonoma. These jurisdictions require each tobacco retailer to hold a TRL, implemented
density requirements (with some no longer issuing TRLs due to being over density), proximity
requirements to youth areas, distance/proximity requirements to other tobacco retailers, no
selling of flavored tobacco, no tobacco retailing at pharmacies, minimum pricing requirements,
and some even banning the sale of electronic cigarettes or vaping products.
There was a wide array of specific ordinances that have been implemented throughout the State.
The various ordinances in place include:
Proximity Requirement to a Youth Sensitive Area
Jurisdictions have set requirements for tobacco retailers operating near youth sensitive
facilities. Youth sensitive facilities mainly include, schools, parks, libraries, day cares,
playgrounds, and ultimately, specific areas defined by the jurisdiction. Jurisdictions set
prohibitions for tobacco retailers near schools because of the belief that children are more
likely to experiment with tobacco products when tobacco retailers are near youth areas.
Setting distance restrictions near youth areas may assist with reducing youth smoking
rates. There are 16 jurisdictions that have set a distance requirement for tobacco retailers
near youth sensitive areas. The distance set by the jurisdictions analyzed ranges from 300
feet to 1,000 feet.
Proximity Requirements Near Existing Tobacco Retailers
There are 10 jurisdictions that have requirements for no new tobacco retailers to operate
within a specific proximity to other tobacco retailers. This requirement prevents the over
concentration of tobacco retailers within particular neighborhoods and how close they
can operate from one another. The overconcentration of tobacco retailers may affect
youth smoking behaviors and youth access to tobacco products. The distance set by the
jurisdictions analyzed ranges from 500 feet to 1,000 feet.
Tobacco Retailers per Population Density or Cap on the Amount of Tobacco Retailers
Jurisdictions have imposed requirements for tobacco retailers based on the local
population. Jurisdictions have based this requirement off of the State's ability to limit the
number of alcohol licenses. Greater tobacco density may lead to higher smoking rates. In
the jurisdictions analyzed, 12 jurisdictions have adopted an ordinance based off the
population. The jurisdictions analyzed had various densities adopted that include one
tobacco retailer for every 1,500 residents (one jurisdiction), 1,750 residents (one
jurisdiction), 2,000 residents (four jurisdictions), and 2,500 residents (three jurisdictions).
This sets local capacity of tobacco retailers based on the number of residents. If
population increases then the number of tobacco retailers can be increased. The City of
Sonoma has a set capacity of 15 retailers, and Nevada City has a set limit of five. The
City of Oroville requires a use permit from planning and has a density requirement of one
for every 4,000 residents for significant tobacco retailers which has been reached.
Report to Redding City Council September 12, 2024
Re: 9.1(a)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 4
No Selling of Flavored Tobacco
With the passing of SB 793, effective January 1, 2023, flavored tobacco or tobacco
product flavor enhancers are now illegal to sell, offer for sale, or possess with the intent
to sell or offer for sale in the State with a few exceptions. Flavored tobacco is considered
a starter product for youth that assists with long term tobacco use. There are countless
flavors that range from. Cotton Candy, Cherry Crush, Pop Tart, Banana Blast,
Wintergreen, and many more. There are 17 jurisdictions that were analyzed that have an
ordinance that prohibits the sale of flavored tobacco with some going above and beyond
SB 793 and banning all flavored tobacco. In communications with jurisdictions, flavored
tobacco products are still being found, mainly at significant tobacco retailers such as
smoke shops.
No Sale of Electric Smoking; Devices (ESDs)/ Vapes
Electronic Cigarettes are also known as e-cigarettes, vapes, or e-vaporizers, and are
battery operated devices used to deliver nicotine, flavorings, and other chemicals into the
body in an aerosol form rather than smoke. The majority of ESDs or vapes are widely
used for flavors. Following the ban on flavored tobacco, jurisdictions noticed that tobacco
companies are finding ways to circumvent the flavor ban and are calling products by the
names of colors such as "Blue." Blue could mean that its flavor is blue raspberry or
blueberry. ESDs are also what the youth are using in higher rates. The State's flavor ban
does leave room for interpretation on what is and is not considered flavored tobacco.
Jurisdictions have decided to go one step further and prohibit the sale of all ESDs for this
reason. Since the majority of ESDs are flavored, jurisdictions reported minimal impacts
to prohibiting the sale of ESDs. The Environmental Protection Agency classifies ESDs as
hazardous waste due to their lithium batteries and nicotine in the liquid. There are seven
jurisdictions analyzed that have prohibited the sale of ESDs.
No Selling of Tobacco at Pharmacies
Jurisdictions have restricted pharmacies from selling tobacco and tobacco related
products. This ordinance is based off pharmacies being a place people go to for health
care and medicine. It can send a mixed message about their safety because it is where
people purchase healthcare products. There are 11 jurisdictions analyzed that have an
ordinance in place prohibiting the sale of tobacco products at pharmacies.
Minimum Package Pricing/ Quantity Requirements/ No Free Samples or Discounts
Jurisdictions have imposed minimum pricing requirements and minimum packaging
requirements. The implementation of pricing requirements is that if tobacco products are
priced higher, then they are likely to be unaffordable by youth. Higher prices make
products less appealing and can make people use tobacco products less. Minimum
packing requirements is thought to have the same logic. Cigarettes are already required to
be sold in packs of 20 but cigars can be sold in singles. Some examples analyzed include:
minimum price for a pack of cigarettes to be no lower than $7 or $10; little cigars to be
sold in packs of five or more and to be priced no less than $7; and smokeless tobacco to
be no less than $10. Jurisdictions that have imposed minimum pricing and packaging
ordinances have also imposed discount restrictions to back up the minimum pricing
Report to Redding City Council September 12, 2024
Re: 9.1(a)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 5
requirement. Coupons and free samples are prohibited under State law. Six jurisdictions
analyzed have requirements on tobacco pricing and quantity packaging requirements.
Smoke Free Multi -Family Housing
Jurisdictions have set no smoking requirements for multi -family housing. This restriction
is in place to protect residents from second hand smoke, minimize fire risk, and provide
overall quality of life to residents. The restriction includes no smoking in the building and
in common areas with a designated smoking area away from the building or any units.
There are nine jurisdictions that were analyzed that have created an ordinance prohibiting
smoking in multi -family housing.
Other Regulations Found
• Tobacco retailer must obtain a use permit through the jurisdiction's planning
department to operate within a certain distance to a youth facility;
• No significant tobacco retailers. A significant tobacco retailer can be defined as their
primary purpose is to sell tobacco and tobacco related products;
• No significant tobacco retailers to operate within a certain distance to residential
property;
• No deliveries of tobacco products to be made by employees or by private delivery
drivers;
• No placing tobacco products or advertising within 5 feet of candy, snacks, and
nonalcoholic beverages;
• No advertising of tobacco products within 500 feet of a youth sensitive area; and
• No advertising of tobacco products on windows or advertising to be seen from
outside the establishment.
Majority of all jurisdictions analyzed that have imposed tobacco retailing restrictions allowed
legally operating tobacco retailers to continue to operate post adoption of their ordinance as long
as the tobacco retailer was in good standing. This included businesses that were within required
distances to youth facilities and within proximity to other tobacco retailers, and if a TRL cap was
initiated. Some offered grace periods such as San Jose, to sell off flavored tobacco which was
prior to the State banning flavored tobacco. Santa Maria required pharmacies to immediately
stop selling tobacco and San Luis Obispo County immediately required businesses to cease
selling ESDs. Further break down of ordinances and analysis can be found on the attached
Tobacco Retailer Regulation Comparison spreadsheet.
What is and is not working
The Council directed staff to follow up on what is and is not working. The jurisdictions that are
successfully running a TRL program, provide education, inspections, and enforcement, feel like
their ordinance is working to prevent youth access to tobacco products. If the jurisdiction has a
density limit, it prevents the over density of more tobacco retailers from operating. Jurisdictions
feel that to be able to back up enforcement with fines and TRL suspension and revocation assist
greatly in preventing retailers from being a bad actor. Fines allow the jurisdiction to immediately
issue a citation for when violations are found such as a business selling flavored tobacco. If a
business continues to sell flavored tobacco a jurisdiction can then issue a second citation and can
suspend their TRL or work towards full revocation. Many jurisdictions expressed the use of
discretion when deciding on the level of enforcement to be issued. It was reported that
Report to Redding City Council September 12, 2024
Re: 9.1(a)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 6
suspension and revocation of TRL can be stronger than fines but having all available options is
best.
The City of San Jose operates a decoy program and issues a citation amount of $2,500 for selling
to a youth. The San Jose City Code Enforcement Inspector felt like the fine amount should be
higher due to one business being fined twice for selling to a decoy on two different occasions.
The City of San Jose has smaller fine amounts for other violations such as selling flavored
tobacco. Other cities have set fine amounts up to $5,000, and include suspension and revocation
of the stores' TRL. A TRL suspension could have a higher business impact over a smaller fine
amount on a business because the store physically has to remove all tobacco products from their
store shelfs for a certain amount of time. Sonoma County has the ability to suspend a TRL and
issue a citation. Some jurisdictions are able to suspend a TRL for any violation of their Tobacco
Retail Ordinance. Jurisdictions with higher fines, suspensions and revocation of TRL are able to
effectively enforce tobacco restrictions to ensure retailers are always in compliance.
In the study that was performed, 2021 State of Tobacco Control: California Local Grades", for a
TRL ordinance to be successful in reducing the sale of tobacco to minors it should include:
• A sufficient fee for the TRL to cover administration and enforcement efforts;
• Permission to sell tobacco through an annual license that must be renewed annually;
• Include provisions against any state laws in ordinance; and
• Financial deterrent that includes fines, penalties, suspensions and revocation of the
license.
In the report Tobacco Retailer Licensing is Effective, 41 jurisdictions were analyzed in 2018 and
determined that youth sales rates dropped following the adoption of a strong tobacco retailer
licensing ordinance. This was determined from youth purchase surveys administered by local
agencies. The report indicates that a TRL alone will not decrease youth access but with
enforcement and education regarding the local regulations will always be needed. Six of the
jurisdictions that were analyzed were included this report (Davis, Elk Grove, Grass Valley,
Oroville, San Luis Obispo County, and Woodland).
City of Redding (City) Tobacco Retailer Landscape
In the City there are 119 tobacco retailers. Staff worked with the County of Shasta and the State
to obtain the actual amount of tobacco retailers to include sole proprietors, husband and wife co -
owners, and domestic partners. The below table shows the number of store types that hold a
CDTFA issued tobacco retailers license:
Redding Tobacco Retailers
Gas Station
39
Smoke Shop/ Significant Tobacco Retailers
29
Small Market/ Convenience Store
25
Liquor Store
8
Pharmacy
8
Super Market
7
Golf Course
2
Winery
1
Staff worked with the City's Information and Technology Department's Geographic Information
System personnel to map all tobacco retailer adresses and compare their distance to youth
Report to Redding City Council September 12, 2024
Re: 9.1(a)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 7
sensitive locations, and their distance to other tobacco retailers. Staff defined youth sensitive
locations as the same as in the City's cannabis ordinance which includes schools, parks, and
child care facilities. Of these stores there are 20 youth sensitive areas that are located within
1,000 feet of a tobacco retailer. There are 1.00 tobacco retailers that are located within 500 feet of
another tobacco retailer. The population density is one tobacco retailer for every 787 residents.
Local Enforcement
RPD received a grant earlier this year to perform decoy operations. RPD receives $1,500 per
operation and must perform five operations a year with each operation requiring 10-12 retailer
visits. To date, RPD has performed three tobacco decoy operations that included 41 decoy
attempt purchases of tobacco. In all, five sales were made by a youth decoy. One tobacco retailer
sold to a decoy twice on two different operations. The four stores are smoke shops and would be
considered a significant tobacco retailer. Of these four store stores, two are located within 500
feet of another tobacco retailer and none are located within 1,000 feet of a youth sensitive area.
In June of 2024 the CDTFA was in in the City doing inspections with Shasta County's Tobacco
Compliance Specialist and RPD. Their mission was to ensure tobacco retailers were properly
licensed through the State and have all proper invoices for their products dating back to a year.
They are also able to confiscate illegally imported tobacco and cannabis products. They are
unable to confiscate flavored tobacco which falls under the California Department of Public
Health (CDPH) and they did not perform underage decoy purchases. They inspected seven
tobacco retailers in Redding and found violations at all seven of the retailers. The violations
range from confiscation of illegally imported products, confiscation of cannabis products, and
confirmation of flavored tobacco. The seven stores inspected were all smoke shops. Two of these
stores were issued a citation and the total amount of confiscated illegal products exceeded
$9,000. Three of these seven retailers sold to a minor as part of RPDs decoy operations earlier
this year.
The Food and Drug Administration (FDA) performs random and unannounced decoy operations
and has their inspection logs publicly available on their website. From January 1, 2022, to July
16, 2024, there was one sale to a decoy out of 22 attempts. Their follow up procedure for a decoy
sale is to send a warning letter, then after another confirmed sale, the FDA can follow up with
civil penalties, injunctions, and criminal prosecution. The confirmed sale to a decoy was made at
a smoke shop or significant tobacco retailer.
How Kids are Targeted
Kids are targeted by tobacco companies in several different ways. The largest is advertising. The
U.S. Centers for Disease Control and Prevention reported that cigarette and smokeless tobacco
companies spent $8.2 billion in 2019 on advertising and promotional expenses"This includes
incentives to retailers by tobacco companies to offer price discounts, promotions, and stocking
certain brands. Lower prices and discounts are more appealing to lower income residents and
more appealing to youth. Tobacco products such as a pack of three small cigars can be found for
$1.19 in the City.
The advertising of tobacco products includes how they are packaged. The packaging of tobacco
products is made and designed similar to candy products. This can make it very appealing to
youth. The placement of tobacco products and advertising are typically placed near candy, soft
drinks, and adjacent to the cash register in places likely to be seen by youth. Advertisements can
also be strategically placed outside to be seen by youth passing by.
Report to Redding City Council September 12, 2024
Re: 9.1(a)--Accept Report and Provide Direction Regarding Tobacco Retailing Page 8
Flavors and ESDs are also more appealing to youth. Flavors can hide the distinct tobacco flavor
and can make products easier to inhale. Flavored tobacco products have been banned in the State
but flavored products are still being found in stores. ESDs come in a variety of designs, relatively
low in price, easily concealable, and have high nicotine content that can make it very addicting to
users.
Next Steps
If the Council would like to move forward with any potential tobacco retail ordinance and/ or
TRL program, staff can further analyze and prepare an ordinance to bring back to the Council at
a future date for possible adoption. This process will include necessary outreach with
stakeholders, work with the City Attorney's Office and any other necessary departments.
Environmental Review
This is not a project defined under the California Environmental Quality Act, and no further
action is required.
Council Priority/City Manager Goals
• Public Safety — "Work to improve all aspects of public safety to help people feel secure
and safe where they live, work, and play in the City of Redding."
Attachments
^Tobacco Staff Report February 6, 2024
^Tobacco Retailer Licensing is Effective September 2018
^California Youth Tobacco Survey -Shasta County Data
California Youth Tobacco Survey 2023 Annual Report
^Jurisdictional Data
I Clodfelter, R., Dutra, L. M., Bradfield, B., Russell, S., Levine, B., & von Jaglinsky, A. (2023). Annual results
report for the California Youth Tobacco Survey 2023. RTI International.
" County Grades. (2021). https://www.lung.org/getmedia/3b258a14-t355-42d0-9cac-18901cl802eb/state-of-
tobacco-control-california-local-grades.pdf
"' CDC. (2018, May 4). Tobacco Industry Marketing. Centers for Disease Control and Prevention.
https://www.cdc.gov/tobacco/data statistics/fact sheets/tobacco industry/marketing/index.htm
Tobacco Retailer Regulation Comparison
Is a Tobacco
Retailer
Number of
Fee amount for
Population
Distance requirement
Distance requirement from
Density
Jurisdiction
Notable Regulations
Tobacco
Tobacco Retail
Population
Density per 1
from youth sensitive
Notes
Fines /Penalties
License
Retailers
License?
Tobacco Retailer
facilities? If so, how far?
other tobacco retailers?
Restrictions?
Required?
Redding
N/A
No
119
N/A
93,600
787
N/A
N/A
N/A
N/A
N/A
1st violation = $100 2nd
City of Anderson
—No sale of flavored tobacco —No
No
22
No
11,300
627
No
No
No
N/A
violation = $200 3rd
tobacco advertising
violation = $500
Interim zoning ordinance adopted August2023
City of Shasta Lake
which requires a use permit for tobacco
No
11
N/A
10,370
1296
900 ft
N/A
N/A
Did not impact existing businesses
N/A
retailing within 900 feet of a youth sensitive
area
Performs inspections of all tobacco retailers
Shasta County
N/A
No
67
N/A
66,180
988
N/A
N/A
N/A
and provides education. Can refer violations
N/A
to the District Attorney's Office
1st Violation: $100
Butte County
N/A
Yes
48
Unknown
69,000
1438
N/A
N/A
N/A
Does not actively enforce due to funding
2nd Violation: $200
3rd Violation: $500
1st Violation: license
suspended for30 days, $100
—No sale of tobacco at pharmacies Pack
fine.
of Cigarettes = Not less than $7
2nd Violation:license
Pack of Little Cigars = Not less than $7
suspended for 60 days, $200
Sonoma Count y
Smokeless tobacco = not less than 10
$
Yes
*79
$505
130,770
1655
1,000 ft
N/A
1 retailer per
No tobacco retail licenses being issued until
fine.
Pack of Cigars = Not less than $7 (CPI
2,000 inhabitants
density is lowered
3rd Violation: license
adjustment)
suspended for 90 days, $500
`No Significant Tobacco Retailers
fine.
4th Violation: license revoked,
$500 fine.
1st Violation: license
`Little cigars = must be sold in packages over 5
suspended for 30 days, $100
—Pack of cigarettes = Price can not be lower
fine.
than $10 —Single
2nd Violation:license
Cigar = can not be lower than $10 or $5
No more
Not allowing any new tobacco retailers.
suspended for 60 days, $200
City of Sonoma
Discount/Coupons = can not be used
Yes
*10
$246
10,730
715
1,000 ft
500 ft
allowed. Set at
Maximum density of 15 addresses that allow
fine.
Pharmacies = Can not sell tobacco
15locations
tobacco retailing.
3rd Violation: license
`No Free samples `No
suspended for 90 days, $500
Sale of Flavored Tobacco —No
fine.
smoking in multi -unit housing
4th Violation: license revoked,
$500 fine.
$100 first violation
$250 second violation within
Santa Rosa
—No free samples —No
No
*119
N/A
178,120
1497
N/A
N/A
N/A
Considering density requirement 1 per 2,500
one year $500 for
smoking in multi -unit housing
each additional violation ithin
one year
—Parmacies can not sell tobacco —No
sale to delivery drivers or deliveries by store
-No sale of electronic smoking devices -No
free samples, coupons or discounts.
Petaluma
"'Little Cigars must be sold in packs of 5.
Yes
*39
$525
59,770
1533
1,000 ft
500 ft
1 retailer per
No new tobacco retailers
Suspension and revocation
—No single cigar sales unless over $10
2,000 inhabitants
-Cigarette pack (20 cigarettes) to be over $10.
(CPI adjustment)
-No sale of flavored tobacco products
—No smoking in duplexes or mutt -unit housing
—No free samples, discounts, or coupons
—No deliveries by employees and no deliveries
by private parties —No sale of
flavored tobacco products —No sale of
1st Violation: license
Electronic Smoking devices —Little
suspended for 30 days.
cigars must be sold in a pack of 5
2nd Violation: license
Sebastopol
—Single cigar must be $10 or more
Yes
*9
$68
7,520
537
1,000 ft
N/A
1 retailer per
No new tobacco retailers
suspended for 60 days.
Cigarettes (pack of 20) must be sold for $SO or
2,000 inhabitants
3rd Violation: license
more —Little cigars
suspended for one year.
not less than $2 per little cigar (CPI
4th Violation: license revoked.
adjustment) —No
pharmacies to sell tobacco —No
smoking in multi -unit housing
Cigars to be sold in minimum pack of 5.
-Chewing tobacco must be sold in packages of
5 units `Single
cigar to be $5 —Pack of
1st Violation: license
Cigarettes (20) to be $7 or more
suspended for 30 days.
—Little cigars to be $7 or more Package
2nd Violation: license
Windsor
of (5) cigars to be $7 or more `Chewing
Yes
*14
$350
26,340
2927
1,000 ft
N/A
1 per 2,000
N/A
suspended for 90 days.
tobacco of 5 units must be $7 or more (CPI
inhabitants
3rd Violation: Iicense
adjusted) `No Sale of of
suspended for one year.
flavored tobacco products
4th Violation: license revoked.
`Electronic smoking device sales prohibited
—No free samples, coupons or discounts
`No pharmacies to sell tobacco
1st Violation: license
suspended for 30 days.
2nd Violation: license
Healdsburg
`No pharmacies to sell tobacco
Yes
*11
$460
11,340
1031
N/A
N/A
N/A
N/A
suspended for 60 days.
—No smoking in multi -unit housing
3rd Violation: license
suspended for 180 days.
4th Violation: license revoked
1st Violation: license
suspended for 15 days. The
tobacco retailer shall
participate in a training or
Auburn
N/A
Yes
*17
$850
13,770
810
1,000 ft
500 ft
N/A
N/A
diversion program or pay a
penalty up to $1,000.
2nd Violation:license
suspended for 90 days.
3rd Violation: license revoked.
1st Violation: $100 penalty.
Loomis
N/A
No
*4
N/A
6,830
1708
1,000 ft
N/A
N/A
Did not impact existing businesses
2nd Violation:$200 penalty.
3rd Violation: $500 penalty.
1st violation: $250 - $1,000
—Restriction on significant tobacco retailers
Limit of 5
2nd Violation: $1,000-$2,500
Nevada City
Pack of cigars must be sold in a pack of 5
Yes
5
$325
15,670
3134
N/A
N/A
retailers for the
N/A
3rd violation: $2,500-$5,000.
"Single cigar must exceed $5
city
Public nuisance
Grass Valley
N/A
Yes
30
$100
14,010
467
N/A
N/A
N/A
N/A
Range from suspension of
tobacco license to revocation
-Smoke shop limit- requires use permit 1:4000
residents (zoning code). Defined as primary
smoke shops
Oroville
business purpose is tobacco or tobacco
Yes
39
$35
20,040
514
N/A
N/A
only 1 for every
N/A
Fines / Penalties
products. `No sale of
4,000 residents
flavors
`No Free Samples, discounts or coupons
Initial application
—No Sale of flavored tobacco
fee of $130 and
1 retailer per
Suspension or revocation of
Humboldt County
—No tobacco advertisements within 5 feet of
Yes
Unkown
68,000
Unknown
500 ft
500 ft
N/A
annual fee of
2,500 inhabitants
license
any candy, snacks, or nonalcholic beverages
$390
`No tobacco selling at pharmacies
lst violation: $100 2nd
Mendocino County
`No sale of flavored tobacco
Yes
Unkown
$350
Unknown
Unknown
N/A
N/A
N/A
N/A
violation: $200 3rd violation:
$500
Include: administrative
Fort Bragg
N/A
Yes
*16
$187
6,980
436
N/A
N/A
N/A
N/A
penalities, suspension, and
revocation of license
—No advertisements of tobacco products within
Del Norte County
500 ft of a youth area `No
yes
11
No Fee
21,070
1915
N/A
N/A
N/A
N/A
advertising within 5 ft of candy, snacks, and
nonalcoholic beverages
—No pharmacies may sell tobacco
Range from issuance of an
Cresent City
Can not advertise tobacco products in a
Yes
8
No Fee
6,670
513
N/A
N/A
1 retailer per
Did not impact existing businesses
administrative citation,
publicly visible location within 500 feet of a
2,500 inhabitants
suspension, &revocation of
youth sensitive area
license
Merced County
N/A
No
Unkown
N/A
60,827
Unknown
N/A
1,000 ft
N/A
Did not impact existing businesses. No
N/A
Enforcement
—No sale of electronic smoking devices or
electronic device fluid -No
sale of flavors —No free
samples, discounts or coupons
—No pharmacies to sell tobacco —Minimum
Package Size for Little Cigars and Cigars = 10
1st Violation: license
Pack of 6 cigars shall be minimum of $5.
suspended for 5 days.
—Cigarettes (20 per package) shall not be sold at
$520 initial and
600 ft also ft from a
1 per 1,750
2nd Violation: license
Benicia
a price less than $7.
Yes
*g
$468 for renewal
27 130
3014
1,000 ft
cannabisis r retailer
inhabitants
Did not impact existing businesses
suspended for 10 days.
—Little cigars shall not be sold at a price less
3rd Violation: license shall be
than $7 per package.
suspended for one year.
-Cigars shall not be sold at a price less than $5
4th Violation: license revoked.
per cigar.
CPI anual adjustment to single price points.
`No pharmacies to sell tobacco
—No smoking in multi -unit housing
—No deliveries or sale to delivery drivers
Notes: Working on updating ordinance to
First violation $100 Second
Vallejo
or discounts coupons "'No free samples, ,
No
* 76
N/A
126,090
1659
N/A
N/A
N/A
include restrictions on location distance from
violation $200 Third
`No smoking in multi -unit housing
youth oriented sites.
violation $500
-No sale of flavors —No
sale of electronic smoking devices includes
Per County Health, no funding to actively
San Benito County
No
Unkown
N/A
16,790
Unknown
N/A
N/A
N/A
enforce and are pursuing grant to update
$250
unincorpoarted and incorporated areas of the
tobacco policies and enforce in County
county
Hollister
—No sale at pharmacies
Yes
*23
N/A
41,678
1812
N/A
N/A
N/A
No active enforcement
Penalties of up to $1,000 for
each violation.
1st Violation: license
suspended for 30 days and
citation.
2nd Violation: license
suspended for 60 days and
San Luis Obispo County
`No sale of electronic smoking devices unless
Yes
Unknown
$1,005
121,960
Unknown
N/A
N/A
N/A
N/A
citation.
have premarket approval by the FDA
3rd Violation: license
suspended for 90 days and
citation.
4th Violation: license revoked
and citation.
First violation $100 Second
Town of Paradise
—No sale of flavors
No
10
N/A
4,760
476
N/A
N/A
N/A
N/A
violation $200 Third
violation $500
Arroyo Grande
N/A
Yes
*17
$161
18,440
1085
N/A
N/A
N/A
No enforcement due to lack of funding
Range from suspension to
revocation
—No sale at pharmacies —No
free samples, coupons or discounts
1st Violation: shall pay a
—Little cigars must be sold in packs of 5 and no
$1,000 fine. 2nd Violation:
less than $5 —Cigar
Initial fee of $505
license shall be suspended for
Santa Maria
must 6e sold in packs of 5 or a single cigar price
Yes
81
and renewal fee
109,700
1354
300 ft
500 ft
1 per 1,500
Dedicated Park Ranger. Did not impact
15 days.
of $5. "'Pack of
of $335
inhabitants
existing businesses
3rd Violation: license shall be
cigarettes must be no less than $7 (CPI
supended for 30 days.
adjusted) —No sale
4th Violation: license revoked.
of flavored tobacco products
Visalia
N/A
No
*78
N/A
141,380
1813
750 ft
750 ft inside or outside city
N/A
N/A
N/A
limits
Chico
N/A
No
95
N/A
101,470
1068
N/A
N/A
N/A
N/A
N/A
Roseville
N/A
No
*76
NA
147,770
1944
NA
NA
NA
N/A
N/A
Fairfield
N/A
No
*59
N/A
119,881
2032
N/A
N/A
N/A
N/A
N/A
Tracy
—Significant tobacco retailers must be 600 ft
No
*53
N/A
93,000
1755
600 ft
N/A
N/A
N/A
N/A
from residential zoning
Folsom
—No smoking in muti-unit housing
No
*36
N/A
80,450
2235
N/A
N/A
N/A
N/A
N/A
Vacaville
N/A
No
*54
N/A
102,380
1896
N/A
N/A
N/A
N/A
N/A
Lodi
N/A
No
*55
N/A
66,340
1206
N/A
N/A
N/A
N/A
N/A
Davis
No sale of flavors
Yes
*26
Unknown
66,850
2571
N/A
N/A
N/A
Adoption of Yolo County's tobacco retailRevocation
of permit and fines
ordinance
Turlock
N/A
No
*46
N/A
72,740
1581
N/A
N/A
N/A
N/A
N/A
Woodland
No sale of flavors
Yes
*24
$473
61,030
2543
N/A
N/A
N/A
Adoption of Yolo County's tobacco retailRevocation
of permit and fines
ordinance
Suspension or revocation of
City of Stockton
—No sale of flavors with the exception of
Yes
* 232
$102
320,800
1383
600 ft
600 ft
N/A
Did not impact existing businesses
license. 1st violation = $1,000
hookah lounges
2nd violation = $2,000 3rd
violation = $3,000
Dedicated Code Enforcement Inspector, Grace
Revocation and fines ranging
City of San Jose
`No sale of flavors with the exception of
Yes
502
$697
1,013,000
2018
1,000 ft
500 ft
N/A
period for businesses to sell stock of flavored
from $500 - $2,500 depending
hookah lounges
tobacco.
on violation
—No sale of flavors —No
$250 - $1,000, suspension and
Livermore
sale of electronic smoking devices or electronic
Yes
62
$969
90,000
1452
1,000 ft
N/A
N/A
Did not impact existing businesses
device fluid (unless FDA approved)
revocation of license
Initial fee $100,
Alturas
—No sale of flavors
Yes
6
renewal fee of
2,715
453
N/A
N/A
N/A
N/A
Fines from $250-$1,000.
$25
Revocation of License
Elk Grove
N/A
Yes
*83
$270
178,440
2150
N/A
N/A
N/A
N/A
DenialSuspension, and
revocation. $250 citation
Santa Clara
—No smoking in multi -unit housing
No
*72
N/A
131,060
1820
N/A
N/A
N/A
N/A
N/A
Sunnyvale
—No smoking in multi -unit housing —No
No
*52
N/A
151,960
2922
N/A
N/A
N/A
N/A
N/A
sale of flavors
*Approximate number pulled from California Department of Tax and Fee Administration website. Does not include licenses issued to individuals (sole proprietors, married co owners, and domestic partners). Did not receive confirmation from jurisdiction.
|nCalifornia, 144communities have adopted strong local
tobacco retailer licensing ordinances inoneffort toreduce
illegal sales nftobacco products hominors. That includes the
following four components:
* License that all retailers must obtain |norder tosell
tobacco products and that must be renewed annually,
*Afee set high enough tosufficiently fund aneffective
program including administration ofthe program and
enforcement efforts, Anenforcement plan, that includes
compliance checks, should beclearly stated.
a Coordination of tobacco regulations so that aviolation
mfany existing local, state orfederal tobacco regulation
violates the license.
9Afinancial deterrent through fines and penalties including
the suspension and revocation ufthe license. Fines and
penalties should be outlined |nthe ordinance.
The table below lists illegal sales rates bominors before
and after astrong licensing law was enacted. These sales
rates were determined byyouth tobacco purchase surveys
administered by local agencies, It is important to note
that results from the youth tobacco purchase surveys
have number ofdifferent factors that influence change.
Results from these surveys are somewhat dependent
oncertain factors that differ |neach community, such as
the age ofthe youth and the number ofstores surveyed.
Furthermore, other factors that could impact these rates
include statewide laws, other city policies, orstatewide
ornational media campaigns, The data below shows that
these decreases occur after atobacco retailer license has
A���N ����N�������W�0�
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N CALIFORNIA
been established. The results overwhelmingly demonstrate
that local tobacco retailer licensing ordinances with strong
enforcement provisions are effective. Rates oƒillegal
tobacco sales tominors have decreased, often significantly,
in all municipalities with a strong tobacco retailer licensing
ordinance where there |sbefore and after youth sales rate
data available. However, alicensing ordinance byitself will
not automatically decrease sales rates; proper education
and enforcement about the local ordinance and state youth
access laws are always needed,
Before and after youth sales rate data isavailable for the
following 41California communities with strong licensing
ordinances- Banning, Baldwin Park, Beaumont, Berkeley,
Burbank, Calabasas, Carpentaria, Coachella, Contra Costa
County, Corona. Davis, Delano, Desert Hot Springs, B
Cajon, Elk Grove, Goleta, Grass Valley, Grover Beach,
Kern County, La Canada F||ntridge, Los Angeles County,
Morgan Hi||, K4urrieta' Nonco,Orovi||e, Pasadena, Riverside'
Rosemead, Sacramento, Sacramento County, San Fernando,
Sao Francisco, San Luis Obispo, San Luis Obispo County,
Santa Barbara County, Sonoma County, Tehachapi, Vista,
Winters, Woodland, ondY6|o County.
For more resources onthese ordinances, including
the Matrix ofStrong Local Tobacco Retailer Licensing
Ordinances with policy and enforcement details for every
strong ordinance in the state, visit:
For model tobacco retailer licensing ordinance language,
visit Changel-ab Solutions at cbinZaL-�ra-aWfQ12!j-QrZ
The Center for Tobacco Policy aOrganizing |American Lung Association inCalifornia
1so:|Street, Suite oo1.Sacramento, cAvSoz4|Phone: (9a)s54.su64|Fax: (916) 4*2.8585
(IL CENTER F t ;il E $..+CAC O i- Ol_I$_Y & ORGANIZING Page `" of 2
Table of youth sales rates before and after the adoption of a strong tobacco retailer licensing ordinance
Banning
August 2006
$350
77%
21%
Baldwin Park
October 2008
$342
34%
9%
Beaumont
December 2006
$350
63%
20%
Berkeley
December 2002
$427*
38%
4.2%
Burbank
February 2007
$235
26.7%
5%
Calabasas
June 2009
$0*
30.8%
5%
Carpentaria
April 2012
$379
26%
7%
Coachella
July 2009
$350
69%
11%
Contra Costa County
January 2003
$160*
37%
13%
Corona
October 2005
350
50%
17%
Davis
August 2007
$377
30.5%
12%
Delano
June 2008
$165
23%
5.6%'
Desert Hot Springs
August 2007
$350
48%
4%
El Cajon
June 2004
$698
40°%
1%
Elk Grove
September 2004
$270
17%
16.7%
Goleta
May 2014
$534
211
7%
Grass Valley
November 2009
$100
27%
0%
Grover Beach
September 2005
$244
46%
17%
Kern County
November 2006
$165
34%
13.3%
La Canada Flintridge
June 2009
$50*
47.1%
0%
Los Angeles County
December 2007
$235
30.6%
8%
Morgan Hill
April 2014
$125
15%
0%
Murrieta
May 2006
$350
31%
7%
Norco
March 2006
$350
40%
6%
Oroville
March 2013
$30
22.6%
0%
Pasadena
January 2004
$225
29%
0%
Riverside
May 2006
$350
65%
31%
Rosemead
July 2017
$235
32%
22%
Sacramento
March 2004
$324
27%
15.1%
Sacramento County
May 2004
$287
21%
7.1%
San Fernando
October 2008
$250
38.5%
3%
San Francisco
November 2003
$175*
22.3%
13.4%
San Luis Obispo
August 2003
$255
17%
13%
San Luis Obispo County
October 2008
$342
33.3%
5%
Santa Barbara County
November 2010
$235
21%
3%
Sonoma County
April 2016
$350
18.4°%0
1.3%
Tehachapi
February 2007
$165
8%
16,7%
Vista
May 2005
$250
39%
1.9%
Winters
January 2016
$377
47%
19%
Woodland
June 2015
$377
32%
8%
Yolo County
May 2006
$377
28%
7.8%
*City or County fee does not fully cover administration and enforcement of the tobacco -retailer license. Rather,
the fee is supplemental with another
stable source of funds, such as the Master Settlement
Agreement (MSA) funds or general funds. See the Center's
Matrix of Strong Local Tobacco Retailer
Licensing Ordinances for full details about the administration
and enforcement of these ordinances.
.
a1531
Center foTobacco Policy OrganizingI Amercan LungAssociation in California
Njlllo��The
l Street, Suite 201, Sacramento,CA 95814Phone:(91L)554.5864 Fax:(91b)4428585A
0018California Department of pubic Health. Funded under contract #24-10013.
The California Youth Tobacco Survey (CYTS) is a project of the California Department of Public
Health's California Tobacco Prevention Program. It aims to obtain statewide estimates of use for
various tobacco products by middle and high school students in California to inform statewide
prevention and intervention efforts. For Shasta County in 2023, 1,022 students in 10th or 12th
grades at 6 high schools completed the survey. This report summarizes their key responses.
Current Use of Any Tobacco Product by Demographic or Risk Factors
Approximately 16.8% of students in Shasta County reported
0 using a tobacco product in the last 30 days. This is higher
than the average use in California of 7.3%.tt 0
30%
ME
0%
Istimate is unstable. MThe difference between this county's and all other counties' estimates was statistically significant to p < 0.05.'All races and ethnicities reported by each respondent are shown. For example, someone who reports
being Black and Hispanic is shown in both the Black and Hispanic categories. 'No estimates reported for other gender identities due to low response rates.
Ever and Current Use by Product
0%
45.7 Ever Used Product t Currently Use Product
22.7
37.0 37.1
30.8
16.5 fM 14.8
M M 11.4 = 12.4
40%
0%
51.3% of students who ever vaped tried to
stop using within the last year.
Most common way students who vope Among students who vape, the most common
• • • report getting their vapes, pods, or e-liquid. E-S,
reason for voping.
Buy them Ask someone Someone Ask someone Take them Get them
myself to buy them gives them for them from some other
for me to me someone way
tEstimate is unstable.
10%
0%
40%
0%
To relax or relieve To fit in/peer For the nicotine To have a good
stress and anxiety pressure buzz time with my
friends
82.2% of students who ever used tobacco reported trying
vapes as their first tobacco product.
On average, students first reported using tobacco at age 13.
Self -reported likelihood of trying a product if it were offered to them by the student's best friend
(among never users of the product).
It looks cool
Alcohol Marijuana Vapes Cigarettes LCCs Smokeless HTPs Hookah Pouches
tCCs = little cigars and cigarillos. HTPs = Heated tobacco products/heat-not-burn. Pouches = nicotine pouches.
Alcohol and marijuana use are included for comparison only and are not included in rates of overall tobacco use.
a
80%
0%
Percent responding `Ahst" or "All" to "How
many students at your school use the following
products?"
Alcohol Marijuana Vapes Cigarettes
80%
0%
Last 30-day prevalence of use of
tobacco products at school.
Saw tobacco used Saw someone caught Used tobacco at school
using tobacco (among tobacco users)
Alcohol and marijuana use are included for comparison only and are not included in rates of overall tobacco use. tEstimate is unstable.
80%
0%
Levels of use at school and consequences for use for each product in the past 30 days.
Alcohol Marijuana Vapes Cigarettes LCCs
tEstimate is unstable. LCCs = Little cigars and cigarillos. Alcohol and marijuana use are included for comparison only and are not included in rates of overall tobacco use.
Reported " oinetimes;' "Often,' or "A IwaysEMER"
seeing someone on social media use these products
in the last 30 days.
80%
For more information on
tobacco use in California,
see the full California Youth
Tobacco Suryp re ort. This can
be found by searching online
for CDPH Tobacco Control Fact
Sheets and Reports.
0%
Marijuana Vapes Cigarettes
Marijuana use is included for comparison only and is not included in rates of overall tobacco use.
� on
RTI Project Number
0217905.004
March 2024
Prepared for
California Department of Public Health,
California Tobacco Prevention Program
Prepared by
Rachel Clodfelter, MPH
Lauren McCarl Dutra, ScD, MA
Brian Bradfield, BA
Sara Russell, MS
Burton Levine, PhD
Annette von Jaglinsky, MPH
RTI International
2150 Shattuck Avenue, Suite 800
Berkeley, CA 94704
Suggested citation: Clodfelter, R., Dutra, L. M., Bradfield, B., Russell, S., Levine, B., & von Jaglinsky, A. (2023).
Annual results report for the California Youth Tobacco Survey 2023. RTI International.
RTI International is a trade name of Research Triangle Institute.
RTI and the RTI logo are U.S. registered trademarks of Research Triangle Institute.
Contents
Executive Summary
1. Tobacco Use Behavior, Overall and for Priority Populations
1-1
1.1
Tobacco Use Among High School Respondents--------------.
1-1
1.2
Frequency ofTobacco Use .......................................................................
1-2
1.3
Tobacco Use bvGender Identity ...............................................................
1-3
1.4
Tobacco Use bvRace/Ethnicity .................................................................
1-4
1.5
Tobacco Use bvGrade ............................................................................
1-0
1.6
Tobacco Use bvkGBTQ+Status ...............................................................
1-6
1.7
Tobacco Use bvGeneral Mental Health ......................................................
1-7
1.8
Po|ytobacooUse .....................................................................................
1-8
1.9
TobaccoUsebvExpehenceeofDiacrrninaUon--------------..
1-9
1.10 VapingCessation ..................................................................................
1-12
1.11
Summary .............................................................................................
1-14
2. Use mfFlavored Tobacco Products 2-1
2.1 Flavored Tobacco Use ............................................................................. 2-1
2.2 Flavored Tobacco Use bvDemographics .................................................... 2-2
2.3 Use ofSpecific Flavored Tobacco Products by Demographics -------- 2-3
2.4 Use ofSpecific HavorTypea----------------------..2-7
2.5 Perceived Accessibility ofFlavored Tobacco Products-----------.. 2-9
2.0 Summary .............................................................................................. 2-1
3. Access WmVapes and Cigarettes 3-1
3.1 Acquisition ofVapee............................................................................... 3-1
3.2 Acquisition ofCigarettes ......................................................................... 3-2
3.3 Perceived Accessibility ofVapes............................................................... 3-2
3.4 Perceived Access for Cigarettes ................................................................ 3-S
3.5 Summary ............................................................................................. 3-1O
Im
^&. Secondhand Exposure and Other Environmental Influences 4-1
4.1 Exposure toSecondhand Vapor and Tobacco Smoke inCar nrRoom and
Outside................................................................................................ 4-1
4.2 Exposure to Secondhand Vapor and Tobacco Smoke by Race/Ethnicity .......... 4-4
4.2.1 IndOors....................................................................................... 4-4
4.2.2 Outside ....................................................................................... 4-b
4.3 Home Bans onVapingand Tobacco Smoking ............................................. 4-8
4.4 Exposure to Vape and Cigarette Advertisements in Last 30 Days .................. 4-11
4.5 Summary ............................................................................................. 4-13
S. Susceptibility to Future Tobacco Use and Perceptions of Va-ng and
Smoking 5-1
5.1 Susceptibility toVapma, Cigarettes, and UCCa by Dernographics------.. 5-1
5.2 Susceptibility to Vape and Cigarette Use by Peer Vaping and Srnoking........... 5-4
5.3 Reasons for Vaping................................................................................ 5-5
5.4 Adult Disapproval nfVapingand Smoking .................................................. 5-6
5.5 Peer Disapproval ofVapingand Smoking ................................................... 5-7
5.6 Summary .............................................................................................. 5-9
6. Tobacco Endgame Attitudes 6-1
7. Geographic Differences 7-1
7.1 Rurality ................................................................................................ 7-1
7.2 County -Level Estimates .......................................................................... 7-2
7.3 Reoion7-9
S. MarijuanaUse0-2
8.1 Marijuana Use ....................................................................................... 8-2
8.2 Marijuana Use and Tobacco Co -use.................................... 8-3
8.3 Exposure to Secondhand Marijuana Smoke in Last 2 VVeaks............... 8-5
8.4 Acquisition ofMarijuana .......................................................................... 8-7
8.5 Summary .............................................................................................. 8-8
iv
9. Changes in Tobacco Use Between 2022 and 2023 9-1
9.1 Tobacco Product Use.............................................................................. 9-1
9.2 Flavored Tobacco Product Use.................................................................. 9-1
9.3 Current Tobacco Use by Demographics..................................................... 9-2
9.4 Marijuana Use and Marijuana Tobacco Co -use ............................................ 9-7
9.5 Summary..............................................................................................9-7
10. 8th-Grade Tobacco Use 10-1
10.1 Tobacco Use among 8th-Grade Respondents.............................................10-1
10.2 Flavored Tobacco Use among 8th-Grade Respondents................................10-2
10.3 Exposure to Secondhand Vapor and Tobacco Smoke in Last 2 Weeks
Among 8th-Grade Respondents...............................................................10-3
10.4 Access to Vapes and Cigarettes Among 8th-Grade Respondents ...................10-4
10.5 Marijuana Use Among 8th-Grade Respondents..........................................10-6
10.6 Exposure to Secondhand Marijuana Smoke in Last 2 Weeks ........................10-6
10.7 Summary.............................................................................................10-7
11. Conclusion 11-1
11.1 Implications.........................................................................................11-2
Appendix
A: List of Terms
A-1
B: Survey Methodology of 2023 California Youth Tobacco Survey B-1
v
Figures
Number Page
1. Map of County Groups................................................................................. 7-3
vi
Number
Page
1-1.
Prevalence ofEver and Current Use of Tobacco Products Among High School
Respondents..............................................................................................
1-3
1-3.
Frequency of Current Use Among High School Respondents Who Were
Currently Using a Given Tobacco Product........................................................
1-2
1-3.
Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Gender Idenbty...................................................................
1-3
1-4a.
Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Race/Ethnicity ....................................................................
1-4
1-4b.
Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Race/Ethnicity ....................................................................
1-5
1-5.
Prevalence of Current Use of Tobacco Products Among High School
Respondents, by {5rada................................................................................
1-6
1-6.
Prevalence of Current Tobacco Use Among High School Respondents, by
UGBTQf5tatus...........................................................................................
1-7
1-7.
Prevalence of Current Use of Tobacco Products Among High School
Respondents, by General Mental Haa|th..........................................................
1-8
1-8.
Prevalence of Current Pu|ytobacco Use Among High School Respondents
Currently Using Tobacco, by Gender Identity, Race/Ethnicity, Grade, and
UGBTO+ Status...........................................................................................
1-8
1-9.
Prevalence of Experiences of Discrimination in the Last Month Among High
School Respondents --...-----.--....—..—..—.--..—.-1-1O
1-10.
Prevalence of Experiences of Discrimination in the Last Month Among High
School Respondents, by Currant Tobacco Use .................................................
1-1O
1-11.
Perceived Reasons for Experiencing Discrimination in the Last Month Among
High School Respondents, by Currant Tobacco User Status ----------1-11
1-12.
Percentage of Respondents Who Reported Attempting to Quit Vaping in the
Last 12 Months Or Intending to Quit Vdping in the Next 30 Days /\rnOng
Currently Veping High School Respondents ....................................................1-13
2-1.
Descriptive Analysis of Current Flavored Tobacco Product Use by Product,
Among Respondents Currently Using Tobacco .................................................
2-1
2-2.
Prevalence of Current Use of Any Flavored Tobacco Among High School
Respondents Who Reported Currently Using These Products, by Gender
Identity, Race/Ethnicity, Grade, and U3BTD+ Status ................................,.......
2-2
2-3.
Prevalence of Current Flavored Tobacco Product Use Among High School
Respondents Who Reported Currently Using Each Tobacco Product by Gander
Identity.....................................................................................................
2-4
2-4a.
Prevalence of Current Flavored Tobacco Product Use Among High School
Respondents Who Reported Currently Using Each Tobacco Product by
2-4b. Prevalence of Current Flavored Tobacco Product Use Among High School
Respondents Who Reported Currently Using Each Tobacco Product by
Race/Ethnicity ............................................................................................
2-5
2-5.
Prevalence of Current Flavored Tobacco Product Use Among High School
Respondents Who Reported Currently Using Each Tobacco Product byGrade .......
2-6
2-6.
Prevalence of Current Flavored Tobacco Product Use Among High School
Respondents Who Reported Currently Using Each Tobacco Product, by
bGBTQfStatus...........................................................................................
2-7
2-7a.
Prevalence of Endorsing Specific Flavors Among High School Respondents
Who Reported Currently Using Each Tobacco Product -------------
2-7
2-7b.
Prevalence of Endorsing Specific Flavors Among High School Respondents
Who Reported Currently Using Each Tobacco Product -------------
2-8
2-8.
Prevalence of Perceiving That it was Easy to Access Flavored Tobacco
Products Among High School Respondenta------------------
2-1
3-1.
Methods of Accessing Vapee Among High School Respondents Who Were
Currently Vaping, by Grade .......................................
3-1
3-2.
Methods of Accessing Cigarettes Among High School Respondents Who Were
Currently Smoking Cigarettes, by Grade.............................
3-1
3-3.
Prevalence of Perceiving That It Was Easy to Access Vapas Among High
School Respondents, by Vaping Status..............................
3-2
3-4.
Prevalence of Perceiving That It Was Easy to Access Vepas from a Store
Among High School Respondents, by Vaping Status and Gender Identity,
Race/Ethnicity, Grade, and UGBTQ+ Status.....................................................
3-3
3-5.
Prevalence ofPerceiving That ItWas Easy toAccess Vapesfrom the Internet
Among High School Respondents, by Vaping Status and Gender Identity,
Race/Ethnicity, Grade, and UGBTOf Status.....................................................
3-4
3-6.
Prevalence of Perceiving That It Was Easy to Access Vapas from Someone
Else Among High School Respondents, by Vaping Status and Gander Identity,
Race/Ethnicity, Grade, and LGBTDf 8tatus.....................................................
3-5
3-7.
Prevalence of Perceiving That It Was Easy to Access Cigarettes Among High
School Respondents, by Cigarette Smoking Status...........................................
3-6
3-8.
Prevalence of Perceiving That It Was Easy to Access Cigarettes from a Store
Among High School Respondents, by Cigarette Smoking Status and (Sender
Identity, Race/Ethnicity, Grade, and UGBTQf Status ........................................
3-7
3-9.
Prevalence ofPerceiving That ItWas Easy toAccess Cigarettes from the
Internet Among High School Respondents, by Cigarette Smoking Status and
Gender Identity, Race/Ethnicity, Grade, and LGBTO+ Status .............................
3-8
3-10.
Prevalence of Perceiving That It Was Easy to Access Cigarettes from Someone
Else Among High School Respondents, by Cigarette Smoking Status and
Gender Identity, Race/Ethnicity, Grade, and UGBTQ+ Status .............................
3-9
4-1.
Prevalence of Last-2-Week Exposure to Vapor and Tobacco 5rnohe in Car or
Room Among High School Respondents, by Vaping and Tobacco Smoking
4-2. Prevalence ofLast-2-VVeakExposure toVapor and Tobacco Smoke Outside
Among High School Respondents, by Vaping and Tobacco Smoking Status.......... 4-3
4-3. Prevalence ofLast-O-Month Exposure toTobacco Smoke in Multiunit Housing
Among High School Respondents Living in Multiunit Housing ............................. 4-3
4-4. Prevalence of Last-2-Week Exposure to Vapor or Tobacco Smoke in a Car or
Room Among High School Respondents, by Race/Ethnicity ................................ 4-4
4-5.
Prevalence of Last-2-Week Exposure toVapor in Car or Room Among High
School Respondents, by Vaping Status and Race/Ethnicity ................
4-5
4-6.
Prevalence of Last-2-Week Exposure to Tobacco Smoke in Car or Rnnnn
Among High School Respondents, by Tobacco Smoking Status and
Race/Ethnicity ............................................................................................
4-5
4-7.
Prevalence of Last-2-Week Exposure to Vapor or Tobacco Smoke Outside
Among High SChO0| Respondents, by RdC8/EthniCity.........................................
4-5
4-8.
Prevalence of Last-2-Week Exposure to Vapor Outside Among High School
Respondents, by Vaping Status and Race/Ethnicity ..........................................
4-7
4-9.
Prevalence of Last-2-Week Exposure to Tobacco Smoke Outside Among High
School Respondents, by Tobacco Smoking Status and Race/Ethnicity..................
4-8
4-10.
Prevalence of Complete Horne Bans on Vaping Among High School
Respondents, by Current Use of Vapea...........................................................
4-9
4-11.
Prevalence of Complete Horne Bans on Tobacco Smoking Among High School
Respondents, by Current Use of Smoked Tubacco............................................
4-9
4-12.
Prevalence of Complete Horne Bans on Vaping and Tobacco Smoking Among
High School Respondents, by Race/Ethnicity ..................................................4-10
4-13.
Prevalence of Complete Horne Vaping Bans Among High School Respondents,
by Vaping Statue and Race/Ethnicity .............................................................
4-10
4-14.
Prevalence of Complete Horne Bans on Tobacco Smoking Among High School
Respondents, by Smoking Status and Race/Ethnicity .......................................
4-11
4-15.
Prevalence of Having Favorite Vaping Advertisement Among High School
Respondents, by Vaping Status ....................................................................
4-12
4-16.
Last-30-Day Social Media Exposure to Vaping Among High School
Respondents, by Vaping Status ....................................................................
4-12
4-17.
Last-30-day Social Media Exposure to Smoking Among High School
Respondents, by Smoking Status ..................................4-13
4-18.
Attention Paid to Social Media Posts About Vaping Among High School
Respondents, by Vaping Status ....................................................................
4-13
5-1.
Susceptibility to Vapas, Cigarettes, and/or LCCs Among High School
Respondents Who Had Never Used One or More of These Products, by Gender
Identity, Race/Ethnicity, Grade, UGBTO+ Status, and General Mental Health ........
5-2
5-2.
Proportion of High School Respondents Who Had Never Vaped, Never Smoked
Cigarettes, and/or Never Smoked LCCo Who Were Susceptible to Future Use
of These Products, by Gender Identity, Race/Ethnicity, Grade, L{SBTOf Status,
5-3. Prevalence of Susceptibility to Vaping Among High School Respondents Who
had NeverVaoad, byFriend Vaping Status —.—.-------.--....-5-4
5-4. Prevalence of Susceptibility to Cigarette Smoking Among High School
Respondents Who Had Never Smoked Cigarette, by Friend Smoking Status......... 5-5
5-5. Reported Reasons for Vaping Among High School Respondents Who Were
CurrentlyVaping ......................................................................................... 5-5
5-6. Percentage of High School Respondents Who Believed That Adults Would Feel
Negatively About Them Vaping and Smoking, by Demographics ......................... 5-6
ix
5-7. Percentage of High School Respondents Who Believed That Close Friends and
Other Respondents at School Would View Vaping Negatively, by Vaping Status.... 5-7
5-8. Percentage of High School Respondents Who Believed That Close Friends and
Other Respondents at School Would View Smoking Negatively, by Smoking
Status....................................................................................................... 5-7
5-9. Percentage of High School Respondents Who Believed That Close Friends or
Other Respondents Would Feel Negatively About Them Smoking Cigarettes,
byDemographics........................................................................................
5-8
6-1.
Agreement with Tobacco Endgame Policies Among High School Respondents,
by Vaping Status and Cigarette Smoking Status ..............................................
6-1
6-2.
Agreement With Tobacco Endgame Policies Among High School Respondents,
byDemographics........................................................................................
6-2
7-1.
Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Rurality..............................................................................
7-1
7-2.
Percentage of Respondents Who Reported Intending to Quit Vaping in the
Next 30 Days Among High School Respondents Who Were Currently Vaping,
byRurality.................................................................................................
7-2
7-3.
Prevalence of Ever and Current Use of Any Tobacco Products Among High
School Respondents, by County Grouping.......................................................
7-3
7-4a.
Prevalence of Current Use of Vapes, Cigarettes, and LCCs Among High School
Respondents, by County Grouping.................................................................
7-6
7-4b.
Prevalence of Current Use of Cigars, Hookah, and Smokeless Tobacco Among
High School Respondents, by County Grouping ................................................
7-7
7-4c.
Prevalence of Current Use of Heated Tobacco Products and Nicotine Pouches
Among High School Respondents, by County Grouping .....................................
7-8
7-5.
Prevalence of Ever and Current Use of Any Tobacco Products Among High
School Respondents, by Region.....................................................................
7-9
7-6.
Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Region..............................................................................7-10
8-1.
Prevalence of Marijuana Use Among High School Respondents, by Gender
Identity, Race/Ethnicity, Grade, and LGBTQ+ Status ........................................
8-2
8-2.
Usual Mode of Marijuana Use Among High School Respondents Who Reported
Currently Using Multiple Marijuana Products ....................................................
8-3
8-3.
Prevalence of Current Marijuana -Only Use and Current Co -Use of Marijuana
and Any Tobacco Product Among High School Respondents, by Gender
Identity, Race/Ethnicity, and Grade...............................................................
8-4
8-4.
Prevalence of Current Co -Use of Marijuana and Tobacco Among High School
Respondents Currently Using Marijuana, by Tobacco Product Currently Used .......
8-5
8-5.
Prevalence of Last-2-Week Exposure to Marijuana Smoke in Car or Room or
Outside Among High School Respondents, by Race/Ethnicity .............................
8-6
8-6.
Prevalence of Last-2-Week Exposure to Marijuana Smoke in Car or Room
Among High School Respondents, by Race/Ethnicity and Marijuana Use Status ....
8-6
8-7.
Prevalence of Last-2-Week Exposure to Marijuana Smoke Outside Among
High School Respondents, by Race/Ethnicity and Marijuana Use Status ...............
8-7
8-8.
Method of Acquiring Marijuana Among High School Respondents Currently
UsingMarijuana..........................................................................................
8-8
x
9-1. Prevalence of Ever and Current Tobacco Product Use by Year Among High
9-2. Prevalence of Flavored Tobacco Product Use by Year Among High School
Students Who Were Currently Using Each Product ........................................... 9-2
9-3.
Prevalence ofCurrent Any Tobacco Use byYear and by Gander Identity
Among High School Students ........................................................................
9-2
9-4.
Prevalence of Current Vaping, Cigarette Smoking, and LCC Smoking by Year
and byGender Identity Among High School Students .......................................
9-3
9-5.
Prevalence of Current Any Tobacco Use byYear and by Race/Ethnicity Among
HighSchool Students ...................................................................................
9-3
9-5.
Prevalence ofCurrent Vaping, Cigarette Smoking, and [CC Smoking by Year
and Raoa/EthnidtyArnong High School Studants----.------.—.--
9-4
9-7.
Prevalence ofCurrent Tobacco Use by Year and by Grade Among High School
Students....................................................................................................
9-5
9-8.
Prevalence of Current Any Tobacco Use by Year and by LG8TOf Status
Among High School Students ........................................................................
9-5
9-9.
Prevalence ofCurrent Vaping, Cigarette Smoking, and LCC Smoking by Year
and k]BTO+ Status Among High School Studenba--------------..
9-6
9-10.
Prevalence of Current Any Tobacco Use by Year and by General Mental Health
Among High School Students ........................................................................
9-6
9-11.
Prevalence ofCurrent Any Tobacco Use ByYear and Rurality Among High
SchoolStudents ..........................................................................................
9-5
9-12.
Prevalence ofEver and Current Marijuana Use and Marijuana Co -Use by Year
Among High School Students ........................................................................
9-7
10-1.
Prevalence ofTobacco Use Among 8th-Grade Respondents ..............................
1O-1
10-2.
Prevalence of Current Use ofAny Tobacco Among 8th+3rade Respondents, by
Gender Identity, Race/Ethnicity, U]BTO+ Status, and Mental Health Status ........
1O-2
10-3.
Prevalence of Flavored Tobacco Use Among 8th-Grade Respondents Currently
Using Each Tobacco Product ........................................................................1U-3
10-4.
Prevalence of Last-2-Week Exposure to Vapor and Tobacco Smoke in Car or
R00rn, Outside, or Multiunit Housing Among 8[h-Grade Respondents Living in
MultiunitHousing .......................................................................................10-4
10-5.
Method of Accessing Vapea (or Pods or *-Liquid) Among 8th-Grade
Respondents Who Were Currently Vaping ......................................................10-4
10-6.
Methods of Accessing Cigarettes Among 8th-Grade Respondents Who Were
Currently Smoking Cigarettes ......................................................................10-5
10-7.
Prevalence of Marijuana Use Among 8th-Grade Respondents ............................
1O-O
10-8.
Prevalence of Last-2-Week Exposure to Marijuana Smoke in Car or Room or
mii
Executive Summary
This report summarizes the main results from the 2023 California Youth Tobacco Survey
(CYTS). ThaCYTS has been administered annually to 8th-, 10th-, and 121h-gradestudenbs
from California middle and high schools since 2021 and prior to 2021, once every 2 years.
Data collection for the 2023 survey occurred between January and June 2023. Schools and
classrooms within schools were randomly selected. The sample was designed to provide
statewide and county -level estimates of tobacco use among youth in California. In 2023, we
collected data from 350 schools and 41,755 students who consented to participate in the
survey and provided valid survey data (see Appendix Bfor additional information). The
survey was administered online during the school day. Most respondents completed the
survey attheir school, except for those engaged in virtual learning or independent study.
The survey was designed to assess the use of, knowledge of, and attitudes toward tobacco
products, including cigarettes, vOp8S, |i[t|8 cigars or cigarillos (LCCS), cigars, hookah,
smokeless tobacco, heated tobacco products (HTPg), and nicotine pouches. The survey also
examined social and environmental exposure totobacco. Marijuana and alcohol were
included in the survey because the co -use ofmarijuana and alcohol with tobacco products is
common. This report primarily focuses on high school respondents (16,255 respondents in
10th grade and 14,711 in 12th grade). Key results for 8th graders (10,789) are presented
inChapter 1O.
This year's report includes tobacco prevalence estimates by rurality, region, and county or
county group for any tobacco use and the use of specific products. In addition, we compare
the prevalence of current tobacco use for high school students between the 2022 and 2023
administrations Ofthe CYTS.
Appendix B provides 8 brief overview of the survey methodology. Additional details about
the sampling strategy, survey administration, and statistical analysis can be found in the
Technical Report onAnalytic Methods and Approaches Used in the California Youth Tobacco
Survey 2023, by Russe|l et al.1 Appendix B also includes information about comparing CYTS
estimates between 2022 and 2023 and information about the criteria we used to label
estimates as imprecise and to suppress specific estimates. For definitions of the terminology
included in table footnotes, see the definitions for analytic terms section in Appendix A.
ES-1. Key Findings
ES-1.1 Tobacco Use Behavior(Chapters I and 2)
� In 2023, 21.696 of California high school respondents had ever used any tobacco
product, and 7.3% currently used tobacco.
z Russell, S, Dutra, L. M, Carter, S.E, Baum, L, & Levine, B. (2023). Technical report for the
California Youth Tobacco SurveyJ023. RTI International.
Results of the 2023 California Youth Tobacco Survey
• Vapes were the most commonly used tobacco product among high school
respondents (18.3% ever use, 5.9% current use), regardless of gender identity,
race/ethnicity, and grade.
■ Ever use of vapes was 18.3% among high school respondents, and current use was
5.9%.
■ Ever cigarette smoking prevalence was 5.6%; 1.2% of high school respondents
reported currently smoking cigarettes.
■ Current prevalence of use of nicotine pouches was 1.1%.
■ Current prevalence was less than 1% for LCCs, cigars, HTPs, smokeless tobacco, and
hookah.
• Current tobacco use prevalence varied by demographics. Current use was highest
among White (10.7%) respondents, 12th-grade (9.4%) respondents, lesbian, gay,
bisexual, transgender, queer or questioning (LGBTQ+) (11.4%) respondents, and
respondents who reported poor mental health (14.8%).
• Approximately a quarter (27.2%) of respondents who reported currently using
tobacco also reported currently using two or more tobacco products. Polytobacco use
varied by LGBTQ+ status.
• Two-thirds of high school students (66.1%) reported experiencing one or more types
of discrimination a few times or more often in the past 30 days. The most commonly
reported experience of discrimination was being treated with less courtesy or respect
than others, with 6.9% of respondents reporting experiencing this almost every day,
12.6% reporting experiencing it at least once a week, and 32.1% reporting
experiencing it a few times in the past month.
• Experiences of discrimination were more commonly reported by respondents
currently using tobacco than respondents not currently using tobacco. Respondents
who were currently using tobacco (11.5%) reported being treated with less courtesy
or respect than others almost every day, compared to 6.4% of non -current tobacco
users.
• Almost half of respondents who were currently vaping reported attempting to quit
vaping in the last 12 months (40.8%), and approximately the same percentage
reported intending to quit vaping in the next 30 days (38.8%).
■ The survey asked respondents who were currently using tobacco which flavor they
used most often (e.g., unflavored, fruit, mint). A substantial majority of respondents
who reported currently using tobacco also reported using flavored tobacco products
(85.6%), with flavored tobacco use being highest for vapes (89.1%) out of all
tobacco products. Fruit was the most popular flavor of vapes reported by
respondents who were currently vaping.
In terms of flavored tobacco use by demographics, among respondents who reported
currently using tobacco, current use of flavored tobacco was highest among
respondents who selected "something else" as their gender identity (90.1%) and
10th-grade respondents (86.6%). in terms of race/ethnicity, use of flavored tobacco
was highest among African American or Black respondents and lowest among
Hispanic respondents. While 96.0% of respondents who reported current use and
identified as African American or Black reported using flavored tobacco, only 82.7%
of respondents who reported current use and identified as Hispanic reported using
flavored tobacco.
ES-2
Results of the 2023 California Youth Tobacco Survey
Methodst Accessing Vapes and Qqarettes (Chapter
■ Among respondents who were currently vaping, the most commonly reported
method of obtaining vapes was buying them (34.9%). Among respondents who
reported buying their own vapes, the most common method of buying them was
from someone else (30.5%).
■ Among respondents who were currently smoking cigarettes, the most commonly
reported method of obtaining cigarettes was buying them (26.5%).
• Reports of respondents buying their own vapes or cigarettes varied by grade; 12th-
grade respondents reported higher prevalence of buying vapes (38.8%) than 10th-
grade respondents (28.7%), and 10th-grade respondents reported higher prevalence
of buying cigarettes (28.5%) than 12th-grade respondents (25.5%).
• Overall, high school respondents reported that it was easy to obtain vapes and
cigarettes. For vapes, 49.9% of respondents reported that it was easy to access
them from a store, 67.3% that it was easy to access them from the internet, and
71.6% that it was easy to access them from someone else. For cigarettes, 37.0% of
respondents reported it was easy to access them from a store, 58.7% that it was
easy to access them from the internet, and 60.8% that it was easy to access them
from someone else.
OtherES-1.3 Secondhand Exposure and it tInfluences
(Chapter
■ Regarding secondhand exposure to vapes, 29.0% of high school respondents
reported being exposed in a car or room in the last 2 weeks. More than a third
(42.1%) reported being exposed outside during the same time period.
• For secondhand tobacco smoke exposure, 14.1% of high school respondents
reported being exposed to secondhand smoke in a car or room in the last 2 weeks.
More than half (57.8%) reported being exposed to secondhand smoke outside.
■ Among high school respondents who reported living in multiunit housing (MUH)
(29.70/o), approximately half (48.8%) reported being exposed to secondhand tobacco
smoke in the home in the last 6 months.
■ Respondents who were currently vaping reported higher prevalence of exposure to
secondhand vapor in a car or room in the last 2 weeks (80.1%), compared with
respondents who formerly vaped (49.9%) and those who had never vaped (22.2%).
• Respondents who were currently smoking tobacco reported higher prevalence of
exposure to secondhand tobacco smoke in a car or room in the last 2 weeks (60.1%),
compared with former (30.5%) and never smokers (12.4%).
• Respondents who were currently vaping or smoking tobacco reported higher
prevalence of exposure to secondhand vapor or tobacco smoke outside in the last 2
weeks (76.1% for vaping, 84.7% for smoking), compared with those who reported
former (56.0% for vaping, 65.8% for smoking) and never use (37.6% for vaping,
56.9% for smoking).
■ Most high school respondents reported having a complete ban on vaping (81.0%)
and tobacco smoking (78.4%) in the home. Generally, a higher percentage of
respondents who had never vaped reported complete home bans compared to
respondents who were currently vaping or had formerly vaped.
ES-3
Results ofthe 2023 California Youth Tobacco Survey
" Few (3.896) respondents reported having a favorite vaping advertisement.
• Over two-thirds (71.896) of respondents reported being exposed to vaping (rarely,
sometimes, often, or always) on social media in the last 30 days. Respondents who
currently (84.596)vapedand had formerly (G4.896)vaped more commonly reported
being exposed to vaping advertisements than respondents who had navervaped
(59.196).
• About half of respondents (55.996) reported being exposed to cigarette smoking on
social media (rarely, sometimes, often, or always) in the last 30 days. Respondents
who were currently smoking cigarettes (72.1%) or formerly smoked cigarettes
(72.496) reported being exposed tocigarette smoking on social media more than
respondents who had never smoked (55.096).
" Lass than half ofrespondents (40.996) reported paying any attention to social media
posts about vaping. Attention to these posts varied by vaping status, with a higher
percentage of respondents who currently vaped (55.196) reporting they paid
attention, C0rnpdr8d to respondents who had formerly (48.196) and nev8rvdp8d
(38.096).
ES-1~4 Tobacco Susceptibility and Knowledge, Attitudes, and Beliefs
(Chapter 5)
• Overall, 44.396 ofrespondents who had never used tobacco were susceptible to one
ormore tobacco products, and 37.8% were susceptible tovapeaspecifically.
" Among high school respondents who had never smoked, 20.196 were susceptible to
future cigarette smoking.
= Among respondents who had never smoked UCCs, 21.496 were susceptible to future
use ofLCCg.
• Susceptibility tovapes, cigarettes, and UCCsvaried bvgender identity and
race/ethnicity. Susceptibility was highest for respondents who identified their gender
as "something else" or "I'm not Bup8 yet" (49.896) and non -Hispanic multiracial
nespondents(46.496).
• Respondents who rated their mental health as poor /55.396\ or fair /51.896\ had
higher susceptibility to vapes, cigarettes, and LCCs than those who rated it good,
very good, or excellent /39.596\.
= Respondents who were LGBTOf were more susceptible (52.696)tovapes,cigarettes,
and LCCs than respondents who were not UGBlFOf /42.296\ and respondents with
undearL{SBTD+ status(44.7%).
• Among youths who had never vaped, never smoked cigarettes, and never smoked
LCCs, 37.896 were susceptible tofuture vaping, 2O.196tofuture cigarette smoking,
and 21.496tofuture LCCsrnoking.
• The most oornnnon|y endorsed reason for vaping (among currentvapers) was to
relax or relieve stress and anxiety (35.296).
• Most respondents believed that adults who were important to them viewed vaping
and smoking cigarettes negatively (96.3%and 9S.896, neapective|y),and this belief
was consistent across demographic categories.
Results of the 2023 California Youth Tobacco Survey
Perceived approval of vaping and smoking among peers varied by product. About
half (49.8%) of respondents reported that other respondents at school would view
vaping negatively, while most (83.6%) reported that their peers would view smoking
cigarettes negatively. A higher percentage of respondents who were never users of
each product believed their peers would disapprove of their use compared to
respondents who were current or former users of vapes and cigarettes.
■ Respondents perceived that more of their peers held negative views of smoking
cigarettes (83.6%) than vaping (49.8%).
- ter
■ Two-thirds (66.9%) of high school respondents reported that they supported a ban
on the sale of all tobacco products. Almost three-quarters supported a ban on public
use of cigarettes and LCCs (73.7%) and a similar percentage supported a ban on the
sale of all flavored tobacco (72.0%).
■ Support for policies varied across vaping and smoking status, with 71.2%, 77.0%,
and 76.9% of never vapers reporting support for a tobacco sales ban, a tobacco
public use ban, and a flavored tobacco ban, respectively, and fewer respondents who
were currently smoking cigarettes reporting support for such bans (19.0% for sales,
29.9% for public use, and 26.8% for flavored).
In general, towns and rural settings (9.6%) tended to have higher tobacco use in
comparison to cities (6.9%) and suburban areas (6.8%).
• Madera (18.7%, 4.2%), Merced (16.2%, 4.5%), Tulare (15.0%, 4.2%), Contra
Costa (15.5%, 2.8%), and Los Angeles (16.6%, 5.0%) counties had the lowest ever
and current tobacco use estimates, respectively, out of all counties or county
groupings.
■ In general, current use estimates for specific products were consistent across region,
except for vaping; the Northern region of the state (8.1%) had the highest
prevalence of current vaping.
ES-1.7 Marijuana
■ Almost a quarter (23.0%) of high school respondents reported having ever used
marijuana, while 10.4% reported current use of marijuana.
■ Current marijuana use (10.4%) was higher than current use of any tobacco (7.3%)
among high school respondents.
Current marijuana use varied by demographics. Current use was highest among
respondents who identified their gender as "something else" or "I'm not sure yet"
(14.1%), African American or Black (18.1%) respondents, and 12th-grade (14.0%)
respondents. Prevalence of current use among LGBTQ+ respondents was more than
double (18.0%) that of non-LGBTQ+ respondents (8.9%) or respondents of unclear
LGBTQ+ status (6.4%).
• Among respondents who were currently using marijuana, the most common mode of
use was smoking marijuana (49.0%).
ES-5
Results of the 2023 California Youth Tobacco Survey
• Overall, the prevalence of current use of marijuana only (5.5%) was slightly higher
than co -use of marijuana and any tobacco product (4.9%). For some demographic
subgroups, co -use was higher than marijuana -only use.
• Among respondents who were currently co -using marijuana and tobacco, the most
commonly used tobacco product was vapes (39.1%).
■ Overall, 21.3% of respondents reported being exposed to marijuana smoke in a car
or room within the last 2 weeks, and 31.1% reported being exposed outside.
Respondents who were currently using marijuana reported greater exposure to
secondhand marijuana smoke than respondents who reported former and never use.
■ Among respondents currently using marijuana, the most commonly endorsed
methods of obtaining the product were buying it (38.2%) and someone giving it to
them (27.0%). Among those who reported purchasing their own marijuana, the most
common methods of obtaining marijuana were from someone else (44.9%) or from a
store or dispensary (38.3%).
Coniparisons of Tobaccotee )
• The use of current and ever use of any tobacco product changed little between 2022
and 2023. Current use of tobacco was 6.6% in 2022 and 7.3% in 2023; ever use
was 20.3% in 2022 and 21.6% in 2023. There were no significant changes in ever or
current use of any tobacco product or ever or current use of specific tobacco
products among all high school respondents.
• There was one significant change over time by race and ethnicity. Current cigarette
smoking increased significantly between 2022 (0.1%) and 2023 (1.8%) among
students who identified as non -Hispanic other race.
• There were also significant changes by grade. Current hookah use increased between
2022 (0.5%) and 2023 (1.0%) among 12th graders, current smokeless tobacco use
increased among 10th graders (0.2% in 2022 and 0.6% in 2023), and current use of
nicotine pouches increased in both grades (loth: 0.5% in 2022 and 0.9% in 2023;
12th: 0.7% in 2022 and 1.2% in 2023).
ES-1.9 Sth-Grade Tobacco Use tee 10)
■ Prevalence of ever tobacco use was lower for 8th-grade respondents (11.4%) than
high school respondents (21.6%).
■ Prevalence of current tobacco use was lower for 8th-grade respondents (3.2%) than
high school respondents (7.3%).
■ Vaping was the most common form of current tobacco use (2.5%), followed by
nicotine pouches (0.6%), among middle school respondents.
• In terms of demographics, current tobacco use was highest among 8th-grade
respondents who identified their gender as "something else" or "I'm not sure yet"
(6.8%). Among racial/ethnic categories, multiracial respondents (5.9%) reported the
highest current use, and Asian respondents (0.7%) reported the lowest.
• Almost all 8th-grade respondents who currently vaped reported using flavored vapes
(91.9%).
• Eighth -grade respondents reported greater exposure to secondhand vapor (20.3%)
than tobacco smoke (15.2%) indoors, and greater exposure to smoke (54.3%) than
ES-6
Results of the 2023 California Youth Tobacco Survey
vapor (31.8%) outdoors. Of those respondents who reported living in MUH, about
half (49.2%) reported tobacco smoke exposure in their unit within the last 6 months.
Eighth -grade respondents who were currently vaping most commonly acquired vapes
by buying them (26.2%), and the most common source was buying them from
someone (45.1%). Of those who currently smoked cigarettes, the most common
method of obtaining them was someone giving them to them (38.6%). Among 8th-
grade respondents, 3.1% reported current marijuana use and 8.5% reported ever
marijuana use.
ES-7
Behavior,1. Tobacco Use
Overall and for Priority Populations
This chapter presents high school tobacco use behavior data from the 2023 California Youth
Tobacco Survey (CYTS), including both ever and current use of various tobacco products.
Ever use is defined as any tobacco use in one's lifetime, and current use is defined as any
use within the last 30 days. In this report, the terms current use and last-30-day use are
used interchangeably. This chapter also provides the overall prevalence rates of tobacco
product use and the frequency of current use of products. Additionally, it presents the use
of multiple tobacco products (i.e., polytobacco use). Last, this chapter includes tobacco use
by demographics commonly found in surveys, specifically, gender identity, race/ethnicity,
and grade. For tobacco use among 8th-grade respondents, see Chapter 10.
This chapter also presents high school tobacco use among specific populations. Because of
high observed tobacco use among members of priority populations, the chapter examines
use by lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) status2; mental
health3; and experiences of discrimination .4,5 Because of higher use of multiple tobacco
products among LGBTQ+ individuals2 (compared to individuals who do not identify as
LGBTQ+), this chapter also examines polytobacco use by LGBTQ+ status. In addition, this
chapter examines characteristics of current vapers who attempted to quit vaping in the last
12 months and who intended to quit vaping in the next 30 days.
1.1 Tobacco Use Among High School Respondents
We asked respondents not to include marijuana products when answering questions about
the use of tobacco products. Table 1-1 presents ever and current use of tobacco products
among high school respondents. The first row of Table 1-1 indicates any tobacco use (use of
one or more of the included tobacco products). Current use of any tobacco product was
7.3%. Vaping was the most popular at 5.9%. The use of tobacco products other than vapes
was low. Current use of cigarettes was 1.2%. Nicotine pouch use was 1.1%. Less than 1%
of high school respondents reported current use of little cigars or cigarillos (LCCs) (0.6%),
cigars (0.8%), hookah (0.7%), smokeless tobacco (0.5%), or heated tobacco products
(HTPs) (0.5%).
2 Creamer, M. R., Everett Jones, S., Gentzke, A. S., Jamal, A., & King, B. A. (2020). Tobacco product
use among high school students - Youth Risk Behavior survey, United States, 2019. MMWR, 69(1),
56-63.
3 National Institute on Drug Abuse. (2022). Research report: Tobacco, nicotine, and e-cigarettes
research report. https:/Inida.nih. ov pubiications/research-re o�rts/tobacco-nicotine-e-cigarettes/.
4 Dutra, L. M., Williams, D. R., Kawachi, I., & Okechukwu, C. A. (2014). Racial and nonracial
discrimination and smoking status among South African adults ten years after apartheid. Tobacco
Control, 23(e2), e114-121. doi:10.1136/tobaccocontrol-2013-051478.
5 Borrell, L. N., Jacobs, D. R., Williams, D. R., Pletcher, M. J., Houston, T. K., & Kiefe, C. I. (2007).
Self -reported discrimination and substance use in the Coronary Artery Risk Development in Adults
Study. American Journal of Epidemiology, 166(9), 1068-1079.
1-1
Results of the 2023 California Youth Tobacco Survey
Table 1-1.
Prevalence of Ever and Current Use of Tobacco Products Among High
School Respondents
Ever Use
Current Use
Tobacco
Product N
%
(95% CI)
N
%
(95% CI)
Any tobacco use
30,966
21.6
(20.3-22.9)
30,966
7.3
(6.5-8.1)
Vapes
30,933
18.3
(17.2-19.5)
30,930
5.9
(5.3-6.5)
Cigarettes
30,943
5.6
(4.9-6.5)
30,943
1.2
(0.9-1.5)
LCCs
30,953
2.3
(2.0-2.6)
30,951
0.6
(0.5-0.8)
Cigars
30,948
3.3
(2.9-3.7)
30,947
0.8
(0.7-1.0)
Hookah
30,966
2.5
(2.0-3.0)
30,966
0.7
(0.5-1.0)
Smokeless
30,966
1.5
(1.3-1.7)
30,966
0.5
(0.4-0.7)
HTPs
30,966
1.2
(1.0-1.4)
30,966
0.5
(0.3-0.7)
Nicotine pouches 30,966
3.1
(2.7-3.5)
30,966
1.1
(0.9-1.3)
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos. CI = confidence interval
1.2 Frequency of Tobacco Use
The 2023 CYTS asked respondents who reported currently using a tobacco product to
indicate how many days they had used the product within the last 30 days. Table 1-2
presents the mean frequency of use among respondents who were currently using each
product. Of the 5.9% of high school respondents who reported vaping in the last 30 days,
41.5% reported frequent vaping (20 or more days in the last 30 days). Among current
vapers, 29.9% reported vaping daily in the last 30 days (daily use not shown in table).
Frequent use (20 or more days in the last month) was the most common response for users
of vapes, LCCs, cigars, and smokeless tobacco. For cigarettes, hookah, HTPs, and nicotine
pouches, using the product either 1 day or 2 days were the most common responses.
Table 1-2. Frequency of Current Use Among High School Respondents Who Were
Currently Using a Given Tobacco Product
Tobacco
1 or 2 days
3-5 days
6-19 days
20-30 days
product
N
% (95% CI)
% (95% CI)
% (95% CI)
% (95% CI)
Vapes
2,051
26.1 (22.9-29.4)
14.1 (11.2-17.4)
18.4
(15.4-21.7)
41.5
(37.4-45.7)
Cigarettes
452
41.1 (33.6-48.9)
Q (13.9-29.7)
12.9
(8.0-19.1)
25.1
(17.1-34.4)
LCCs
231
24.4 (15.8-34.8)
18.9 (9.1-32.7)
18.8
(10.3-30.1)
38.0
(26.9-50.0)
Cigars
293
38.9 (29.9-48.6)
11.8 (6.4-19.3)
7.4t
(3.5-13.5)
41.9
(31.0-53.3)
Hookah
192
51.2 (36.2-66.0)
11.4t (3.1-27.2)
lilt
(4.5-21.8)
26.3
(16.7-37.8)
Smokeless
176
32.9t (18.1-50.6)
11.4t (4.3-23.2)
-
-
40.8t
(23.4-60.0)
HTPs
137
39.8t (23.7-57.7)
8.7t (2.7-19.5)
21.4t
(9.6-38.2)
30.2
(18.0-44.7)
(continued)
1-2
Results of the 2023 California Youth Tobacco Survey
Table 1-2. Frequency of Current Use Among High School Respondents Who Were
Currently Using a Given Tobacco Product (continued)
Tobacco 1 or 2 days 3-5 days 6-19 days 20-30 days
product N % (95% CI) % (95% CI) % (95% CI) % (95% CI)
Nicotine 410 51.9 (38.5-65.1) - - 11.5 (6.3-18.6) 22.5 (15.3-31.1)
pouches
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos. CI = confidence interval
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample size less
than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
>- 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate. For more information
about Korn-Graubard confidence intervals, see Appendix A.
Tobacco1.3
Table 1-3 presents current use of each tobacco product by gender identity. The gender
identity category "identified in another way" includes respondents who reported their gender
as "something else" or "I'm not sure yet." The `declined to answer" gender identity category
represents those who skipped this question.
Respondents who identified their gender in another way (12.5%) or declined to answer the
question about gender identity (15.6%) had a higher prevalence of current use of any
tobacco product than those who identified as female (7.0%) or male (6.5%). This pattern
was similar for vapes and hookah. For the remaining products, those who identified another
way, but not those who declined to answer, reported higher use than those who identified
as male or female.
Table 1-3. Prevalence of Current Use of Tobacco
Products Among
High School
Respondents, by Gender Identity
Identified in
Declined to
Male Female
Another Way
Answer
N = 13,750 N = 13,537
N = 1,767
N = 198
Tobacco Product % (95% Cl) % (95% CI)
% (95% CI)
% (95% CI)
Any tobacco use
6.5
(5.7-7.5)
7.0
(6.1-8.0)
12.5
(9.8-15.5)
15.6
(8.4-25.5)
Vapes
5.1
(4.4-5.8)
6.0
(5.1-6.9)
8.6
(6.8-10.8)
12.3t
(5.8-21.9)
Cigarettes
1.1
(0.8-1.5)
0.7
(0.5-1.1)
5.2
(3.6-7.2)
1.5
(0.2-5.1)
LCCs
0.5
(0.4-0.7)
0.3
(0.2-0.5)
3.9
(2.5-5.6)
0.7
(0.2-1.8)
Cigars
1.0
(0.8-1.4)
0.2
(0.1-0.3)
4.2
(2.8-6.0)
1.1
(0.3-3.1)
Hookah
0.7
(0.4-1.0)
0.5
(0.3-1.0)
2.9
(1.6-4.7)
3.4t
(0.8-9.4)
Smokeless
0.5
(0.3-0.8)
0.2
(0.0-0.5)
2.8
(1.5-4.7)
0.6
(0.2-1.5)
HTPs
0.3
(0.2-0.5)
0.4
(0.2-0.8)
2.6
(1.5-4.1)
0.2
(0.0-1.0)
Nicotine pouches
1.3
(1.0-1.6)
0.7
(0.3-1.2)
3.1
(1.9-4.7)
1.0
(0.2-2.9)
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos. CI = confidence interval
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one
or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the
estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30
and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than 130% of the
estimate.
1-3
Results ofthe 2023 California Youth Tobacco Survey
1.4 Tobacco Use by Race/Ethnicity
Tables 1-4a and 1-4b present tobacco use by race/ethnicity. The raoa/ethnicitvvahab|e was
created by combining responses totwo questions, one about Hispanic ethnicity and the
other about race (Hispanic is not considered a race in the survey). Tables 1-4a and 1-4b
include all race/ethnicity categories created by combining Hispanic ethnicity with the
response options for race. However, elsewhere in the survey, American Indian or Alaska
Native (AI/AN), Native Hawaiian orother Pacific Is|andar(NH<]PI), and respondents who did
not identify with any ofthe races listed inthe survey are collapsed into category called
"other"due to ynna|| sample sizes. For more information on demographic variables used in
the survey, see Appendix A.
Tables 1-4a and 1-4b present race/ethnicity differences in current use of any tobacco
product. Although vvemake comparisons between NH{}Pl respondents and other
race/ethnidtycatagories in the text, all estimates for NH0PI and all comparisons that
include this group should be interpreted with caution due to srna|| sample sizes. ForAI/AN
respondents, we were not able to provide estimates for any current tobacco use or any
vaping due to srna|| aanop|a sizes, and the estimates for L[Cs and cigars should be
interpreted with caution for the same reason.
Table 1-4a. Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Race/Ethnicity
Tobacco
Product
WhiteHispasim
N= 7,386
% (95%Cl)
African
American or
Black
#y=688
96 (9596Cl)
00= 16,691
% (95%CI)
Asian
N= 3,172
96 (95%CD)
Any tobacco use
10.7
(9.4-12.2)
7.9
(5.4-11.1)
6.3
(5.5-7.1)
3.3
(2.5-4.2)
Vapes
8.7
(7.6-9.0)
5.4
(2.9-9.0)
5.1
(4.4-5.9)
2.7
(2.1-3.4)
Cigarettes
2.3
(1.6-3.1)
1.4
(0.2-4.5)
0.7
(0.5-0.9)
0.6
(0.3-1.2)
LCCs
0.6
(0.3-0.9)
0.7
(0.1-1.9)
0.7
(0.5-0.9)
0.4
(0.1-0.9)
Cigars
1.3
(0.8-1.8)
0.7
(0.2-1.7)
0.7
(0.5-0.9)
0.5
(0.2-1.0)
Hookah
0.0
(0.4-1.5)
2.1f
(0.4-6.3)
0.5
(0.3-0.7)
0.6
(0.3-1.2)
Smokeless
0.6
(0.3-1.1)
0.3
(0.1-0.6)
0.4
(0.2-0.6)
O.5
(0.2-1.1)
HTPs
0.4
(0.2-0.8)
1.0
(0.0-5.0)
0.4
(0.2-0.6)
0.5
(0.2-1.1)
Nicotine
1.7
(1.3-2.2)
1.5
(0.3-4.5)
0.7
(0.5-0.0)
0.8
(0.4-1.3)
pouches
Note. HTPs = heated tobacco products; L[Cs = little cigars or cigarillos. [J = confidence interval
+ The estimate should be interpreted with caution given concerns about precision. The estimate meets
one orboth ufthe following criteria: (a)the absolute width ofthe Korn-Graubardconfidence interval
for the estimate is > 0.30 OR (b) the absolute width of the Korn-Gnaubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
13096ofthe estimate.
1-4
Results of the 2023 California Youth Tobacco Survey
For any tobacco use, non -Hispanic White (hereafter, White) high school respondents had
the highest current use (10.7%) followed by NHOPI (9.6%), and multiracial respondents
(9.5%). Asian respondents had the lowest current use (3.3%). For vapes, NHOPI
respondents (9.6%), followed by White respondents (8.7%), had the highest current
prevalence of use. For cigarette smoking, current use was similar across multiple races and
ethnicities, with the highest prevalence estimates for White (2.3%), NHOPI (2.2%),
multiracial (2.1%), and other race (2.0%) respondents. AI/AN (1.5%) and NHOPI (1.7%)
respondents had notably higher use of LCCs than other races and ethnicities, but, again,
these estimates should be interpreted with caution. African American/Black (2.1%), NHOPI
(1.7%), other race (2.0%), and multiracial (2.1%) respondents all reported higher current
hookah use than the other race/ethnicity categories. NHOPI respondents reported the
highest current use of smokeless tobacco (2.0%) and HTPs (2.0%). For nicotine pouches,
current use was higher for White (1.7%), African American/Black (1.5%), NHOPI (2.1%),
multiracial (1.8%), and other race (1.5%) respondents, compared to the other
race/ethnicity groups.
Table 1-4b.
Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Race/Ethnicity
Native
American
Hawaiian or
Indian or
Other Pacific
Alaska Native
Islander
Other
Multiracial
N=177
N=117
N=492
N=2,168
Tobacco Product % (95% CI)
% (950/0 CI)
% (95% CI)
%
(95% CI)
Any tobacco use
- -
9.6t (2.7-22.7)
6.7
(3.9-10.6)
9.5
(7.7-11.7)
Vapes
- -
9.6t (2.7-22.7)
3.8
(1.9-6.9)
7.6
(5.9-9.6)
Cigarettes
0.5 (0.0-2.3)
2.2t (0.1-9.5)
2.0
(0.6-4.8)
2.1
(1.3-3.3)
LCCs
1.5t (0.0-7.9)
1.7t (0.0-9.6)
0.2
(0.0-1.0)
0.8
(0.3-1.7)
Cigars
1.4t (0.0-8.0)
1.7t (0.0-9.6)
1.1
(0.4-2.4)
0.9
(0.4-1.6)
Hookah
0.8 (0.0-3.6)
1.7t (0.0-9.6)
2.0
(0.5-5.1)
1.6
(0.8-2.9)
Smokeless
0.7 (0.0-3.7)
2.Ot (0.1-9.4)
0.8
(0.1-3.1)
1.2
(0.5-2.5)
HTPs
0.7 (0.0-3.7)
2.Ot (0.1-9.4)
0.8
(0.1-3.1)
1.1
(0.5-2.2)
Nicotine
0.7 (0.0-3.6)
2.1t (0.1-9.3)
1.5
(0.5-3.5)
1.8
(1.0-2.9)
pouches
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos. CI = confidence interval
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >- 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
1-5
Results of the 2023 California Youth Tobacco Survey
1.5 Tobacco Use by Grade
Table 1-5 presents current tobacco use by grade. Current use of any tobacco product was
higher among 12th graders (9.4%) than loth graders (5.3%). Current use of specific
products was higher among 12th-grade respondents for each product except for HTPs and
nicotine pouches.
Table 1-5. Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Grade
loth Grade
12th Grade
Tobacco Product
N
% (95% CI)
N
% (95% CI)
Any tobacco use
16,255
5.3
(4.6-6.2)
14,711
9.4
(8.2-10.8)
Vapes
16,235
4.3
(3.7-5.0)
14,695
7.6
(6.6-8.6)
Cigarettes
16,244
0.8
(0.5-1.1)
14,699
1.6
(1.2-2.1)
LCCs
16,244
0.6
(0.4-0.8)
14,707
0.7
(0.5-0.9)
Cigars
16,243
0.7
(0.5-1.0)
14,704
1.0
(0.7-1.3)
Hookah
16,255
0.4
(0.3-0.6)
14,711
1.0
(0.6-1.6)
Smokeless
16,255
0.6
(0.4-0.9)
14,711
0.4
(0.2-0.6)
HTPs
16,255
0.5
(0.3-0.7)
14,711
0.5
(0.3-0.9)
Nicotine pouches
16,255
0.9
(0.7-1.2)
14,711
1.2
(0.9-1.5)
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos. CI = confidence interval
1.6 Tobacco Use by LGBTQ+ Status
Respondents were asked to indicate their sexual orientation and gender identity in two
separate questions. Using responses from these questions, three categories of LGBTQ+
status were created: LGBTQ+, non-LGBTQ+, and unclear LGBTQ+ status. See Appendix A
for additional information on this variable.
Table 1-6 presents tobacco use by LGBTQ+ status. LGBTQ+ respondents had higher
prevalence of any current tobacco use (11.4%) than non-LGBTQ+ respondents (6.4%) and
those of unclear LGBTQ+ status (5.3%). LGBTQ+ respondents also had a higher prevalence
of tobacco use for each specific tobacco product than respondents with unclear LGBTQ+
status or who identified as non-LGBTQ+. Vapes were the most commonly used product
across all groups. Current vaping was 9.1% among LGBTQ+ respondents, 4.0% among
respondents with unclear LGBTQ+ status, and 5.1% among non-LGBTQ+ respondents.
1-6
Results of the 2023 California Youth Tobacco Survey
Table 1-6. Prevalence of Current Tobacco Use Among High School Respondents,
by LGBTQ+ Status
Tobacco
LGBTQ+*
Non-LGBTQ+*
Unclear LGBTQ+
Status*
Product
N
% (95% CI)
N
% (95% CI)
N
% (95% CI)
Any tobacco use
5,146
11.4
(9.5-13.6)
21,360
6.4
(5.6-7.2)
2,414
5.3
(4.0-6.8)
Vapes
5,142
9.1
(7.7-10.7)
21,337
5.1
(4.5-5.9)
2,412
4.0
(2.8-5.4)
Cigarettes
5,145
2.5
(1.8-3.3)
21,348
0.9
(0.6-1.2)
2,413
1.1
(0.6-1.8)
LCCs
5,143
1.6
(1.1-2.2)
21,353
0.4
(0.3-0.5)
2,414
0.4
(0.2-0.8)
Cigars
5,144
1.5
(1.0-2.2)
21,352
0.7
(0.5-0.9)
2,412
0.6
(0.3-1.1)
Hookah
5,146
1.5
(0.8-2.3)
21,360
0.5
(0.3-0.9)
2,414
1.0
(0.4-1.9)
Smokeless
5,146
1.2
(0.7-1.9)
21,360
0.3
(0.2-0.5)
2,414
0.7
(0.3-1.5)
HTPs
5,146
1.4
(0.8-2.3)
21,360
0.3
(0.2-0.5)
2,414
0.5
(0.1-1.2)
Nicotine
5,146
1.7
(1.1-2.5)
21,360
1.0
(0.7-1.3)
2,414
0.9
(0.5-1.6)
pouches
Note. LCCs = little cigars or cigarillos; HTPs = heated tobacco products; LGBTQ+ = lesbian, gay,
bisexual, transgender, queer or questioning. CI = confidence interval
* Respondents who reported (a) their gender identity as transgender or "something else" and/or (b)
identified their sexual orientation as gay or lesbian, bisexual, "something else," or "don't know what
this question means" were considered LGBTQ+. Respondents who identified as female or male and
straight (that is, not gay or lesbian) were considered non-LGBTQ+. Respondents who responded (a)
unsure for gender identity and straight for sexual orientation or (b) male, female, or unsure for
gender identity and unsure or "don't know" for sexual orientation were considered to have unclear
LGBTQ+ status.
Health1.7 Tobacco Use by General Mental
Table 1-7 presents respondents' current tobacco use according to reported general mental
health (see Appendix A). Respondents who rated their mental health as poor reported
higher use of any tobacco product (14.8%) than those who reported their mental health as
fair (7.2%) or good to excellent (5.9%). This pattern was consistent for each tobacco
product.
1-7
Results of the 2023 California Youth Tobacco Survey
Table 1-7. Prevalence of Current Use of Tobacco Products Among High School
Respondents, by General Mental Health
Tobacco
Product
Good to Excellent Fair Poor
N % (95% CI) N % (95% CI) N % (95% CI)
Any tobacco use
19,149
5.9
(5.1-6.7)
7,155
7.2
(6.0-8.7)
3,107
14.8
(12.3-17.6)
Vapes
19,137
4.6
(4.0-5.2)
7,146
6.3
(5.2-7.7)
3,098
11.5
(9.4-13.8)
Cigarettes
19,141
1.1
(0.8-1.5)
7,151
0.9
(0.6-1.2)
3,103
2.4
(1.7-3.3)
LCCs
19,141
0.6
(0.4-0.8)
7,154
0.3
(0.2-0.6)
3,105
0.9
(0.4-1.8)
Cigars
19,141
0.9
(0.7-1.2)
7,153
0.3
(0.2-0.5)
3,104
1.2
(0.6-2.3)
Hookah
19,149
0.8
(0.5-1.3)
7,155
0.3
(0.2-0.5)
3,107
0.9
(0.5-1.7)
Smokeless
19,149
0.5
(0.3-0.6)
7,155
0.2
(0.1-0.5)
3,107
1.4
(0.6-2.6)
HTPs
19,149
0.5
(0.3-0.7)
7,155
0.2
(0.1-0.4)
3,107
1.2
(0.6-2.1)
Nicotine
19,149
1.1
(0.9-1.3)
7,155
0.5
(0.3-0.8)
3,107
2.3
(0.9-4.7)
pouches
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos. CI = confidence interval
1.8 Pollytobacco Use
Table 1-8 presents the current use of multiple tobacco products, often referred to as
polytobacco use. Some estimates are imprecise due to small sample sizes. Overall, 27.2%
of high school respondents who were currently using tobacco reported using two or more
tobacco products. Due to small sample sizes, we excluded respondents who declined to
answer questions about gender identity from the table. Of the remaining categories,
respondents who identified their gender another way reported the highest prevalence of
polytobacco use (50.6%). Polytobacco use was higher for 10th-grade respondents (30.4%)
than 12th-grade respondents (25.2%). LGBTQ+ respondents had a higher prevalence of
polytobacco use (31.1%) than non-LGBTQ+ (26.8%) or respondents with unclear LGBTQ+
status (27.0%).
Table 1-8.
Prevalence of Current Polytobacco Use Among High School
Respondents Currently Using Tobacco, by Gender Identity,
Race/Ethnicity, Grade, and LGBTQ+ Status
Used Only One
Used Two or More
Tobacco Product
Tobacco Products
Characteristic N % (950/0 CI)
% (950/0 CI)
Overall
2,584 72.8 (69.0-76.3)
27.2 (23.7-31.0)
Gender identity
Male
1,027 67.4 (61.3-73.0)
32.6 (27.0-38.7)
Female
1,078 80.9 (75.5-85.6)
19.1 (14.4-24.5)
(continued)
1-8
Results of the 2023 California Youth Tobacco Survey
Table 1-8. Prevalence of Current Polytobacco Use Among High School
Respondents Currently Using Tobacco, by Gender Identity,
Race/Ethnicity, Grade, and LGBTQ+ Status (continued)
Used Only One Used Two or More
Tobacco Product Tobacco Products
Characteristic N a/o (950/0 CI) % (950/0 CI)
Identified in another way
252
49.4
(39.6-59.3)
50.6
(40.7-60.4)
Declined to answer
35
-
-
-
-
Race/ethnicity*
White
958
71.0
(62.2-78.7)
29.0
(21.3-37.8)
African American or Black
68
-
-
-
-
Hispanic
1,133
76.9
(72.4-80.9)
23.1
(19.1-27.6)
Asian
126
73.1
(60.0-83.8)
26.9
(16.2-40.0)
Other
60
-
-
-
-
Multiracial
232
65.7
(55.8-74.8)
34.3
(25.2-44.2)
Grade
10
1,056
69.6
(62.6-76.0)
30.4
(24.0-37.4)
12
1,528
74.8
(70.0-79.2)
25.2
(20.8-30.0)
LGBTQ+ status
LGBTQ+
671
68.9
(62.8-74.5)
31.1
(25.5-37.2)
Non-LGBTQ+
1,522
73.2
(67.9-78.1)
26.8
(21.9-32.1)
Unclear LGBTQ+ status
161
73.0
(60.9-83.0)
27.0
(17.0-39.1)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning. CI = confidence interval
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
1.9 Tobacco Use by Experiences of Discrimination
The CYTS captures experiences of discrimination based on literature establishing a
relationship between discrimination and tobacco use.6,'-8 Specifically, since 2022, the CYTS
has contained a modified version of the Everyday Discrimination Scale.9 The scale was
6 See Dutra et al., 2014.
Borrell, L. N., Jacobs, D. R., Williams, D. R., Pletcher, M. J., Houston, T. K., & Kiefe, C. I. (2007).
Self -reported discrimination and substance use in the Coronary Artery Risk Development in Adults
Study. American Journal of Epidemiology, 166(9), 1068-1079.
8 Wiehe, S.E., Aalsma, M.C., Liu, G.C., Fortenberry, J.D. (2010). Gender differences in the association
between perceived discrimination and adolescent smoking. American Journal of Public Health,100(3),
510-516.
9 Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and
mental health: Socioeconomic status, stress, and discrimination. Journal of Health Psychology, 2(3),
335-351.
im,
Results of the 2023 California Youth Tobacco Survey
modified to specify a time period for the experiences —the past 30 days; otherwise, the
scale is identical to its original version. Additional information on the discrimination variable
is available in Appendix A.
Table 1-9 presents the list of experiences and how frequently high school students reported
experiencing them. Overall, 66.1% of high school students reported one or more
experiences of discrimination a few times or more in the past month. The most commonly
endorsed experience of discrimination was "people acted as if they think you are not smart;"
8.1% of respondents reported having this experience almost every day. The second most
common experience was "you were treated with less courtesy or respect than other people;"
6.9% of respondents reported having this experience almost daily.
Table 1-9. Prevalence of Experiences of Discrimination in the Last Month Among
High School Respondents
Almost Every At Least Once a
Experience of Day Week A Few Times Not At All
Discrimination N % (95% CI) % (95% CI) % (95% CI) % (95% CI)
You were 28,871 6.9 (6.3-7.6) 12.6 (11.8-13.5) 32.1 (31.1-33.2) 48.3 (46.7-50.0)
treated with
less courtesy or
respect than
other people
You received 28,852 2.7 (2.3-3.2) 4.7 (4.2-5.2) 15.8 (14.9-16.7) 76.9 (75.7-78.0)
poorer service
than other
people at
restaurants or
stores
People acted as 28,835 8.1 (7.4-8.8) 12.2 (11.4-13.0) 30.1 (29.3-31.0) 49.5 (48.3-50.8)
if they think you
are not smart
People acted as 28,829 4.4 (3.8-5.0) 6.4 (5.9-6.9) 16.9 (16.1-17.8) 72.3 (70.9-73.6)
if they are
afraid of you
You were 28,843 3.5 (3.0-4.0) 4.7 (4.1-5.4) 14.0 (13.3-14.7) 77.8 (76.6-79.0)
threatened or
harassed
Note. CI = confidence interval
We examined these experiences by tobacco user status (Table 1-10). The two most
commonly reported experiences were the same among respondents who were using tobacco
and not using tobacco, but those using tobacco endorsed them at higher rates. For example,
respondents who used tobacco reported experiencing "almost every day" that "people acted
as if they think you are not smart" at twice the rate (15.6%) of those who didn't use
tobacco (7.5%). Respondents who used tobacco generally reported higher rates of
discrimination than respondents who didn't use tobacco.
Results of the 2023 California Youth Tobacco Survey
Table 1-10. Prevalence of Experiences of Discrimination in the Last Month Among
High School Respondents, by Current Tobacco Use
Almost Every At Least Once
Experience of
Day a Week A Few Times
Not At All
Discrimination
% (95% CI) % (95% CI) % (95% CI)
% (95% CI)
Currently using
tobacco'
You were treated
13.5 (10.6-16.9) 19.9 (17.2-22.8) 31.3 (27.5-35.3)
35.3 (31.2-39.5)
with less courtesy or
respect than other
people
You received poorer
6.6 (4.3-9.6) 11.0 (8.7-13.6) 17.5 (14.8-20.4)
64.9 (60.9-68.8)
service than other
people at restaurants
or stores
People acted as if
15.6 (12.5-19.2) 18.7 (15.5-22.2) 29.3 (25.8-33.0)
36.4 (32.5-40.4)
they think you are
not smart
People acted as if
11.7 (9.0-14.8) 12.0 (9.8-14.4) 24.3 (20.9-27.8)
52A (48.2-56.0)
they are afraid of you
You were threatened
9.4 (6.9-12.5) 10.3 (8.1-12.9) 20.1 (17.4-23.0)
60.1 (56.7-63.6)
or harassed
Not currently using
tobacco2
You were treated 6.4
(5.8-7.1)
12.0 (11.2-13.0) 32.2
(31.1-33.4)
49.3 (47.7-51.0)
with less courtesy or
respect than other
people
You received poorer 2.4
(2.0-2.8)
4.2 (3.8-4.6) 15.6
(14.7-16.6)
77.8 (76.6-78.9)
service than other
people at restaurants
or stores
People acted as if 7.5
(6.9-8.2)
11.7 (11.0-12.5) 30.2
(29.3-31.1)
50.6 (49.2-51.9)
they think you are
not smart
People acted as if 3.8
(3.3-4.4)
6.0 (5.5-6.5) 16.4
(15.5-17.3)
73.8 (72.5-75.1)
they are afraid of you
You were threatened 3.0
(2.6-3.5)
4.3 (3.8-4.9) 13.5
(12.8-14.3)
79.1 (78.0-80.2)
or harassed
Note. CI = confidence interval
' n = 2,324 for respondents currently using tobacco in this table.
2 n = 26,547 for respondents not
currently using tobacco in this table.
Next, we examined the perceived reason for experiences of discrimination among high
school students who reported one or more of the experiences of discrimination (Table 1-11).
The most common perceived reasons for experiencing discrimination in the last month were
some other aspect of physical appearance (35.3%) and age (30.7%). The least common
Results of the 2023 California Youth Tobacco Survey
reason was religion (8.4%). The findings were similar when examining reason for
discrimination across tobacco user status.
Table 1-11. Perceived Reasons for Experiencing Discrimination in the Last Month
Among High School Respondents, by Current Tobacco User Status
Reason for Discrimination
(Select All That Apply)
Age
Race/ethnicity
Gender identity
Some other aspect of physical
appearance
Weight
Height
Ancestry or national origins
Household or family education or
income
Currently Using
Not Currently
Overall Tobacco
Using Tobacco
N = 19,152 N = 1,861
N = 17,291
0/0
(950/0 CI)
%
(950/0 CI)
%
(950/0 CI)
30.7
(29.4-32.0)
33.8
(29.3-38.4)
30.4
(29.0-31.9)
28.6
(26.8-30.4)
28.0
(23.9-32.4)
28.6
(26.8-30.5)
27.8
(26.5-29.2)
31.0
(27.2-35.0)
27.5
(26.2-29.0)
35.3
(33.7-37.0)
38.7
(34.8-42.7)
35.0
(33.4-36.7)
20.8 (19.6-22.1)
23.3 (19.9-26.9)
20.6 (19.3-22.0)
19.9 (18.6-21.3)
20.1 (16.6-23.8)
19.9 (18.6-21.3)
11.3 (10.5-12.1)
14.2 (10.8-18.2)
11.0 (10.3-11.8)
17.6 (16.6-18.8)
17.2 (14.4-20.4)
17.7 (16.6-18.8)
Sexual orientation
11.5 (10.6-12.4)
16.7 (13.0-20.9)
11.0 (10.2-11.8)
Religion
8.4 (7.5-9.4)
9.2 (7.0-11.8)
8.3 (7.4-9.3)
Other
19.2 (18.3-20.2)
16.3 (13.5-19.5)
19.5 (18.4-20.6)
Note. CI = confidence interval
1.10 Vaping Cessation
The 2023 CYTS examined quit attempts among current vapers and their intentions to quit
vaping in the future. Appendix A provides additional information about these variables.
Table 1-12 presents reported quit attempts and intention to quit vaping in the next 30 days
among vapers in specific populations. Among respondents who currently vaped, 40.8%
reported attempting to quit vaping in the last 12 months, and 38.8%reported intending to
quit in the next 30 days. Respondents who identified their gender in another way had the
lowest prevalence of quit attempts (30.6%) and lowest reported intention to quit (24.5%).
Quit attempts and intention to quit were more common among 12th-grade respondents
(41.8% and 40.8%, respectively) than 10th-grade respondents (39.2% and 35.5%,
respectively). Non-LGBTQ+ respondents had a higher prevalence of quit attempts and
reporting intentions to quit (41.7% and 41.5%, respectively) than respondents who were
LGBTQ+ (36.9% and 32.6%, respectively) and respondents who had unclear LGBTQ+
status (36.7% and 33.6%, respectively). Respondents with poor mental health (36.4%)
reported fewer quit attempts, but respondents with fair mental health status (43.1%)
reported a higher prevalence of quit attempts than those with good to excellent mental
health (40.5%). When asked about the next 30 days, respondents with good to excellent
1-12
Results ofthe 2023 California Youth Tobacco Survey
mental health /41.796\ had the highest prevalence of intention to quit out of all mental
health statuses. Suppressed values prevented comparisons by race/ethnicity.
Table 1-12. Percentage of Respondents Who Reported Attempting to Quit Vaping
in the Last 12Momths or Intending to Quit Vaping in the Next 30 Days
Among Currently Vaping High School Respondents
Attempted to Quit Intending to Quit
Characteristic N 0/0 (950/00I) N 0/0 (950/0 CI)
Overall 2,099 40.8 (37.5-44.2) I,090 38.8 (34J-43J)
Gender identity
Male 767 41.2 (35.4-47.2) 767 40.7 (]4.]-47.3)
Female 965 40.6 (3E9-45.4) 965 39.2 (33.7-45.0)
Identified in another way 182 30.6 (19.6-43.6) 182 24.5 (14.6-368)
Declined toanswer 25 -- -- 25 -- --
Race/ethnicity*
White 761 39.1 (33.5-44.8) 761 32.7 (25.3-40.7)
African American or Black 55 -- -- 55 -- --
Hispanic 939 42.1 (36.9-47.5) 939 42.4 (36.1-48.9)
Asian 107 39.9 (27.2-53.6) 107 44.8 (31.5-58.8)
Other 43 -- -- 43 -- --
Multiracial 192 42.6 (30.8-55.1) 102 40.2 (28.4-52.9)
Grade
10 853 30.2 (33.1-45.6) 853 35.5 (30.6-40.7)
12 1,246 41.8 (37.2-46.5) 1,246 40.8 (34.6-47.2)
LGBT{}+staLus
LGBTO+ 543 36.9 (29.8-44.4) 543 32.6 (25.0-40.9)
Non LGBTO+ 1,246 41.7 (36.9-46.5) 1,246 41.5 (36.2-46.9)
Unclear LGBTD+status 124 36.7 (24.0-50.9) 124 33.6f (18.9-51.0)
Mental health status
Good toexcellent 980 40.5 (35.0-46.2) 980 41.7 (34.0-49.6)
Fair 537 43.1 (35.5-50.9) 537 38.4 (31.2-46.0)
Poor 430 36.4 (27.7-45.8) 420 30.8 (23.8-38.5)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender,queer orquestioning. CI= confidence interval.
* With the exception of Hispanic, all ethnidties are classified as non Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured bythe survey.
The estimate has been suppressed due to snna|| sample sizes, specifically, a nominal or effective
sample size less than ]O. For definitions of nominal and effective sample size, see Appendix A.
fThe estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (e) the absolute width of the Korn-Graubard confidence interval
for the estimate is > 0.20 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
13096ofthe estimate.
Results ofthe 2023 California Youth Tobacco Survey
1.11 Summary
In 2023, the most frequently used tobacco product among California high school
respondents was vapes, with 5.996 reporting current use and 18.396 reporting ever use.
Current use of cigarettes was 1.296, and current use ofUCCs, cigars, hookah, smokeless
tobacco, and H-[Ps were all less than 1.096. Respondents who identified their gender in
another way or declined to answer questions about gender had a higher prevalence of any
tobacco used compared to female or male respondents. This was also true for most
individual tobacco products. Tobacco use was highest among respondents in the 12th grade
(compared with 10th grade). About a quartar(27.296) of respondents who currently used
tobacco also reported using two or more tobacco products. Experiences of discrimination
were common (66.196), and respondents who currently used tobacco reported experiencing
discrimination more frequently. A higher prevalence of quit attempts and intention to quit
was observed among males, 12th graders, and non-LGTB0f respondents. Prevalence of
quit attempts in the last 12 months and intention to quit in the next]O days varied byself-
reported
2. Use of Flavored Tobacco Products
This chapter presents the information about the use of flavored tobacco products among
respondents currently using tobacco. It also presents the use of specific flavors. It should be
noted that the flavored cigarette use reported in this chapter reflects the use of menthol
cigarettes (the only flavor available). For flavored tobacco use among 8th-grade
respondents, see Chapter 10.
2.1 Flavored Tobacco Use
The 2023 CYTS asked respondents who were currently using tobacco which flavors they
used most often for each tobacco product. Since menthol cigarettes are the only type of
flavored cigarette, the CYTS only asked about the use of menthol cigarettes in the past 30
days for respondents reporting current smoking. However, for the other products, the CYTS
asked respondents to select their most commonly used flavor from a list of multiple flavors.
We divided respondents based on their use of flavored or unflavored products. This report
defines flavored tobacco use as smoking menthol cigarettes in the last 30 days or, for users
of all other tobacco products, selecting any flavor other than tobacco or unflavored as their
most used flavor (see Appendix A). This report defines unflavored tobacco use as not having
smoked menthol cigarettes in the last 30 days or, for users of all other products, selecting
"tobacco" or "unflavored" as their most used flavor.
Table 2-1 indicates that, for the products included in the table, most respondents who were
using tobacco also reported using a flavored tobacco product (85.6%), with the use of
flavored vapes (89.1%) being the most prevalent. Almost half of respondents who were
smoking cigarettes (45.0%) reported using menthol cigarettes in the past 30 days.
Table 2-1.
Descriptive Analysis of Current Flavored Tobacco Product Use by
Product, Among Respondents Currently Using Tobacco
Flavored Product Use
Tobacco Product N
%
(95% Cl)
Any of the below* 2,464
85.6
(82.6-88.2)
Vapes
2,070
89.1
(85.8-91.9)
Cigarettes**
457
45.0
(36.4-53.9)
LCCs
232
50.1
(38.5-61.7)
Cigars
294
49.9
(38.1-61.6)
Hookah
195
77.2
(60.8-89.2)
Smokeless
178
66.1t
(49.3-80.5)
(continued)
2-1
Results of the 2023 California Youth Tobacco Survey
Table 2-1. Descriptive Analysis of Current Flavored Tobacco Product Use by
Product, Among Respondents Currently Using Tobacco (continued)
Flavored Product Use
Tobacco Product N % (95% CI)
HTPs 140 75.2 (60.8-86.3)
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos; CI = confidence interval.
* As the sample size for the subgroup for each product varies, estimates for each product may be
greater than that of "any of the below."
** Menthol was the only available flavor for cigarettes.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is > 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
Tobacco2.2 Flavored
Table 2-2 presents the current use of flavored tobacco among respondents who reported
currently using tobacco, by demographics. Overall, most respondents who used these
products reported using a flavored tobacco product. Use of flavored tobacco was highest
among high school respondents who identified their gender in another way (90.1%) and
lowest among males (81.5%). Use of flavored tobacco was highest among African American
or Black respondents, followed by Asian respondents. Among respondents who currently
used tobacco, 96.0% of African American or Black respondents and 94.4% of Asian
respondents reported using flavored tobacco. Use of flavored tobacco was lowest among
Hispanic respondents (82.7%). Use among 10th- and 12th-grade students was 86.6% and
85.0% respectively. LGBTQ+ respondents reported higher use (86.9%) than non-LGBTQ+
respondents (85.7%) and respondents with unclear LGBTQ+ status (79.8%).
Table 2-2. Prevalence of Current Use of Any Flavored Tobacco Among High
School Respondents Who Reported Currently Using These Products,
by Gender Identity, Race/Ethnicity, Grade, and LGBTQ+ Status
Current Use
Characteristic N % (95% CI)
Overall 2,464 85.6 (82.6-88.2)
Gender identity
Male 951 81.5 (77.5-85.1)
Female 1,056 88.4 (83.4-92.3)
Identified in another way 244 90.1 (84.8-94.1)
Declined to answer 30 — —
Race/ethnicity*
(continued)
2-2
Results of the 2023 California Youth Tobacco Survey
Table 2-2.
Prevalence of Current Use of Any Flavored Tobacco Among High
School Respondents Who Reported Currently Using These Products,
by Gender Identity, Race/Ethnicity, Grade, and LGBTQ+ Status
(continued)
Current Use
Characteristic N
% (95% CI)
White
900
86.3
(82.0-89.8)
African American
or Black 67
96.0
(91.2-98.6)
Hispanic
1,085
82.7
(77.1-87.4)
Asian
120
94.4
(87.4-98.2)
Other
59
91.7
(77.1-98.4)
Multiracial
226
87.8
(80.8-93.0)
Grade
10
998
86.6
(82.1-90.3)
12
1,466
85.0
(81.4-88.1)
LGBTQ+ status
LGBTQ+
656
86.9
(80.6-91.8)
Non-LGBTQ+
1,441
85.7
(82.7-88.4)
Unclear LGBTQ+ status 151
79.8
(63.1-91.3)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey.
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
2.3 Use of Specific Flavored Tobacco Products by Demographics
The following section (Tables 2-3, 2-4, and 2-5) presents the current use of flavored
tobacco for specific products among respondents who were currently using tobacco across
respondent demographics, including gender identity, race/ethnicity, and grade.
Table 2-3 indicates the percentage of respondents currently using vapes, cigarettes, and
cigars who were using flavored versions of these products, by gender identity, excluding
participants who declined to answer gender identity questions due to small sample sizes. We
excluded other tobacco products due to small sample sizes. Female respondents reported
the highest use of flavored vapes (90.3%) out of the gender identities included in the table.
Participants who identified their gender in another way (69.0%) reported higher current use
of menthol cigarettes than males (38.0%), but the estimate for males should be interpreted
with caution, and we could not include females in this comparison due to small sample sizes.
2-3
Results of the 2023 California Youth Tobacco Survey
Table 2-3. Prevalence of Current Flavored Tobacco Product Use Among High
School Respondents Who Reported Currently Using Each Tobacco
Product by Gender Identity
Tobacco
Product
Male Female Identified in Another Way
N % (95% Cl) N % (95% Cl) N % (95% CI)
Any flavored 951 81.5 (77.5-85.1) 1,056 88.4 (83.4-92.3) 244 90.1 (84.8-94.1)
tobacco use*
Vapes 752 87.7 (83.2-91.4) 958 90.3 (84.5-94.5) 180 85.5 (72.0-94.1)
Cigarettes** 183 38.Ot (23.6-54.2) 138 — — 98 69.0 (55.6-80.5)
Note. CI = confidence interval. The "decline to answer" category for gender identity was removed
because all values were suppressed due to small sample size.
* Includes use of vapes, cigarettes, LCCs, cigars, hookah, smokeless tobacco, and/or HTPs. All
products except for vapes and cigarettes were removed from the table due to small sample sizes.
** Menthol was the only available flavor for cigarettes.
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
Tables 2-4a and 2-4b display the use of flavored tobacco products by race/ethnicity. African
American/Black respondents reported the highest use of any flavored tobacco (96.0%),
followed by Asian (94.4%) and other race (91.7%) respondents. For flavored vapes, African
American/Black respondents had the highest prevalence of using flavored vapes (98.7%) of
the race/ethnicity groups with a sufficient sample size to include in the table (all groups
except "other race"). The sample sizes for menthol cigarette smoking use were too small to
determine patterns by product and race/ethnicity. We excluded the remaining tobacco
products from the table due to small sample sizes.
2-4
Results of the 2023 California Youth Tobacco Survey
Table 2-4a. Prevalence of Current Flavored Tobacco Product Use Among High
School Respondents Who Reported Currently Using Each Tobacco
Product by Race/Ethnicity
Tobacco
Product
African American or
White Black Hispanic
N % (95% CI) N % (95% CI) N % (95% Cl)
Any flavored 900 86.3 (82.0-89.8) 67 96.0 (91.2-98.6) 1,085 82.7 (77.1-87.4)
tobacco use*
Vapes 754 92.9 (89.9-95.2) 55 98.7 (95.4-99.8) 923 84.6 (78.3-89.7)
Cigarettes** 222 28.7 (19.0-40.0) 13 — — 137 57.6 (43.7-70.6)
Note. CI = confidence interval.
* Includes use of vapes, cigarettes, LCCs, cigars, hookah, smokeless tobacco, and/or HTPs. All
products except for vapes and cigarettes were removed from the table due to small sample sizes.
** Menthol was the only available flavor for cigarettes.
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
Table 2-4b. Prevalence of Current Flavored Tobacco Product Use Among High
School Respondents Who Reported Currently Using Each Tobacco
Product by Race/Ethnicity
Asian Other Multiracial
Tobacco
Product N % (950/0 CI) N % (950/0 CI) N % (950/0 Cl)
Any flavored 120 94.4 (87.4-98.2) 59 91.7 (77.1-98.4) 226 87.8 (80.8-93.0)
tobacco use*
Vapes 104 95.9 (88.3-99.2) 43 — — 189 89.2 (79.7-95.3)
Cigarettes** 20 — — 13 — — 52 — —
Note. CI = confidence interval.
* Includes use of vapes, cigarettes, LCCs, cigars, hookah, smokeless tobacco, and/or HTPs. All
products except for vapes and cigarettes were removed from the table due to small sample sizes.
** Menthol was the only available flavor for cigarettes.
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
Table 2-5 shows results by grade. Due to small sample sizes, we are unable to make
comparisons for some tobacco products. Use of flavored vapes was higher among
respondents in 12th grade (90.0%) than in 10th grade (87.7%). Use of menthol cigarettes
and flavored cigars was higher among respondents in loth grade (51.1% and 62.7%,
respectively) than in 12th grade (41.7% and 39.7%, respectively).
2-5
Results ofthe 2023 California Youth Tobacco Survey
TabUe2-5.
Prevalence of Current Flavored Tobacco Product Use Among High
School Respondents Who Reported Currently Using Each Tobacco
Product by Grade
10Kh Grade
12th Grade
Tobacco Product N
0/0 (9596CI)
N
96(950/0CI)
Any ofthe below* 998
86.6 (82.7-00.5)
1,466
85.0 (81.7-88.3)
Vapes
830
87.7 (8I.8-0I.6)
1,231
90.0 (87.1-02.8)
Oganettes"
160
51.1 (38.3-63.9)
297
41.7 (29.9-53.4)
LCCs
102
-- --
130
51.5 (38.4-64.5)
Cigars
122
62.7+ (46.8-78.6)
172
39.7 (27.9-51.4)
Hookah
88
76.2t (61.1-91.3)
107
-- --
Smokeless
89
72.0 (58.5-85.5)
89
-- --
HTPs
72
-- --
68
77.7 (64.8-90.6)
Note. HTPs = heated tobacco products; L[Cs = little cigars or cigarillos; CI = confidence interval.
* As the sample size for the subgroup for each product varies, estimates for each product may be
greater than that of"any ofthe be|ow."
*� Menthol was the only available flavor for cigarettes.
The estimate has been suppressed due to snna|| sample sizes, specifically, a nominal or effective
sample size less than ]O. For definitions of nominal and effective sample size, see Appendix A.
+ The estimate should be interpreted with caution given concerns about precision. The estimate meets
one orboth ofthe following criteria: (a)the absolute width ofthe Korn-Graubardconfidence interval
for the estimate is �: 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn Graubard confidence interval is greater than
13O96ofthe estimate.
Table 2-6 shows the use of flavored tobacco products by LGBTQf status. Estimates for
respondents of unclear LGBTO+ status and estimate for products other than vapes,
cigarettes, and cigars are suppressed due tosmall sample sizes. Where estimates are
available for specific products, use of flavored tobacco products varied by LGBT[>f status.
Use of menthol cigarettes and flavored cigars was higher among L(]BTD+ respondents (48.496
and 03.896, respectively) than non-LGBTO+ respondents (39.5%and 44.296, respectively);
however, these estimates should be interpreted with caution. Use offlavored vapasvvas
higher among non-L{SBTD+ respondents (89.796) than L{SBTQ+ respondents (88.7%).
2-6
Results of the 2023 California Youth Tobacco Survey
Table 2-6. Prevalence of Current Flavored Tobacco Product Use Among High
School Respondents Who Reported Currently Using Each Tobacco
Product, by LGBTQ+ Status
LGBTQ+ Non-LGBTQ+
Tobacco Product N % (95% CI) N % (95% CI)
Any flavored tobacco use* 656 86.9 (80.6-91.8) 1,441 85.7 (82.7-88.4)
Vapes 537 88.7 (80.4-94.3) 1,229 89.7 (86.3-92.5)
Cigarettes** 165 49.4 (37.4-61.4) 216 39.5t (24.8-55.7)
Cigars 86 63.8t (44.6-80.2) 164 44.2t (28.8-60.4)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* Includes use of vapes, cigarettes, LCCs, cigars, hookah, smokeless tobacco, and/or HTPs. All
products except for vapes and cigarettes were removed from the table due to small sample sizes.
** Menthol was the only available flavor for cigarettes.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
Specific2.4 Use of r Types
The 2023 CYTS asked respondents to indicate the flavor type they used most often. As
shown in Tables 2-7a and 2-7b, flavor popularity varied by product. Fruit was the most
popular flavor among respondents who were currently vaping (48.7%), using hookah
(32.9%), and using HTPs (17.5%). Tobacco was the most popular flavor among
respondents who were smoking cigars (29.8%) and using smokeless tobacco (23.5%).
Almost half (45%) of respondents who currently smoked reported smoking menthol
cigarettes.
Table 2-7a. Prevalence of Endorsing Specific Flavors Among High School
Respondents Who Reported Currently Using Each Tobacco Product
Vapes Cigarettes*** LCCs Cigars
N = 2,070 N = 457 N = 232 N = 294
Flavors % (95% CI) % (95% CI) % (95% CI) % (95% CI)
Unflavored
8.0
(5.6-11.0)
55.0 (46.1-63.6)
29.2
(18.6-41.6)
20.4
(12.4-30.5)
Tobacco flavored
2.9
(1.6-4.7)
N/A
20.8
(13.2-30.1)
29.8
(21.0-39.8)
Menthol
2.2
(1.3-3.6)
45.0 (36.4-53.9)
9.7t
(3.6-20.0)
3.4t
(1.0-8.1)
Mint
9.3
(7.1-12.0)
N/A
2.3t
(0.5-6.6)
7.2t
(1.1-22.2)
Cooling, ice, or
9.2
(7.1-11.6)
N/A
0.4
(0.0-1.3)
5.8t
(2.1-12.4)
frosty
Clove or spice
0.4
(0.1-1.4)
N/A
3.9t
(1.1-9.5)
1.0
(0.4-2.3)
(continued)
2-7
Results of the 2023 California Youth Tobacco Survey
Table 2-7a. Prevalence of Endorsing Specific Flavors Among High School
Respondents Who Reported Currently Using Each Tobacco Product
(continued)
Vapes
Cigarettes***
LCCs
Cigars
N = 2,070
N = 457
N = 232
N = 294
Flavors % (95% CI)
% (95% CI)
% (95% CI)
% (95% CI)
Fruit
48.7
(44.1-53.4)
N/A
14.4
(7.5-24.2)
10.7t
(5.1-19.1)
Alcoholic drink*
1.2
(0.7-2.1)
N/A
2.5
(1.1-4.7)
3.1
(1.3-6.1)
Non-alcoholic
0.9
(0.3-1.9)
N/A
0.8
(0.2-2.0)
1.8t
(0.2-5.9)
drink**
Candy, chocolate,
10.0
(7.7-12.7)
N/A
7.5t
(2.9-15.3)
5.6t
(2.2-11.5)
desserts, or other
sweets
Some other flavor
7.1
(5.4-9.0)
N/A
8.7t
(3.8-16.5)
11.3t
(5.4-20.3)
Note. LCCs = little cigars or cigarillos; CI = confidence interval.
* Such as wine, cognac, margarita, or other cocktails.
** Such as coffee, soda, energy drinks, or other beverages.
*** Menthol was the only available flavor for cigarettes. All other flavors are labeled N/A (not
applicable).
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
Table 2-7b.
Prevalence of Endorsing Specific Flavors Among High School
Respondents Who Reported Currently Using Each Tobacco Product
Hookah
Smokeless
HTPs
N=195
N=178
N=140
Flavors
% (950/0 CI)
% (950/0 CI)
% (950/0 CI)
Unflavored
5.7t (2.4-11.2)
10.4 (5.3-17.8)
10.6 (6.2-16.5)
Tobacco flavored
17.1t (6.1-34.7)
23.5 (10.9-40.8)
14.3t (5.2-29.2)
Menthol
7.9 (4.1-13.6)
13.5t (5.4-26.5)
8.9 (4.4-15.5)
Mint
8.1t (2.8-17.3)
- -
- -
Cooling, ice, or
1.1 (0.3-2.8)
2.0 (0.7-4.6)
4.7t (1.7-10.3)
frosty
Clove or spice 6.9t (2.1-16.1) 1.6 (0.2-5.1) 1.9t (0.3-5.8)
Fruit 32.9 (21.4-46.1) 9.4t (2.6-22.3) 17.5t (8.0-31.4)
Alcoholic drink* 2.1t (0.4-6.4) 2.0 (0.9-3.8) - -
Non-alcoholic - - 0.2 (0.0-1.0) 0.6 (0.2-1.3)
drink**
(continued)
2-8
Results of the 2023 California Youth Tobacco Survey
Table 2-7b. Prevalence of Endorsing Specific Flavors Among High School
Respondents Who Reported Currently Using Each Tobacco Product
(continued)
Hookah Smokeless HTPs
N=195 N=178 N=140
Flavors % (950/0 CI) % (950/0 CI) % (950/0 CI)
Candy, chocolate, 4.2t (1.5-9.1) 9.4t (2.4-23.1) 1.7 (0.8-3.1)
desserts, or other
sweets
Some other flavor 8.2 (4.2-14.2) 9.7 (5.2-16.2) 9.6t (4.4-17.6)
Note. HTPs = heated tobacco products; CI = confidence interval.
* Such as wine, cognac, margarita, or other cocktails.
** Such as coffee, soda, energy drinks, or other beverages.
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
2.5 Perceived AccessibilityProducts
In addition to asking questions of respondents who were currently using tobacco products
about which flavors they were using, we asked all respondents, regardless of user status,
how easy they thought it was to access flavored tobacco products from a store, the internet
(including apps), or someone else. The survey did not provide a definition for flavored
tobacco products in the survey item. Respondents who responded "somewhat easy" or "very
easy" to each question were coded as perceiving that it was easy to access flavored tobacco
products. Respondents who responded "somewhat difficult" or "very difficult" were coded as
not perceiving that it was easy to access flavored tobacco products. Perceived access for
vapes and cigarettes (without mention of the products being flavored or unflavored) is
presented in Chapter 3.
Table 2-8 presents the percentage of high school respondents who perceived that it was
easy to obtain flavored tobacco products from a store, from the internet, and from someone
else. About a third of respondents thought it was easy to access flavored tobacco products
from a store (38.5%), while many more thought it was easy to access flavored products
from the internet (61.4%) or from someone else (63.6%).
M
Results of the 2023 California Youth Tobacco Survey
Table 2-8. Prevalence of Perceiving That it was Easy to Access Flavored Tobacco
Products Among High School Respondents
From a store From the internet From someone else
% (95%
Characteristic N % (95% CI) N % (95% CI) N CI)
Overall 29,943 38.5 (37.3-39.8) 29,809 61.4 (60.2-62.6) 29,861 63.6 (62.3-64.9)
w
6 Summary
Most high school respondents who were currently using tobacco reported using flavored
tobacco. This finding was consistent regardless of gender identity, race/ethnicity, or grade.
Out of all tobacco products, flavored product use was highest for vapes, with 89.1% of
respondents who currently vaped reporting using flavored vapes. Almost half (45.0%) of
respondents who smoked cigarettes reported using menthol cigarettes in the last 30 days.
The popularity of flavor types varied by product, but fruit flavors were popular for several
products, including vapes. Respondents reported that they believed it was easier to access
flavored tobacco products from the internet or another person than from a store. Findings
for flavored tobacco should be interpreted with caution. The CYTS asks respondents to
identify their most commonly used flavor, as opposed to asking them for all flavors they
have used in the past 30 days. As a result, it is possible that some users categorized as
unflavored users have also used flavored products in the past 30 days, and vice versa. For
discussion of flavored tobacco use within the context of Senate Bill (SB) 793, please see the
Conclusions section of the report.
2-1
3. Access to Vapes and Cigarettes
Age restrictions are intended to make it difficult for youth to access tobacco products. The
minimum legal age to purchase tobacco products, including vapes, in California is 21 years
old. As a result, it is important to monitor how underage youth acquire tobacco products,
particularly through retail sources. This chapter presents data on how respondents acquired
vapes and cigarettes. We asked respondents who currently vaped and smoked cigarettes
how they usually got their vapes (or pods or e-liquid) or cigarettes, respectively. We then
asked respondents who reported buying their own vapes or cigarettes where they usually
bought their vapes (or pods or e-liquid) or cigarettes.
3.1 Acquisition of Vapes
Table 3-1 presents methods of vape acquisition among respondents who reported currently
vaping. The most common method of obtaining vapes was buying their own (34.9%).
Besides purchasing one's own vapes, other common methods were asking someone else to
buy them (21.4%) and someone giving them to the respondent (18.2%). The least
commonly reported method was taking them from someone (4.9%).
Among respondents who reported purchasing their own vapes, the most common source
was buying them from another person (30.5%), followed by from a tobacco or smoke shop
(25.0%). When looking by grade, among respondents who purchased their own vapes, the
most common purchasing source reported by 10th graders was another person (45.5%),
and the most common purchasing source for 12th graders was a tobacco or smoke shop
(29.6%).
Table 3-1. Methods of Accessing Vapes Among High School Respondents Who
Were Currently Vaping, by Grade
Overall
10th Grade
12th Grade
N = 2,055
N = 836
N = 1,219
Method
% (950/0 CI)
%
(950/0 CI)
% (950/0 CI)
I ask someone to buy them
21.4 (18.0-25.1)
23.9
(17.9-30.8)
19.8 (16.2-23.8)
for me
Someone gives them to me
18.2 (15.2-21.6)
16.8
(11.5-23.4)
19.1 (15.9-22.7)
I ask someone for them
11.5 (9.3-14.1)
11.2
(7.2-16.5)
11.7 (9.2-14.6)
I take them from someone
4.9 (3.5-6.7)
6.8
(3.9-10.9)
3.7 (2.5-5.2)
I get them some other way
9.0 (6.8-11.7)
12.5
(8.7-17.3)
6.8 (4.5-9.8)
I buy them myself*
34.9 (30.9-39.1)
28.7
(21.7-36.5)
38.8 (34.0-43.8)
From a gas station or
11.0 (6.6-17.1)
8.Ot
(3.3-15.8)
12.5 (7.2-19.6)
convenience store
From a grocery store
1.4 (0.4-3.5)
2.2t
(0.5-5.9)
1.0 (0.0-4.6)
(continued)
3-1
Results of the 2023 California Youth Tobacco Survey
Table 3-1. Methods of Accessing Vapes Among High School Respondents Who
Were Currently Vaping, by Grade (continued)
Overall
10th Grade
12th Grade
N = 2,055
N = 836
N = 1,219
Method
%
(950/0 Cl)
% (950/0 Cl)
%
(950/0 Cl)
From a drugstore or
0.0
N/A
0.0
N/A
0.0
N/A
pharmacy
From a liquor store
2.7
(1.0-5.7)
0.7
(0.0-3.7)
3.6t
(1.2-8.1)
From a tobacco or smoke
25.0
(17.6-33.7)
15.4t
(5.2-32.2)
29.6
(21.0-39.5)
shop
From a vape shop
17.4
(12.8-22.8)
14.0
(7.0-24.1)
19.0
(13.0-26.3)
From a mall or shopping
0.0
N/A
0.0
N/A
0.0
N/A
center kiosk/ stand
On the internet (including
2.1
(1.2-3.4)
2.8
(1.1-5.6)
1.8
(0.7-3.6)
apps)
From someone
30.5
(23.1-38.7)
45.5t
(28.7-63.1)
23.4
(16.3-31.8)
Some other way
7.9
(4.8-12.0)
9.6t
(4.2-18.2)
7.1
(3.6-12.3)
Note. CI = confidence interval. A value of 0.0 indicates that no respondents selected that item. N/A is
used in the table to indicate that there is no confidence interval because the value of the estimate is
0.0. For definitions of nominal and effective sample size, see Appendix A.
* Numbers below this row represent the percentage of respondents endorsing each location among
those who reported buying their own vapes.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
3.2 AcquisitionCigarettes
Table 3-2 shows how respondents who were current cigarette smokers acquired cigarettes.
The most common method of obtaining cigarettes was buying them (26.5%). Besides
purchasing one's own cigarettes, other common methods of obtaining them were being
given them (22.1%) and taking them from someone (22.0%). The least common method
was to ask someone for them (7.5%). In terms of location of purchase among respondents
who reported purchasing their own cigarettes, for several methods, the estimate was
suppressed. However, among the estimates that could be obtained, the most common
method of purchase among those who reported buying their own cigarettes was from a gas
station or convenience store (41.0%).
3-2
Table 3-2. Methods of Accessing Cigarettes Among High School Respondents
Who Were Currently Smoking Cigarettes, by Grade
Overall
10th Grade
12th Grade
N = 452
N = 156
N = 296
Method
% (950/0 CI)
% (950/0 CI)
% (950/0 CI)
I ask someone to buy them
8.8
(5.0-14.2)
5.5t
(2.1-11.4)
10.6
(5.4-18.2)
for me
Someone gives them to me
22.1
(15.9-29.4)
14.9
(7.2-26.1)
26.0
(19A-33.5)
I ask someone for them
7.5
(4.5-11.7)
7.7t
(2.8-16.2)
7.4
(3.9-12.7)
I take them from someone
22.0
(14.5-31.1)
24.7
(12.6-40.7)
20.6
(11.5-32A)
I get them some other way
12.9
(7.2-20.9)
18.6t
(7.3-35.9)
9.9
(4.9-17.5)
I buy them myself*
26.5
(19.2-35.0)
28.5
(17.5-41.7)
25.5
(17.3-35.2)
From a gas station or
41.0
(28.3-54.6)
-
-
41.7
(28.1-56.4)
convenience store
From a grocery store
-
-
5.9t
(0.6-20.2)
-
From a drugstore or
0.0
N/A
0.0
N/A
0.0
N/A
pharmacy
From a liquor store
4.Ot
(0.8-11.5)
0.0
N/A
6.4t
(1.4-17.6)
From a tobacco or smoke
12.6t
(4.1-27.4)
2.5
(0.9-5.2)
-
-
shop
From a vape shop
-
-
0.0
N/A
0.0
N/A
From a mall or shopping
0.0
N/A
0.0
N/A
0.0
N/A
center kiosk/ stand
On the internet (including
5.2t
(1.5-12.2)
-
-
3.3t
(0.7-9.3)
apps)
From someone
16.9
(11.2-23.9)
-
-
9.4t
(4.2-17.7)
Some other way
6.9t
(2.1-16.0)
-
-
3.6t
(0.9-9.0)
Note. CI = confidence interval. A value of 0.0 indicates that no respondents selected that item. N/A is
used in the table to indicate that there is no confidence interval because the value of the estimate is
0.0.
* Numbers below this row represent the percentage of respondents endorsing each location among
those who reported buying their own cigarettes.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
There were some differences by grade. In terms of method of acquisition, 10th-grade
respondents reported buying their own cigarettes (28.5%) as the most common method,
followed by getting them some other way (18.6%). Twelfth -grade respondents reported
being given cigarettes as the most common method of acquisition (26.0%), followed by
3-1
Results of the 2023 California Youth Tobacco Survey
buying them (25.5%). For 10th graders, too many estimates were suppressed to determine
the most common method of purchase among respondents who were currently smoking
cigarettes and reported purchasing their own cigarettes. Several methods of purchase were
also suppressed for 12th graders, but for those estimates that could be presented,
purchasing from a gas station or convenience store was the most common method of
purchase (41.7%).
3.3 Perceived Accessibility f Vapes
In addition to asking questions of respondents who were currently using vapes about how
they obtained their products, we asked all respondents, regardless of user status, how easy
they thought it was to access these products from a store, the internet (including apps), or
someone else. Respondents who responded "somewhat easy" or "very easy" to these
questions were coded as perceiving that it was easy to access these products. Respondents
who responded 'somewhat difficult" or "very difficult" were coded as not perceiving that it
was easy to access these products. Overall, about half of respondents or more reported that
they thought it was easy to get vapes from a store, the internet, or someone else. Variation
in perceived ease of access existed by current vaping status.
Table 3-3 presents the percentage of high school respondents who perceived that it was
easy to get vapes from a store, from the internet, and from someone else. A little over two-
thirds of respondents thought it was easy to access vapes from someone else (71.6%) or
from the internet (67.3%), and about half of high school respondents thought it was easy to
access vapes from a store (49.9%). Current vapers reported the highest perceived ease of
access from a store or from someone else, but the lowest perceived access to vapes from
the internet.
Table 3-3. Prevalence of Perceiving That It Was Easy to Access Vapes Among
High School Respondents, by Vaping Status
From a Store From the Internet
From Someone Else
Characteristic N % (95% CI) N % (95% CI)
N
% (95% CI)
Overall 29,941 49.9 (48.7-51.1) 29,814 67.3 (66.0-68.6)
29,858
71.6 (70.3-72.8)
Vaping status
Never vaping 23,927 48.3 (47.0-49.6) 23,842 67.0 (65.7-68.4)
23,876
68.8 (67.5-70.1)
Former vaping 4,000 54.2 (51.2-57.2) 3,972 70.5 (67.4-73.4)
3,981
83.5 (81.2-85.7)
Current vaping 2,014 63.2 (59.2-67.1) 2,000 64.2 (60.6-67.7)
2,001
84.4 (81.5-87.1)
Note. CI = confidence interval.
Table 3-4 includes findings for perceived access to vapes from a store by vaping status and
demographics. Overall, respondents who currently vaped had the highest perceived access
3-2
Results of the 2023 California Youth Tobacco Survey
to vapes from a store (63.2%), followed by those who formerly (54.2%) and never vaped
(48.3%). This pattern was generally true across gender identity, race/ethnicity, and grade,
and LGBTQ+ status, with a couple of exceptions. Asian respondents who had never vaped
and respondents who had never vaped and identified their gender in another way had
higher perceived ease of access than former vapers in these same categories.
Table 3-4. Prevalence of Perceiving That It Was Easy to Access Vapes from a
Store Among High School Respondents, by Vaping Status and Gender
Identity, Race/Ethnicity, Grade, and LGBTQ+ Status
Never Vaping Former Vaping Current Vaping
Characteristic
N
%
(95% Cl)
N
% (95%
Cl)
N
% (95% Cl)
Overall
23,927
48.3
(47.0-49.6)
4,000
54.2
(51.2-57.2)
2,014
63.2
(59.2-67.1)
Gender identity
Male
11,142
48.3
(46.5-50.0)
1,649
55.1
(50.1-60.1)
752
65.5
(59.4-71.3)
Female
10,466
49.1
(47.5-50.8)
1,903
54.7
(51.5-57.8)
952
62.2
(56.4-67.7)
Identified in
1,311
46.4
(41.7-51.2)
243
45.8
(34.6-57.3)
177
60.0
(46.5-72.5)
another way
Declined to
121
45.9
(31.9-60.4)
27
-
-
22
-
-
answer
Race/ethnicity*
White
5,379
49.9
(47.5-52.3)
1,038
54.4
(48.1-60.5)
732
66.7
(59.2-73.7)
African
503
58.7
(50.5-66.6)
101
71.4
(61.9-79.7)
53
88.8
(75.8-96.2)
American or
Black
Hispanic
12,943
46.3
(44.5-48.1)
2,266
51.7
(47.5-56.0)
893
58.5
(51.6-65.1)
Asian
2,782
48.9
(46.2-51.5)
215
47.2
(38.1-56.5)
104
69.8
(55.7-81.6)
Other
641
52.8
(44.9-60.7)
77
69.5t
(52.5-83.3)
42
-
-
Multiracial
1,628
50.6
(46.5-54.7)
299
61.9
(54.5-69.0)
188
65.1
(53.6-75.4)
Grade
10
13,100
46.2
(44.7-47.7)
1,768
49.3
(45.0-53.5)
816
59.7
(54.0-65.2)
12
10,827
50.8
(48.9-52.7)
2,232
58.2
(54.4-61.9)
1,198
65.4
(59.5-71.0)
LGBTQ+ status
LGBTQ+
3,639
46.9
(43.6-50.2)
904
53.3
(47.0-59.5)
531
63.4
(56.8-69.5)
Non-LGBTQ+
17,174
50.0
(48.7-51.4)
2,642
55.9
(52.2-59.7)
1,224
63.8
(57.8-69.6)
Unclear LGBTQ+
1,999
39.7
(34.6-45.0)
241
41.5
(31.7-51.8)
123
57.9t
(41.7-72.9)
status
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample size less
than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
> 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate.
Perceived access to vapes from the internet shows a different pattern (Table 3-5). Overall,
more respondents who had formerly vaped perceived it was easy to access vapes from the
3-3
Results of the 2023 California Youth Tobacco Survey
internet (70.5%) than those who had never vaped (67.0%) or currently vaped (64.2%).
However, this pattern varied by gender identity, race/ethnicity, grade, and LGBTQ+ status.
Table 3-5. Prevalence of Perceiving That It Was Easy to Access Vapes from the
Internet Among High School Respondents, by Vaping Status and
Gender Identity, Race/Ethnicity, Grade, and LGBTQ+ Status
Never Vaping Former Vaping Current Vaping
Characteristic N % (95% Cl) N % (95% Cl) N % (95% Cl)
Overall
23,842
67.0
(65.7-68.4)
3,972
70.5
(67.4-73.4)
2,000
64.2
(60.6-67.7)
Gender identity
Male
11,106
67.1
(65.6-68.7)
1,640
68.1
(64.6-71.4)
749
59.3
(54.2-64.3)
Female
10,453
67.6
(65.7-69.5)
1,893
73.7
(70.3-76.8)
943
67.2
(61.8-72.2)
Identified in
1,310
70.1
(66.2-73.8)
241
66.6
(54.4-77.3)
179
69.9
(55.8-81.6)
another way
Declined to
120
59.5
(44.3-73.5)
24
-
-
23
-
-
answer
Race/ethnicity*
White
5,368
69.7
(67.1-72.3)
1,023
69.0
(62.9-74.6)
730
60.9
(53.6-67.9)
African
499
67.9
(63.1-72.4)
100
73.8
(60.0-84.8)
53
-
-
American or
Black
Hispanic
12,899
64.8
(62.8-66.8)
2,256
70.2
(66.0-74.1)
886
65.4
(59.5-71.0)
Asian
2,780
72.1
(69.8-74.3)
215
67.1
(56.8-76.4)
103
68.4
(52.5-81.7)
Other
631
66.1
(58.5-73.1)
77
86.0
(74.6-93.6)
41
-
-
Multiracial
1,613
68.4
(64.1-72.5)
297
76.8
(68.0-84.2)
185
64.5
(50.8-76.7)
Grade
10
13,058
66.5
(64.7-68.2)
1,758
70.8
(66.9-74.4)
813
69.6
(64.4-74.5)
12
10,784
67.7
(65.9-69.5)
2,214
70.3
(66.6-73.8)
1,187
60.8
(55.6-65.8)
LGBTQ+ status
LGBTQ+
3,631
71.6
(68.4-74.6)
901
75.1
(69.4-80.3)
533
73.0
(65.9-79.3)
Non-LGBTQ+
17,138
67.9
(66.5-69.2)
2,624
70.0
(66.8-73.1)
1,214
60.9
(56.0-65.5)
Unclear LGBTQ+
1,990
58.6
(53.9-63.2)
240
67.5
(58.0-76.0)
122
51.8
(37.9-65.6)
status
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample size less
than 30. For definitions of nominal and effective sample size, see Appendix A.
Table 3-6 presents findings for perceived access to vapes from someone else. Overall,
respondents who currently vaped had the highest perceived access to vapes from someone
else (84.4%), followed by respondents who had formerly (83.5%) and never vaped (68.8%).
This pattern was generally true across gender identity, race/ethnicity, grade, and LGBTQ+
3-4
Results of the 2023 California Youth Tobacco Survey
status. One exception was that Hispanic respondents who had formerly vaped reported
higher perceived access than Hispanic respondents who currently vaped.
Table 3-6.
Prevalence of Perceiving That It Was Easy to Access Vapes from
Someone Else Among High School Respondents, by Vaping Status and
Gender Identity, Race/Ethnicity, Grade, and LGBTQ+ Status
Never Vaping
Former Vaping
Current Vaping
Characteristic N
%
(950/0 CI)
N
% (95%
Cl)
N
% (95% Cl)
Overall
23,876
68.8
(67.5-70.1)
3,981
83.5
(81.2-85.7)
2,001
84.4
(81.5-87.1)
Gender identity
Male
11,135
67.4
(65.5-69.3)
1,644
81.1
(78.0-83.9)
750
82.6
(77.9-86.7)
Female
10,494
72.1
(70.5-73.6)
1,900
87.1
(84.4-89.6)
953
87.2
(82.6-91.0)
Identified in
1,314
63.2
(58.5-67.7)
245
76.6
(66.2-85.1)
177
81.9
(71.0-90.0)
another way
Declined to
115
55.3
(40.8-69.2)
25
-
-
23
-
-
answer
Race/ethnicity*
White
5,380
72.2
(69.9-74.5)
1,032
85.3
(80.4-89.4)
729
89.0
(83.5-93.2)
African American 502
71.8
(61.1-81.0)
100
83.8
(74.5-90.8)
52
92.3
(79.5-98.3)
or Black
Hispanic
12,910
67.7
(65.8-69.6)
2,261
82.8
(79.7-85.7)
888
80.9
(75.7-85.4)
Asian
2,780
65.6
(61.9-69.2)
212
80.3
(71.7-87.2)
103
82.0
(67.9-91.8)
Other
636
65.2
(58.7-71.3)
77
75.4t
(56.9-88.8)
42
-
-
Multiracial
1,618
72.4
(68.8-75.8)
295
86.7
(80.2-91.7)
185
87.1
(75.7-94.4)
Grade
10
13,077
66.8
(65.0-68.6)
1,758
84.6
(81.1-87.7)
812
85.7
(80.7-89.9)
12
10,799
71.2
(69.6-72.7)
2,223
82.7
(78.6-86.2)
1,189
83.6
(78.8-87.7)
LGBTQ+ status
LGBTQ+
3,637
70.7
(68.0-73.2)
907
85.8
(81.6-89.4)
531
87.4
(82.5-91.3)
Non-LGBTQ+
17,191
70.3
(68.6-72.0)
2,635
83.9
(81.0-86.5)
1,224
83.7
(79.3-87.4)
Unclear LGBTQ+ 2,005
59.0
(53.8-64.0)
239
79.5
(71.4-86.2)
123
81.3
(69.2-90.1)
status
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample size less
than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
>_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate.
Cigarettes3.4 Perceived Access for
We also examined perceived access to cigarettes from the same three locations (Table 3-7).
As with vapes, respondents reported highest perceived access from someone else (60.8%),
followed by the internet (58.7%) or a store (37.0%). Also in alignment with vapes,
3-5
Results of the 2023 California Youth Tobacco Survey
respondents who currently smoked cigarettes reported the highest perceived access to
cigarettes from someone else or from a store, and respondents who had never smoked
reported the lowest. Respondents who currently, formerly, and never smoked reported
similar perceived access to cigarettes from the internet.
Table 3-7. Prevalence of Perceiving That It Was Easy to Access Cigarettes
Among High School Respondents, by Cigarette Smoking Status
From a Store From the Internet From Someone Else
Characteristic N % (95% CI) N % (95% CI) N % (95% CI)
Overall 29,963 37.0 (35.9-38.0) 29,826 58.7 (57.4-60.0) 29,866 60.8 (59.3-62.2)
Cigarette
smoking status
Never smoking 27,967 36.2 (35.2-37.2) 27,845 58.7 (57.3-60.0) 27,884 59.9 (58.4-61.5)
Former 1,554 44.5 (40.1-48.9) 1,546 58.7 (54.2-63.2) 1,549 71.3 (64.1-77.8)
smoking
Current 442 66.3 (56.4-75.2) 435 55.7 (46.1-65.0) 433 85.9 (79.6-90.8)
smoking
Note. CI = confidence interval.
Table 3-8 presents findings for perceived access to cigarettes from a store by vaping status
and demographics. Overall, more respondents who currently smoked reported it was easy
to access cigarettes from a store (66.3%) than those who had formerly (44.5%) or never
smoked (36.2%). This pattern was consistent across gender identity categories,
race/ethnicity, grade, and LGBTQ+ status, where responses were not suppressed.
Table 3-9 examines perceived ease of access to cigarettes on the internet. Perceived ease of
access was similar among respondents who currently smoked and those who had formerly
and never smoked. For subgroups in which there was variation across smoking status (e.g.,
Hispanic and LGBTQ+ students), the highest perceived access was reported by respondents
who had never smoked, followed by those who currently smoked and those who had
formerly smoked. This is the opposite pattern as that observed by smoking status for access
to cigarettes from a store or another person. However, many of these differences should be
interpreted with caution due to low precision for some estimates.
3-6
Results of the 2023 California Youth Tobacco Survey
Table 3-8. Prevalence of Perceiving That It Was Easy to Access Cigarettes from a
Store Among High School Respondents, by Cigarette Smoking Status
and Gender Identity, Race/Ethnicity, Grade, and LGBTQ+ Status
Never Smoking Former Smoking Current Smoking
Characteristic N % (95% CI) N % (95% Cl) N % (95% Cl)
Overall 27,967 36.2 (35.2-37.2) 1,554 44.5 (40.1-48.9) 442 66.3 (56.4-75.2)
Gender identity
Male
12,706
36.6
(34.8-38.4)
665
Female
12,544
36.4
(34.9-37.9)
648
Identified in
1,491
33.3
(29.4-37.5)
142
another way
Declined to
154
31.6
(19.6-45.6)
11
answer
Race/ethnicity*
White
6,359
35.6
(33.3-37.9)
577
African
622
44.1
(38.1-50.4)
23
American or
Black
Hispanic
15,278
34.8
(33.7-36.0)
703
Asian
3,001
40.2
(38.0-42.4)
81
Other
710
37.1
(29.5-45.1)
41
Multiracial
1,943
38.6
(34.9-42.5)
125
Grade
10
14,923
33.4
(32.1-34.7)
618
12
13,044
39.5
(38.0-40.9)
936
LGBTQ+ status
LGBTQ+
4,466
34.2
(31.7-36.7)
444
Non-LGBTQ+
19,949
37.3
(36.1-38.5)
890
Unclear LGBTQ+
2,213
32.4
(28.7-36.2)
117
status
49.0
(42.0-56.1)
182
65.2t
(48.5-79.6)
43.0
(36.2-49.9)
137
55.4t
(39.3-70.7)
35.9
(24.4-48.6)
99
76.0
(59.8-88.2)
-
-
6
-
-
44.6
(37.6-51.9)
215
66.5
(51.2-79.6)
-
-
13
99.1
-
42.5 (36.7-48.3) 133 59.4t (42.8-74.6)
45.8t (29.0-63.3) 20 - -
- - 12 - -
41.0 (28.3-54.6) 49 - -
43.9 (35.1-53.0) 157 60.8t (41.7-77.8)
44.8 (40.1-49.6) 285 69.2 (58.0-79.0)
38.9
(30.3-48.0)
165
69.6 (56.0-81.0)
50.0
(43.6-56.3)
214
63.9 (49.8-76.4)
32.5
(19.4-48.0)
38
- -
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample size less
than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
> 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate.
3-7
Results of the 2023 California Youth Tobacco Survey
Table 3-9. Prevalence of Perceiving That It Was Easy to Access Cigarettes from
the Internet Among High School Respondents, by Cigarette Smoking
Status and Gender Identity, Race/Ethnicity, Grade, and LGBTQ+
Status
Never Smoking Former Smoking Current Smoking
Characteristic N % (95% Cl) N % (95% Cl) N % (95% CI)
Overall
27,845
58.7
(57.3-60.0)
1,546
58.7
(54.2-63.2)
435
55.7
(46.1-65.0)
Gender identity
Male
12,655
59.0
(57.4-60.7)
664
57.0
(50.9-63.0)
181
41.6t
(27.0-57.3)
Female
12,519
58.8
(57.2-60.4)
644
56.9
(48.5-65.1)
134
55.3t
(38.6-71.1)
Identified in
1,490
61.1
(57.2-64.9)
142
77.3
(65.5-86.7)
97
-
-
another way
Declined to
149
56.3
(43.5-68.5)
12
-
-
7
-
-
answer
Race/ethnicity*
White
6,341
59.8
(57.4-62.1)
568
52.7
(45.0-60.4)
212
46.9
(34.6-59.6)
African
617
60.5
(54.0-66.8)
23
-
-
13
-
-
American or
Black
Hispanic
15,211
56.4
(54.4-58.3)
706
59.5
(53.5-65.2)
130
51.1
(37.1-65.0)
Asian
2,997
66.2
(63.9-68.4)
81
67.5t
(49.8-82.1)
20
-
-
Other
701
61.8
(54.7-68.6)
41
-
-
11
-
-
Multiracial
1,924
61.1
(57.2-64.9)
123
59.8t
(42.5-75.5)
49
-
-
Grade
10
14,871
58.5
(56.9-60.2)
614
59.6
(51.3-67.5)
155
51.2
(38.9-63.5)
12
12,974
58.9
(57.2-60.5)
932
58.2
(52.9-63.3)
280
58.1
(44.6-70.8)
LGBTQ+ status
LGBTQ+
4,462
63.3
(60.6-65.9)
445
61.6
(53.4-69.5)
162
60.2
(45.4-73.9)
Non-LGBTQ+
19,886
59.0
(57.5-60.5)
888
59.4
(54.2-64.4)
211
46.2t
(31.5-61.5)
Unclear LGBTQ+
2,199
52.4
(48.3-56.5)
115
39.7t
(25.0-55.9)
38
-
-
status
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample size less
than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
>_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate.
3-8
Results of the 2023 California Youth Tobacco Survey
Table 3-10 presents findings for perceived access of cigarettes from someone else by vaping
status and demographics. Overall, respondents who currently smoked had the highest
perceived access (85.9%) compared to those who had formerly (71.3%) and never smoked
(59.9%). This pattern was consistent across gender identity, race/ethnicity, grade and
LGBTQ+ status. Comparisons by smoking status and race/ethnicity were difficult to make
due to suppressed values.
Table 3-10.
Prevalence of Perceiving That It Was Easy to Access Cigarettes from
Someone
Else Among High School Respondents,
by Cigarette
Smoking
Status and Gender Identity, Race/Ethnicity, Grade,
and LGBTQ+
Status
Never Smoking
Former Smoking
Current Smoking
Characteristic N
%
(95% CI)
N
% (95% CI)
N
%
(95% CI)
Overall
27,884
59.9
(58.4-61.5)
1,549
71.3 (64.1-77.8)
433
85.9
(79.6-90.8)
Gender identity
Male
12,683
57.9
(56.0-59.8)
663
68.5 (54.4-80.5)
179
83.2
(69.6-92.4)
Female
12,572
63.3
(61.1-65.4)
650
73.4 (66.5-79.5)
136
87.5
(78.5-93.8)
Identified in
1,496
53.1
(48.9-57.4)
144
76.0 (63.0-86.2)
96
87.6
(75.4-95.1)
another way
Declined to
145
51.5
(38.7-64.2)
12
- -
7
-
-
answer
Race/ethnicity*
White
6,358
62.0
(59.6-64.4)
575
77.3 (69.9-83.6)
211
88.7
(79.6-94.7)
African
619
55.5
(48.5-62.4)
23
- -
13
98.0
-
American or
Black
Hispanic
15,224
59.6
(57.6-61.6)
704
68.4 (60.9-75.2)
129
77.4
(62.0-88.7)
Asian
2,995
58.9
(55.9-61.8)
80
72.8t (53.8-87.2)
20
93.7
(72.7-99.7)
Other
705
58.1
(51.4-64.5)
41
- -
12
-
-
Multiracial
1,931
62.0
(58.2-65.8)
122
81.7 (67.5-91.5)
48
90.1
(73.6-98.0)
Grade
10
14,884
58.0
(56.2-59.8)
618
66.8 (54.9-77.3)
154
77.3
(62.8-88.2)
12
13,000
62.2
(60.2-64.1)
931
74.3 (68.1-79.9)
279
90.5
(82.1-95.8)
LGBTQ+ status
LGBTQ+
4,470
59.8
(55.8-63.6)
446
72.2 (64.1-79.3)
161
89.2
(79.8-95.2)
Non-LGBTQ+
19,950
61.2
(59.6-62.8)
893
72.1 (61.7-81.1)
211
83.0
(72.2-90.9)
Unclear
2,215
53.1
(48.9-57.3)
116
62.9t (46.3-77.5)
38
-
-
LGBTQ+ status
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific
Islander, and any race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample
size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one
or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the
estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30
and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than 130% of the
estimate.
9
Results ofthe 2023 California Youth Tobacco Survey
3.5 Summary
The most cDnnrDOn method of obtaining vapes among high achUO| respondents who currently
vaped was buying their own. Among those who bought their own vapes, the most common
method of accessing them was to buy from someone else. The most common method of
obtaining cigarettes was buying them.
Among all respondents, vapes were perceived as easier to obtain than cigarettes. We
examined perceived ease of access via a stone, the intarnat, and someone else. For vapes,
the source that was easiest to access was from another person; 71.696 of respondents
thought it was easy to access vapes from someone else. The same was true for cigarettes;
60.8% of respondents thought it was easy to access cigarettes from someone else. There
were differences in perceived access byvaping and cigarette smoking status, with
respondents who were currently using vapes generally reporting greater ease of access than
those who had formerly ornever used them, except when accessing vapes from the internet.
For accessing vapes from the internet, respondents who had formerly and never vaped
reported higher ease of access than those who currently vaped. In general, patterns of ease
of access by user status persisted across demographic categories.
Influences4. Secondhand Exposure and Other Environmental
This chapter focuses on environmental influences for tobacco use. It presents self -reported
respondent exposure to secondhand vapor (i.e., vapor or aerosol from a vape or e-cigarette)
and tobacco smoke and information on home bans for vaping and tobacco smoke. It also
presents information on exposure to vaping and smoking in the media. The prevalence of
exposure to environmental influences is compared across tobacco use status when possible.
It should be noted that questions about vapes reported in this chapter asked about vapes
generally and did not specify the substance in the vape (e.g., nicotine, marijuana). As a
result, responses could include exposure to vapes with marijuana.
Exposure4.1
OutsideRoom and
The 2023 CYTS asked respondents about exposure to vapor and tobacco smoke. To assess
exposure to secondhand vapor in a car or room, the survey asked, "In the last 2 weeks,
were you in a car or room when someone was using a vape?" A similar question asked
about secondhand exposure to tobacco smoke in a car or room by replacing the phrase
NAusing a vape" with the phrase "smoking a cigarette, little cigar, or cigarillo." To assess
exposure to secondhand vapor outside, the survey asked, "In the last 2 weeks, were you
near someone who was using a vape..." We defined participants as having been exposed to
secondhand vapor outside if they endorsed one or more of the following: "outside of a
restaurant;" "outside of a store;" "at a park, playground, or beach"; or "on a sidewalk." A
similar question asked about secondhand exposure to tobacco smoke outside by replacing
the phrase "using a vape" with the phrase "smoking a cigarette, little cigar, or cigarillo."
Table 4-1 reports high school respondents' exposure to secondhand vapor and tobacco
smoke in a car or room. One-third (32.9%) of respondents had been exposed to vapor or
tobacco smoke in a car or room within the last 2 weeks. Secondhand exposure in a car or
room was higher for exposure to vapes (29.0%) than tobacco smoke (14.1%). Respondents
who currently vaped and currently smoked tobacco reported higher rates of exposure to
vapor, tobacco smoke, and either vapor or tobacco smoke, compared to those who had
never or formerly vaped and never or formerly smoked tobacco.
4-1
Results of the 2023 California Youth Tobacco Survey
Table 4-1.
Prevalence of Last-2-Week Exposure to Vapor and Tobacco Smoke in
Car or Room Among High
School
Respondents,
by Vaping and Tobacco
Smoking Status
Tobacco Smoke*
Vapor or Tobacco
Vapor Exposure
Exposure
Smoke Exposure
Use Status
N % (95% CI)
N
% (95% CI)
N % (95% CI)
Overall
30,917 29.0 (27.2-30.9)
30,940
14.1 (13.3-15.0)
30,918 32.9 (31.0-34.8)
Vaping status
Never
24,689 22.2 (20.5-24.0)
24,703
11.6 (10.7-12.6)
24,690 26.2 (24.4-28.1)
Former
4,110 49.9 (46.7-53.0)
4,113
21.4 (19.2-23.6)
4,111 53.5 (50.5-56.5)
Current
2,092 80.1 (76.3-83.5)
2,093
33.4 (29.5-37.6)
2,091 81.7 (78.0-85.0)
Tobacco
smoking
status*
Never
28,467 26.4 (24.7-28.2)
28,484
12.4 (11.6-13.3)
28,466 30.3 (28.5-32.2)
Former
1,849 60.6 (56.3-64.8)
1,851
30.5 (27.4-33.8)
1,851 63.7 (59.5-67.8)
Current
584 79.3 (73.0-84.8)
585
60.1 (52.3-67.5)
584 84.9 (78.9-89.8)
Note. CI = confidence interval.
*Includes cigarettes, little cigars or cigarillos, or both.
Table 4-2 shows respondents' exposure to secondhand vapor and tobacco smoke outside.
Respondents were considered having been exposed outside if they reported being near
someone who was using a vape, smoking tobacco, or either outside of a restaurant, outside
of a store, on a sidewalk, or at a park, playground, or beach in the last 2 weeks. Reported
exposure outside was higher than reported exposure in a car or room. Over half (63.8%) of
respondents had been exposed to vapor or tobacco smoke outside within the last 2 weeks.
Exposure to tobacco smoke outside (57.8%) was higher than exposure to vapor outside
(42.1%). Respondents who currently vaped and currently smoked tobacco reported higher
rates of exposure to vapor, tobacco smoke, and either vapor or tobacco smoke outside than
respondents who had never or formerly vaped and never or formerly smoked tobacco.
4-2
Results of the 2023 California Youth Tobacco Survey
Table 4-2. Prevalence of Last-2-Week Exposure to Vapor and Tobacco Smoke
Outside Among High School Respondents, by Vaping and Tobacco
Smoking Status
Tobacco Smoke Vapor or Tobacco
Vapor Exposure Exposure Smoke Exposure
Use Status N % (95% CI) N % (95% Cl) N % (95% Cl)
Overall
30,649
42A
(40.6-43.7)
30,696 57.8
(56.1-59.4)
30,660
63.8 (62.2-65.4)
Vaping status
Never
24,501
37.6
(36.0-39.2)
24,526 56.1
(54.4-57.7)
24,499
60.9 (59.1-62.6)
Former
4,066
56.0
(53.6-58.4)
4,070 63.1
(60.0-66.1)
4,067
72.6 (70.3-74.8)
Current
2,057
76.1
(72.5-79.5)
2,071 69.9
(65.7-73.8)
2,067
85.4 (82.3-88.1)
Tobacco smoking
status*
Never
28,236
40.3
(38.8-41.8)
28,269 56.9
(55.2-58.5)
28,238
62.6 (60.9-64.2)
Former
1,821
64.6
(60.2-68.9)
1,830 65.8
(60.8-70.5)
1,829
77.9 (73.2-82.1)
Current
576
80.2
(74.2-85.4)
577 84.7
(76.9-90.7)
576
91.6 (87.0-95.0)
Note. CI = confidence interval.
* Includes cigarettes, little cigars or cigarillos, or both.
Table 4-3 shows exposure to secondhand smoke in MUH. About half of respondents (49.8%)
reported any exposure to smoke in their home in the last 6 months. However, less than 10%
of respondents reported frequent exposure ("often" or "most of the time").
Table 4-3. Prevalence of Last-6-Month Exposure to Tobacco Smoke in Multiunit
Housing Among High School Respondents Living in Multiunit Housing
Tobacco Smoke Exposure*
Frequency of Exposure N % (95% Cl)
Never 4,135 51.2 (48.8-53.5)
Rarely 1,749 25.2 (23.8-26.7)
Sometimes 962 13.8 (12.6-15.1)
Often 327 5.7 (4.7-6.8)
Most of the time 238 4.1 (3.0-5.5)
Note. CI = confidence interval.
* Includes cigarettes, little cigars or cigarillos, or both.
4-3
Results of the 2023 California Youth Tobacco Survey
Race/Ethnicity4.2 Exposure to Secondhand Vapor and Tobacco Smoke by
4.2.1 Indoors
We examined exposure to secondhand vapor and tobacco smoke by demographics. Table 4-
4 provides data on secondhand exposure to vapor, tobacco smoke, and either vapor or
tobacco smoke in a car or room by race/ethnicity. White respondents had the highest
reported secondhand vapor exposure (42.0%), tobacco smoke exposure (32.7%), and
either vapor or tobacco smoke exposure (45.6%) out of all race/ethnicity groups, and Asian
respondents had the lowest (20.2% vapor exposure, 16.5% smoke exposure, 25.4%
exposure to either).
Table 4-4. Prevalence of Last-2-Week Exposure to Vapor or Tobacco Smoke in a
Car or Room Among High School Respondents, by Race/Ethnicity
Tobacco Smoke Vapor or Tobacco Smoke
Vapor Exposure Exposure Exposure
Characteristic N % (950/0 Cl) N % (95% Cl) N % (950/0 Cl)
Overall 30,891 29.0 (27.2-30.9) 30,920 14.1 (13.3-15.0) 30,918 32.9 (31.0-34.8)
Race/ethnicity*
White
7,375
42.0
(39.7-44.2)
7,378
18.1
(16.5-19.8)
7,380
45.6
(43.2-47.9)
African American or
686
28.4
(24.0-33.1)
688
19.9
(14.3-26.6)
687
36.2
(29.9-43.0)
Black
Hispanic
16,652
24.5
(22.5-26.7)
16,667
11.7
(10.6-12.8)
16,666
27.8
(25.6-30.0)
Asian
3,171
20.2
(17.3-23.4)
3,171
12.5
(10.5-14.6)
3,171
25.4
(22.6-28.3)
Other
778
27.5
(22.7-32.7)
781
16.0
(12.3-20.2)
779
32.5
(28.1-37.2)
Multiracial
2,160
36.6
(33.4-40.0)
2,165
18.0
(15.4-20.8)
2,164
41.1
(37.6-44.6)
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
Table 4-5 presents exposure to vapor in a car or room by vaping status and race/ethnicity.
Overall, current vapers reported higher exposure (80.1%) than former (49.9%) and never
vapers (22.2%). This pattern was consistent across race/ethnicity categories, where values
were available.
Table 4-6 shows secondhand exposure to tobacco smoke in a car or room by smoking status
and race/ethnicity. As with vaping, respondents who currently smoked reported higher
exposure (60.1%) than respondents who formerly (30.5%) or never smoked (12.4%). This
pattern was consistent across race/ethnicity categories, where values were available.
4-4
Results of the 2023 California Youth Tobacco Survey
Table 4-5. Prevalence of Last-2-Week Exposure to Vapor in Car or Room Among
High School Respondents, by Vaping Status and Race/Ethnicity
Never Vaping
Former Vaping
Current Vaping
Characteristic
N
%
(95% Cl)
N
%
(95% Cl)
N
%
(95% Cl)
Overall
24,689
22.2
(20.5-24.0)
4,110
49.9
(46.7-53.0)
2,092
80.1
(76.3-83.5)
Race/ethnicity*
White
5,543
32.7
(30.3-35.1)
1,071
63.7
(59.4-67.8)
761
89.1
(84.5-92.8)
African
524
19.8
(15.0-25.3)
107
-
-
55
-
-
American or
Black
Hispanic
13,402
18.7
(16.7-20.9)
2,315
42.8
(38.9-46.9)
935
73.1
(67.6-78.0)
Asian
2,843
16.5
(13.8-19.4)
221
49.7
(39.8-59.7)
107
78.9
(63.1-90.2)
Other
656
23.3
(18.3-29.0)
80
31.4t
(17.1-48.9)
42
-
-
Multiracial
1,658
28.8
(25.7-32.2)
312
53.9
(42.8-64.7)
190
86.7
(78.8-92.4)
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample size less
than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
>_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate.
Table 4-6.
Prevalence of Last-2-Week Exposure to Tobacco Smoke in Car or
Room Among High School Respondents, by Tobacco Smoking Status
and Race/Ethnicity
Never Smoking**
Former Smoking**
Current Smoking**
Characteristic
N % (950/0 CI)
N % (950/0 Cl)
N % (950/0 Cl)
Overall
28,484 12.4 (11.6-13.3)
1,851 30.5 (27.4-33.8)
585 60.1 (52.3-67.5)
Race/ethnicity*
White
6,465 15.6 (14.0-17.2)
656 34.0 (28.8-39.4)
257 63.8 (50.4-75.7)
African
634 19.4 (13.2-26.8)
36 - -
18 - -
American or
Black
Hispanic
15,591 10.2 (9.2-11.3)
866 28.7 (23.8-34.1)
210 60.0 (47.6-71.6)
Asian
3,062 11.5 (9.6-13.7)
87 36.1t (20.8-53.8)
22 - -
Other
718 14.7 (10.7-19.4)
48 - -
15 - -
Multiracial
1,949 16.1 (13.3-19.2)
155 32.0 (21.3-44.3)
61 53.9t (34.7-72.3)
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
** Includes cigarettes, little cigars or cigarillos, or both.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample size less
than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
>_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate.
4-5
Results of the 2023 California Youth Tobacco Survey
4.2.2 Outside
Table 4-7 presents data on secondhand exposure to vapor or tobacco smoke outside by
race/ethnicity. White respondents reported the greatest secondhand exposure to vapor
(47.9%) outside. High school students who identified as multiracial reported the greatest
secondhand exposure to tobacco smoke (60.0%) outside. Exposure to vapor outside was
lowest among Asian respondents (34.5%) and exposure to smoke outside was lowest
among African American or Black respondents (45.9%). When looking at exposure to either
vapor or smoke, White respondents reported greatest exposure to either vapor or tobacco
smoke (67.7%) and African American or Black respondents reported the lowest exposure
(53.5%).
Table 4-7. Prevalence of Last-2-Week Exposure to Vapor or Tobacco Smoke
Outside Among High School
Respondents, by Race/Ethnicity
Tobacco Smoke Vapor or Tobacco
Vapor Exposure
Exposure Smoke Exposure
Characteristic N % (95% CI)
N % (95% CI) N % (95% CI)
Overall 30,624 42.1 (40.6-43.7)
30,676 57.8 (56.1-59.4) 30,660 63.8 (62.2-65.4)
Race/ethnicity*
White 7,307 47.9 (45.5-50.4)
7,315 59.8 (57.6-61.9) 7,315 67.7 (65.5-69.9)
African American 674 37.0 (31.2-43.1)
676 45.9 (37.2-54.7) 672 53.5 (45.8-61.1)
or Black
Hispanic 16,500 41.2 (39.2-43.1)
16,530 57.7 (55.3-60.0) 16,512 63.1 (60.8-65.4)
Asian 3,159 34.5 (31.5-37.6)
3,158 58.6 (55.5-61.6) 3,159 62.4 (59.2-65.5)
Other 770 39.6 (32.7-46.8)
780 55.7 (50.6-60.8) 779 60.4 (53.7-66.8)
Multiracial 2,147 47.0 (43.9-50.2)
2,149 60.0 (56.7-63.1) 2,154 66.8 (63.7-69.8)
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified
as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific
Islander, and any race not captured by the survey.
Table 4-8 presents exposure to vapor outside by vaping status and race/ethnicity. Overall,
current vapers reported higher exposure to vapor (76.1%) than former (56.0%) or never
vapers (37.6%). This pattern was consistent across race/ethnicity categories.
4-6
Results ofthe 2023 California Youth Tobacco Survey
Table 4-8. Prevalence of Last-2-Week Exposure to Vapor Outside Among High
School Respondents, by Vaping Status and Race/Ethnicity
Never Vapling Former Vaping Current Vapisg
Characteristic N % (95% CI) N % (95% CI) N % (95% CI)
Overall 24,501 37.6 (36.0-39.2) 4,066 56.0 (53.6-58.4) 2,057 76.1 (72.5-79.5)
Race/ethnidty*
White 5,496 42.2 (39.6-44.8) 1,061 59.2 (55.0-63.3) 750 80.6 (73.0-86.3)
African 513 33.0 (27.5-40.7) 107 38.8 (29.7-48.6) 54 -- -
-
Americanor
Black
Hispanic 13,299 37.0 (34.9-39.2) 2,287 56.0 (52.4-59.6) 914 72.0 (66.3-77.2)
Asian 2,833 31.7 (28.7-34.8) 220 57.8 (48.3-66.9) 106 74.3 (61.6-84.6)
Other 650 35.8 (I8.2-44.1) 78 54.2f(36.4-71.3) 42 -- --
Multiracial 1,648 41.4 (38.3-44.5) 309 50.1 (47.0-60.6) 190 84.1 (74.5-01.1)
Note. CI = confidence interval.
� With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured bythe survey.
The estimate has been suppressed due to snna|| sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
fThe estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is �: 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< O.]O and > 0.05 and the relative width of the Korn Graubard confidence interval is greater than
13U96ufthe estimate.
Table 4-9 presents exposure to tobacco smoke outside by vaping status and race/ethnicity.
As with vapor, exposure to tobacco smoke outside was higher for respondents who currently
Srn0k8d (84.796) than those who had formerly (55.896) Or never smoked (55.996) Ov8rO||.
4-7
Results of the 2023 California Youth Tobacco Survey
Table 4-9. Prevalence of Last-2-Week Exposure to Tobacco Smoke Outside
Among High School Respondents, by Tobacco Smoking Status and
Race/Ethnicity
Never Smoking** Former Smoking** Current Smoking**
Characteristic N % (95% CI) N % (95% Cl) N % (95% CI)
Overall 28,269 56.9 (55.2-58.5) 1,830 65.8 (60.8-70.5) 577 84.7 (76.9-90.7)
Race/ethnicity*
White 6,413 58.4 (56.1-60.6) 649 67.6 (61.7-73.1) 253 89.3 (81.1-94.8)
African 622 46.8 (38.4-55.3) 36 — — 18 — —
American or
Black
Hispanic 15,470 56.8 (54.4-59.1) 854 68.7 (62.5-74.6) 206 83.4 (71.8-91.6)
Asian 3,049 58.4 (55.3-61.5) 87 56.3t (39.2-72.4) 22 — —
Other 717 54.1 (48.7-59.5) 48 — — 15 — —
Multiracial 1,935 58.8 (55.4-62.1) 153 66.2 (54.1-76.9) 61 — —
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey.
** Includes cigarettes, little cigars or cigarillos, or both.
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
4.3 Home Bans on Vaping and Tobacco Smoking
Home bans are an important influence on tobacco use, including influencing initiation,
relapse among respondents who previously used tobacco, and continued use among
respondents who currently use tobacco. In two separate questions, respondents were asked
to indicate which statement best described rules about (a) vaping and (b) smoking
cigarettes or other tobacco products inside their homes. Respondents who indicated that
vaping or smoking was not allowed anywhere or at any time inside their home were
classified as having a "complete home ban" on vaping or smoking and were compared with
respondents who provided all other responses for rules about vaping or smoking in the
home ("incomplete home ban").
Tables 4-10 and 4-11 present the prevalence of complete home bans on vaping and tobacco
smoking by vaping and tobacco smoking status. For tobacco user status, tobacco smoking
included smoking cigarettes and/or LCCs to create consistency with the definition for
secondhand tobacco smoke exposure. Most respondents had a complete home ban on
vaping and tobacco smoking (81.0% and 78.4%, respectively). Respondents who had never
4-8
Results ofthe 2023 California Youth Tobacco Survey
vaoed /82.996\ and fonnedvvaoed (76.096) more commonly reported complete home
vaping bans than respondents who currently vaped (64.7%).
Table 4_10. Prevalence of Complete Home Bans on Vaping Among High School
Respondents, by Current Use mf Vapes
Vaping Ban
Use Status N % (9596CI)
Overall 30,837 81.0 (79.9-82.0)
Vaping status
Never 24,634 82.9 (81.8-84.0)
Former 4,004 76.0 (73.3-78.5)
Current 3,084 64.7 (59.7-69.4)
Note. CI = confidence interval.
Similarly, respondents who had never smoked /79.196\ and f0nn8dy Grn0k8d (71.0%) more
commonly reported complete home bans on smoking than those who currently smoked
Table 4_11. Prevalence of Complete Home Bans on Tobacco Smoking Among High
School Respondents, by Current Use of Smoked Tobacco
Tobacco Smoking Ban
Use Status N % (95q6CI)
Overall 30,745 78.4 (77.2-79.5)
Tobacco smoking status*
Never 28,322 70.1 (78.0-80.3)
Former 1,829 71.0 (67.0-74.8)
Current 577 56.8 (48.3-65.0)
Note. [3 = confidence interval.
*Includes cigarettes, little cigars or cigarillos, or both.
We examined home bans by demographics. Table 4-12 provides data on complete home
bans on vaping and smoking by race/ethnicity. Hispanic respondents had the highest
prevalence of complete home bans on vaping (82.1%), and Asian respondents had the
highest prevalence ofcomplete home bans onsmoking (79.696).
Table 4-13 presents the prevalence of home vaping bans by vaping status and
race/ethnicity. Generally, a higher percentage of respondents who had neversspad
reported complete home bans (82.996)compared tothose who currently (64.7%) and
formerly /76.096\ vaped. The pattern of bans by vaping status observed for the overall
sample was consistent with the pattern observed across race/ethnicity categories, where
data were not suppressed. The exception was among Asian respondents, where those who
current|yvaped (70.8%) reported a higher prevalence ofhome vaping bans than those who
Results of the 2023 California Youth Tobacco Survey
had formerly vaped (66.2%), but those who had never vaped still reported the highest
prevalence of bans (82.8%) across vaping user status.
Table 4-12. Prevalence of Complete Home Bans on Vaping and Tobacco Smoking
Among High School Respondents, by Race/Ethnicity
Vaping Ban Tobacco Smoking Ban
Characteristic N % (950/0 CI) N % (950/0 CI)
Overall
30,812 81.0 (79.9-82.0) 30,728 78.4 (77.2-79.5)
Race/ethnicity*
White
7,358 80.7 (78.4-82.9) 7,346 79.2 (76.8-81.5)
African American or Black 683 72.0 (65.2-78.2) 684 66.1 (58.3-73.3)
Hispanic
16,593 82.1 (80.8-83.4) 16,540 79.1 (77.8-80.4)
Asian
3,170 81.4 (79.3-83.4) 3,163 79.6 (76.9-82.1)
Other
778 79.5 (74.8-83.7) 770 75.1 (69.7-80.0)
Multiracial
2,162 78.4 (75.2-81.3) 2,158 77.5 (74.4-80.5)
Note. CI = confidence interval.
* With the exception
of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey.
Table 4-13.
Prevalence of Complete Home Vaping Bans Among High School
Respondents, by Vaping Status and Race/Ethnicity
Never Vaping Former Vaping Current Vaping
Characteristic
N % (950/0 CI) N % (950/0 CI) N % (950/0 CI)
Overall
24,634 82.9 (81.8-84.0) 4,094 76.0 (73.3-78.5) 2,084 64.7 (59.7-69.4)
Race/ethnicity*
White
5,535 83.3 (80.9-85.4) 1,067 75.2 (69.2-80.6) 756 67.3 (60.4-73.7)
African
521 73.6 (64.0-81.8) 108 70.4 (54.9-83.0) 54 - -
American or
Black
Hispanic 13,357 83.9 (82.5-85.3) 2,305 78.5 (75.4-81.4) 931 62.3 (54.8-69.4)
Asian 2,843 82.8 (80.5-84.9) 220 66.2 (53.5-77.4) 107 70.8 (56.5-82.6)
Other 657 81.4 (76.6-85.5) 79 67.8t (49.1-83.1) 42 - -
Multiracial 1,659 80.4 (76.8-83.6) 311 71.8 (63.5-79.1) 192 69.2 (57.8-79.1)
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific
Islander, and any race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample
size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one
or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the
estimate is >- 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30
and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than 130% of the
estimate.
4-10
Results ofthe 2023 California Youth Tobacco Survey
Table 4-14 presents the prevalence of home smoking bans by smoking status and
race/ethnicity. Consistent with hornevaping bans, a higher percentage ofrespondents who
had never smoked reported complete home bens (79.1%) compared to those who currently
(55.896) and formerly (71.096) smoked. Too many values were suppressed to make
comparisons across race/ethnicity.
Table 4-14. Prevalence of Complete Home Bans on Tobacco Smoking Among High
School Respondents, by Smoking Status and Race/Ethnicity
Never Smoking**
Former Smoking**
Current Smoking**
Characteristic
N
% (95% CI)
N
% (95% CI)
N
%
(95% CI)
Overall
28,322
79.1
(78.0-80.3)
1,829
71.0 (67.0-74.8)
577
56.8
(48.3-65.0)
Race/ethnidty*
White
6,442
80.3
(78.0-82.4)
651
72.1 (65.6-77.9)
253
60.9
(46.2-74.2)
African
621
68.1
(60.9-74.7)
35
-- --
18
--
--
Americanor
Black
Hispanic
15,480
79.7
(78.3-81.0)
853
73.0 (66.4-78.9)
207
60.1
(46.9-72.4)
Asian
3,055
80.3
(77.5-82.9)
87
63.0+(45.0-78.7)
21
--
--
Other
709
76.2
(70.6-81.1)
46
-- --
15
--
--
Multiracial
1,943
78.1
(75.0-81.0)
154
78.1 (67.5-86.5)
61
--
--
Note. CI = confidence interval.
With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured bythe survey.
�= Includes cigarettes, little cigars or cigarillos, or both.
The estimate has been suppressed due to snna|| sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
tThe estimate should be interpreted with caution given concerns about precision. The estimate meets
one orboth ofthe following criteria: (a)the absolute width ofthe Korn-Graubardconfidence interval
for the estimate is �! 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn Graubard confidence interval is greater than
13096ofthe estimate.
4°4 Exposure to Vape and Cigarette Advertisements in Last 30 Days
Exposure toadvertising influences tobacco use behavior. The survey asked respondents
several questions about advertising exposure. First, they were asked whether they had a
favorite advertisement for vaping products. They were also asked how often they saw
someone smoking cigarettes orvaping on a social media site in the last 30 days (never,
rarely, sometimes, often, always). Respondents were also asked how much attention they
paid to social media posts about vaping (none, a little, snrna, or lot).
Results of the 2023 California Youth Tobacco Survey
Table 4-15 presents results for having a favorite vaping advertisement. Very few
respondents (3.8%) reported having a favorite vaping advertisement. The prevalence of
reporting having a favorite advertisement was highest among current vapers (13.8%).
Table 4-15.
Prevalence of Having Favorite Vaping Advertisement Among High
School Respondents, by Vaping Status
Have a Favorite Advertisement
Use Status N
% (950/0 CI)
Overall
29,497 3.8
(3.4-4.4)
Vaping status
Never
23,655 2.6
(2.3-3.1)
Former
3,892 7.1
(6.0-8.4)
Current
1,950 13.8
(10.9-17.1)
Note. CI = confidence interval.
Table 4-16 presents the reported prevalence of having seen someone on a social media site
vaping in the last 30 days. Response options were rarely, sometimes, often, or always.
Approximately two-thirds of respondents reported some exposure (rarely, sometimes, often
or always in the past 30 days) to vaping on social media (71.9%). Responses to this
question varied by vaping status. Respondents who currently and formerly vaped more
commonly reported being exposed to vaping advertisements always (14.2% and 9.7%,
respectively) or often (31.3% and 26.5%, respectively) compared with those who had never
vaped (5.8% always, 16.7% often).
Table 4-16. Last-30-Day Social Media Exposure to Vaping Among High School
Respondents, by Vaping Status
Frequency of
Exposure
Never
Rarely
Sometimes
Often
Always
Overall
N = 29,288
0/0 (95% CI)
28.1
(26.8-29.5)
20.7
(19.9-21.6)
25.7
(24.8-26.5)
18.7
(17.9-19.5)
6.7
(6.1-7.5)
Note. CI = confidence interval.
Never Vaping
N = 23,508
0/0 (95% CI)
31.0
(29.5-32.5)
21.3
(20.3-22.3)
25.3
(24.3-26.2)
16.7
(15.8-17.6)
5.8
(5.1-6.6)
Former Vaping
N = 3,863
0/0 (95% CI)
15.3 (12.7-18.2)
19.8 (17.8-21.9)
28.8 (26.0-31.8)
26.5 (24.3-28.7)
9.7 (8.4-11.1)
Current Vaping
N = 1,917
(95% CI)
15.6
(13.1-18.4)
14.2
(11.9-16.8)
24.8
(21.4-28.4)
31.3
(26.9-35.9)
14.2
(11.5-17.3)
Respondents also answered the same question about exposure to tobacco smoking on social
media. Half (55.9%) of respondents reported being exposed to smoking on social media in
the last 30 days (i.e., rarely, sometimes, often, or always; Table 4-17). Respondents who
4-12
Results of the 2023 California Youth Tobacco Survey
currently smoked reported a higher prevalence of being exposed than those who had
formerly or never smoked. For example, 17.6% of respondents who currently smoked
reported always being exposed, compared with 7.5% of those who had formerly smoked
and 3.1% of those who had never smoked.
Table 4-17.
Last-30-day Social Media Exposure to Smoking Among High School
Respondents, by Smoking Status
Overall
Never Smoking
Former Smoking
Current Smoking
Frequency of
N = 29,296
N = 27,389
N = 1,490
N = 417
Exposure
% (95% CI)
% (95% CI)
% (95% CI)
% (95% CI)
Never
44.1 (42.5-45.6)
45.0 (43.5-46.6)
27.6 (24.0-31.6)
27.9 (19.9-37.1)
Rarely
26.3 (25.3-27.3)
26.3 (25.3-27.4)
29.2 (24.1-34.7)
16.0 (9.8-24.0)
Sometimes
18.4 (17.5-19.3)
18.1 (17.2-18.9)
23.4 (19.3-27.9)
22.8 (15.1-32.1)
Often
7.8 (7.1-8.5)
7.5 (6.8-8.3)
12.3 (9.4-15.6)
15.7 (10.5-22.2)
Always
3.4 (3.0-3.9)
3.1 (2.7-3.5)
7.5 (4.5-11.5)
17.6 (11.3-25.5)
Note. CI = confidence interval.
The survey also asked respondents how much attention they paid to social media posts on
vaping (Table 4-18). More than half (59.1%) of respondents reported not paying any
attention to social media posts about vaping. Attention to these posts varied by vaping
status. A higher percentage of respondents who currently vaped reported that they paid a
lot of attention to these posts (3.9%) than those who had formerly (2.6%) and never (1.80/0)
vaped.
Table 4-18. Attention Paid to Social Media Posts About Vaping Among High School
Respondents, by Vaping Status
Overall
Amount Of N = 29,400
Attention % (950/0 CI)
Never Vaping
Former Vaping
N = 23,583
N = 3,881
0/0 (950/0 CI)
% (950/0 CI)
Current Vaping
N = 1,936
(95% CI)
None 59.1 (57.6-60.5) 61.2
(59.5-62.8)
51.9 (48.9-54.9)
44.9 (40.8-49.0)
A little 27.8 (26.7-28.9) 26.5
(25.4-27.7)
32.6 (29.7-35.7)
35.5 (31.5-39.5)
Some 11.1 (10.4-11.9) 10.5
(9.7-11.4)
12.9 (11.0-15.0)
15.7 (12.7-19.1)
A lot 2.0 (1.7-2.4) 1.8
(1.4-2.3)
2.6 (1.6-3.8)
3.9 (2.6-5.7)
Note. CI = confidence interval.
Summary4.5
Most high school respondents reported living in a home that had a complete home ban on
tobacco smoking and vaping. Still, 22.2% of respondents who had never vaped had been
exposed to vapor in a car or room in the last 2 weeks, and 37.6% reported exposure to
4-13
Results of the 2023 California Youth Tobacco Survey
vaping outside during the same time period. Only 12.4% of respondents who had never
smoked tobacco reported exposure to secondhand tobacco smoke in a car or room, but 56.9%
reported being exposed outside. About half (49.8%) of respondents who lived in MUH
reported any exposure to tobacco smoke in the last 6 months. Of all races and ethnicities,
White respondents and multiracial respondents reported the highest exposure to
secondhand vapor and secondhand smoke both in a car or room and outside, with the
exception of tobacco smoke exposure in a car or room, for which African American or Black
respondents reported the highest exposure.
More than half of respondents reported being exposed to social media posts about vaping or
smoking in the past 30 days. Less than half of respondents reported paying any attention to
social media posts about vaping, and few respondents reported having a favorite vaping
advertisement.
4-14
5. Susceptibility to Future Tobacco Use and Perceptions of
Vaping and Smoking
The 2023 CYTS measured susceptibility in two different ways. For the most popular products
(vapes, cigarettes, and LCCs, we used a three -item susceptibility scale. These questions
were only asked of respondents who reported that they had never used each product. The
scale asked three questions: whether they would use a product if one of their best friends
offered the product to them, whether they thought they would try the product soon, and
whether they thought they would use the product in the next year. Only those who
answered "definitely not" to all three items were considered not susceptible to future
tobacco use. All others were considered susceptible. For the other tobacco products
captured by the survey (HTPs, hookah, smokeless, and nicotine pouches), we only asked
one question: whether respondents would use the product if one of their best friends offered
the product to them. Because of low use of cigars among youth, we did not administer a
susceptibility item for cigars. Because the three -item susceptibility scale is superior to the
single -item scale, we only present susceptibility for vapes, cigarettes, and LCCs in this
chapter.
Social norms affect tobacco use behavior. This chapter also presents data on reported
reasons for vaping among current vapers. It also presents data on respondents' beliefs
about how adults, peers or classmates, and friends perceive vaping and smoking cigarettes.
Finally, respondents' opinions of the tobacco industry are reported. These perceptions are
compared across tobacco use status (i.e., never, former, or current use) or demographics,
when appropriate.
5.1 Susceptibility Demographics
Table 5-1 presents susceptibility to future use of vapes, cigarettes, and/or LCCs among
respondents who had never used one or more of these three products by respondent
demographics. This table only includes those three products because the susceptibility items
were different for other products. Overall, 44.3% of respondents who had never used one or
more of these products were susceptible to one or more products. We found differences in
susceptibility by demographics. Respondents who identified their gender in another way
were the most susceptible (49.8%) out of all gender categories. Multiracial and White
respondents were the most susceptible (46.4% and 46.0%, respectively) out of all
race/ethnicity categories, and Asian respondents were the least susceptible (35.8%).
Twelfth -grade respondents were more susceptible (45.6%) than 10th-grade respondents
(43.2%). LGBTQ+ respondents were more susceptible (52.6%) than non-LGBTQ+
respondents (42.2%) and respondents with unclear LGBTQ+ status (44.7%). Respondents
who rated their mental health as fair (51.8%) or poor (55.3%) were more susceptible to
future use than who rated their mental health status as good to excellent (39.5%).
5-1
Results of the 2023 California Youth Tobacco Survey
Table 5-1. Susceptibility to Vapes, Cigarettes, and/or LCCs Among High School
Respondents Who Had Never Used One or More of These Products, by
Gender Identity, Race/Ethnicity, Grade, LGBTQ+ Status, and General
Mental Health
Susceptible to Vapes, Cigarettes, and/or LCCs
Characteristic
N
% (950/0 CI)
Overall
30,493
44.3
(42.7-45.9)
Gender identity
Male
13,523
42.3
(40.5-44.1)
Female
13,415
45.4
(43.0-47.8)
Identified in another way
1,691
49.8
(45.7-53.9)
Declined to answer
191
43.2
(32.2-54.7)
Race/ethnicity*
White
7,204
46.0
(43.7-48.2)
African American or Black
681
40.1
(33.9-46.6)
Hispanic
16,490
45.7
(43.4-48.0)
Asian
3,152
35.8
(33.7-37.9)
Other
772
36.6
(32.0-41.3)
Multiracial
2,125
46.4
(43.3-49.4)
Grade
10
16,078
43.2
(41.6-44.8)
12
14,415
45.6
(43.3-48.0)
LGBTQ+ status
LGBTQ+
5,017
52.6
(49.8-55.4)
Non-LGBTQ+
21,085
42.2
(40.4-44.1)
Unclear LGBTQ+ status
2,395
44.7
(40.4-49.0)
Mental health status
Good to excellent
18,914
39.5
(37.8-41.3)
Fair
7,057
51.8
(49.6-53.9)
Poor
3,014
55.3
(52.0-58.6)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey.
When looking at susceptibility to vapes, cigarettes, and LCCs individually (Table 5-2),
patterns of susceptibility varied by demographics. Female respondents were most
susceptible to vapes (41.0%) out of all gender identities. Respondents who identified their
gender in a different way were most susceptible to cigarettes (29.4%). Respondents who
identified as males and respondents who identified in another way both had the highest
susceptibility to LCCs (24.0%).
5-2
Results of the 2023 California Youth Tobacco Survey
Table 5-2. Proportion of High School Respondents Who Had Never Vaped, Never
Smoked Cigarettes, and/or Never Smoked LCCs Who Were
Susceptible to Future Use of These Products, by Gender Identity,
Race/Ethnicity, Grade, LGBTQ+ Status, and General Mental Health
Vapes Cigarettes LCCs
Characteristic
N
%
(95% Cl)
N
%
(95% Cl)
N
% (95% Cl)
Overall
24,693
37.8
(36.4-39.3)
28,865
20.1
(19.1-21.2)
30,054
21.4
(20.1-22.6)
Gender identity
Male
11,313
34.5
(32.7-36.3)
12,882
18.6
(17.2-20.0)
13,285
24.0
(22.5-25.6)
Female
10,620
41.0
(38.8-43.3)
12,734
20.5
(19.1-21.9)
13,293
18.0
(16.4-19.7)
Identified in
1,335
39.0
(35.2-43.0)
1,520
29.4
(25.5-33.6)
1,648
24.0
(21.2-27.0)
another way
Declined to
139
34.9t
(20.9-51.1)
176
22.4
(14.8-31.6)
187
19.9
(12.1-29.9)
answer
Race/ethnicity*
White
5,544
36.1
(34.0-38.3)
6,560
22.1
(20.2-24.1)
7,095
25.9
(23.9-28.0)
African
523
38.5
(33.0-44.3)
651
12.2
(9.1-16.1)
662
12.2
(8.4-17.0)
American or
Black
Hispanic
13,402
40.3
(38.0-42.7)
15,806
20.5
(19.1-22.0)
16,246
21.3
(19.7-22.9)
Asian
2,841
30.7
(28.8-32.6)
3,070
17.6
(15.9-19.4)
3,139
14.5
(12.9-16.2)
Other
658
28.1
(23.4-33.2)
729
14.4
(10.6-19.0)
762
18.9
(14.9-23.5)
Multiracial
1,663
37.9
(33.9-41.9)
1,983
21.0
(18.5-23.7)
2,083
24.9
(22.5-27.5)
Grade
10
13,558
37.1
(35.5-38.7)
15,431
20.0
(18.9-21.1)
15,884
19.9
(18.9-21.0)
12
11,135
38.7
(36.8-40.7)
13,434
20.3
(18.5-22.1)
14,170
23.0
(21.1-25.0)
LGBTQ+ status
LGBTQ+
3,687
44.2
(41.2-47.3)
4,525
28.6
(26.3-31.1)
4,942
24.6
(22.6-26.8)
Non-LGBTQ+
17,416
36.3
(34.7-38.0)
20,225
17.9
(16.7-19.1)
20,780
20.4
(18.9-21.8)
Unclear LGBTQ+
2,042
39.2
(35.0-43.5)
2,257
23.3
(19.8-27.2)
2,372
21.3
(18.5-24.2)
status
Mental health
status
Good to
15,937
33.1
(31.5-34.7)
18,110
16.7
(15.5-17.9)
18,667
18.8
(17.4-20.1)
excellent
Fair
5,489
46.9
(44.6-49.1)
6,644
25.3
(23.5-27.1)
6,969
24.0
(22.0-26.2)
Poor
2,113
47.9
(43.8-52.1)
2,712
29.3
(25.9-32.9)
2,943
29.0
(26.1-32.0)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
>- 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate.
When examining susceptibility to specific products by race and ethnicity, Hispanic
respondents had highest susceptibility to vapes (40.3%), and White respondents had the
highest susceptibility to cigarettes (22.1%) and LCCs (25.9%). In general, respondents in
5-3
Results of the 2023 California Youth Tobacco Survey
12th grade had a higher susceptibility than respondents in 10th grade for all products.
LGBTQ+ respondents had the highest susceptibility to all three products, followed by
respondents with unclear LGBTQ+ status and non-LGBTQ+ respondents.
Table 5-2 also presents susceptibility to vaping, smoking cigarettes, and LCCs by self -rated
general mental health, among respondents who had never vaped, never smoked cigarettes,
and/or never smoked LCCs. The results broken down by individual product were consistent
with the overall findings: respondents with poor mental health status were the most
susceptible, and respondents with good to excellent mental health were the least
susceptible.
5.2 Susceptibility to Vape and Cigarette Use by Peer Vaping and
Smoking
One factor that affects youth susceptibility is peer tobacco use. The survey asked
respondents to indicate the proportion of their friends who used vapes or smoked cigarettes.
It should be noted that this question asked about vapes generally and did not specify the
substance in the vape (e.g., nicotine, marijuana, or only flavoring). As a result, responses
could include friends who used vapes with marijuana.
Overall, peer use and individual susceptibility appeared to be positively correlated. Tables 5-
3 and 5-4 present the susceptibility to future vape or cigarette use (among respondents
who had never used these products), by the self -reported proportion of their friends who
used the tobacco product. Susceptibility to vaping among respondents increased as the
proportion of their friends who vaped increased, with half (52.1%) of those who had never
vaped and were susceptible to vaping reporting that most or all of their friends vaped.
Table 5-3. Prevalence of Susceptibility to Vaping Among High School
Respondents Who had Never Vaped, by Friend Vaping Status
Susceptible to Vapes
Friends Who Vape N % (95% Cl)
None 3,921 28.4 (27.1-29.8)
Some 4,449 48.3 (45.9-50.7)
Most/all 995 52.1 (47.0-57.2)
Note. CI = confidence interval.
Respondents who had never smoked cigarettes and reported having some (33.5%) or
most/all (31.5%) friends who smoked had higher susceptibility to cigarettes than those who
did not have friends who smoked cigarettes (18.0%).
5-4
Results of the 2023 California Youth Tobacco Survey
Table 5-4. Prevalence of Susceptibility to Cigarette Smoking Among High School
Respondents Who Had Never Smoked Cigarette, by Friend Smoking
Status
Susceptible to Cigarettes
Friends Who Smoke Cigarettes N % (950/0 CI)
None 4,372 18.0 (17.0-19.0)
Some 1,114 33.5 (30.7-36.3)
Most/all 219 31.5 (23.7-40.3)
Note. CI = confidence interval.
5.3 Reasons r Vaping
Respondents who had vaped in the last 30 days were asked why they vaped. Table 5-5
shows the percentage of respondents who endorsed each reason. The most commonly
endorsed response was "to relax or relieve stress and anxiety" (35.2%). The next top
response was "for the nicotine buzz" (20.6%).
Table 5-5. Reported Reasons for Vaping Among High School Respondents Who
Were Currently Vaping
Reason for Vaping
Current Vapers
N = 2,069
% (95% CI)
To relax or relieve stress and anxiety
35.2 (31.1-39.4)
For the nicotine buzz
20.6 (17.8-23.6)
To have a good time with my friends
9.8 (7.7-12.2)
Because I am "hooked"
5.6 (4.3-7.3)
Cloud competitions
4.7 (3.2-6.7)
To focus or concentrate
4.6 (3.1-6.6)
It looks cool
4.6 (2.8-7.0)
To control my weight
4.3 (2.7-6.4)
They are available in flavors I like
4.0 (2.8-5.5)
To fit in/peer pressure
2.9 (1.8-4.6)
To try to quit using other products
2.1 (1.2-3.4)
I can use them unnoticed or hide them at home or at school
1.6 (0.7-3.0)
Note. CI = confidence interval.
Results of the 2023 California Youth Tobacco Survey
Disapproval5.4 Adult i
Respondents were asked how adults who were important to them (such as parents,
teachers, coaches, or relatives) would feel about the respondent using vapes. The same
questions were asked about smoking cigarettes, using marijuana, and drinking alcohol.
Table 5-6 presents the percentage of respondents who reported that adults important to
them would feel negatively ("negative" and every negative" as opposed to "positive" or
every positive") about the respondent vaping. Most respondents (96.3%) believed that
adults important to them would feel negatively about the respondent vaping. Across all
demographic categories, most respondents held this belief.
Table 5-6. Percentage of High School Respondents Who Believed That Adults
Would Feel Negatively About Them Vaping and Smoking, by
Demographics
Characteristic
Overall
Gender identity
Male
Female
Identified in another way
Declined to answer
Race/ethnicity*
White
African American or Black
Hispanic
Asian
Other
Multiracial
Grade
10
12
LGBTQ+ status
LGBTQ+
Non-LGBTQ+
Unclear LGBTQ+ status
Negative Views About Vaping Negative Views About Smoking
N % (95% CI) N % (95% CI)
29,661 96.3 (95.6-96.9) 29,668 96.8 (96.2-97.3)
13,594
96.2
(95.1-97.0)
13,597
96.8
(96.0-97.4)
13,399
97.4
(96.9-97.9)
13,404
97.8
(97.2-98.4)
1,745
89.9
(87.3-92.2)
1,745
90.4
(87.7-92.6)
149
-
-
149
-
-
7,112
97.2
(96.4-97.9)
7,112
98.0
(97.4-98.5)
644
93.0
(90.1-95.2)
645
95.8
(92.0-98.1)
15,921
96.0
(95.0-96.8)
15,924
96.4
(95.6-97.1)
3,093
98.1
(97.2-98.8)
3,095
97.7
(96.7-98.5)
750
91.6
(87.1-94.9)
750
92.4
(88.1-95.5)
2,078
96.2
(93.9-97.8)
2,079
96.6
(94.3-98.2)
15,535
96.3
(95.5-97.0)
15,537
96.6
(95.9-97.2)
14,126
96.3
(95.5-96.9)
14,131
97.0
(96.3-97.6)
5,100
95.0 (93.8-96.0)
5,103
95.4 (94.4-96.3)
21,134
97.0 (96.2-97.7)
21,139
97.6 (96.9-98.2)
2,378
93.6 (91.4-95.3)
2,377
93.8 (91.6-95.6)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
5-6
Results of the 2023 California Youth Tobacco Survey
Table 5-6 also presents the percentage of respondents who reported that adults important
to them would feel negatively about the respondent smoking cigarettes. Almost all
respondents (96.8%) believed that adults important to them would feel negatively about
the respondent smoking cigarettes. This opinion was consistent across demographic
categories.
5.5 Peer Disapproval of Vaping and Smoking
In addition to being asked about adults, respondents were asked to describe the views of
"other respondents at your school" on using vapes. Response options included "very
positive," "positive," "negative," and every negative." The same questions were asked about
smoking cigarettes.
Tables 5-7 and 5-8 present the percentage of respondents who believed that their peers
would view vaping and smoking cigarettes negatively ("negative" or every negative"). A
greater proportion of respondents reported that their peers would view smoking negatively
(83.6%) than those who reported that their peers would view vaping negatively (49.8%).
The percentage of respondents endorsing these views for vaping varied by vaping status,
with respondents who had never used vapes reporting the highest peer disapproval.
Table 5-7. Percentage of High School Respondents Who Believed That Close
Friends and Other Respondents at School Would View Vaping
Negatively, by Vaping Status
Negative Views About Vaping
Use Status N % (95% Cl)
Overall 29,585 49.8 (48.2-51.5)
Vaping status
Never 23,686 52.3 (50.4-54.2)
Former 3,920 39.5 (36.9-42.1)
Current 1,979 37.4 (33.9-41.0)
Note. CI = confidence interval.
Table 5-8. Percentage of High School Respondents Who Believed That Close
Friends and Other Respondents at School Would View Smoking
Negatively, by Smoking Status
Negative Views About Smoking
Use Status
N
% (95% Cl)
Overall
29,589
83.6 (82.5-84.7)
Cigarette smoking status
Never
27,637
83.8 (82.7-85.0)
Former
1,518
80.9 (77.2-84.3)
Current
434
74.9 (66.4-82.2)
Note. CI = confidence interval.
PM
Results of the 2023 California Youth Tobacco Survey
The same was true for smoking, with the highest proportion of respondents who had never
smoked believing their peers would view smoking negatively.
Table 5-9 presents the perceived prevalence of peers' negative views of vaping and smoking
by demographics. Male respondents had the highest perceived prevalence of negative views
of both vaping (57.6%) and smoking cigarettes (86.8%). Across different races/ethnicities,
Asian respondents most commonly reported that their peers viewed vaping negatively
(63.2%), and African American or Black respondents most commonly reported that their
peers viewed smoking cigarettes negatively (88.0%). It was more common for 10th-grade
respondents to believe that peers viewed vaping negatively (52.2%) than 12th-grade
respondents (47.2%), whereas loth- and 12th-grade respondents held similar beliefs that
their peers viewed smoking cigarettes negatively (83.5% and 83.7%, respectively).
Respondents with unclear LGBTQ+ status had the highest perceived prevalence of reporting
that their peers had negative views of vaping (54.8%), whereas non-LGBTQ+ respondents
had the highest prevalence of reporting that their peers had negative views of smoking
(84.4%).
Table 5-9. Percentage of High School Respondents Who Believed That Close
Friends or Other Respondents Would Feel Negatively About Them
Smoking Cigarettes, by Demographics
Negative Views About
Negative Views About Vaping Smoking
Characteristic N % (95% CI) N % (95% CI)
Overall
29,606
49.8
(48.2-51.5)
29,599
83.6
(82.5-84.7)
Gender identity
Male
13,548
57.6
(55.5-59.7)
13,542
86.8
(85.3-88.1)
Female
13,316
42.6
(40.4-44.9)
13,315
81.6
(79.9-83.3)
Identified in another way
1,740
46.9
(42.2-51.7)
1,741
78.3
(74.7-81.6)
Declined to answer
151
50.5t
(34.4-66.6)
150
—
—
Race/ethnicity*
White
7,096
44.5
(42.1-47.0)
7,095
84.8
(83.0-86.4)
African American or Black
648
50.7
(45.5-55.8)
648
88.0
(83.8-91.4)
Hispanic
15,886
49.6
(47.6-51.6)
15,879
82.3
(80.8-83.8)
Asian
3,083
63.2
(59.0-67.3)
3,085
86.6
(84.0-88.9)
Other
750
51.1
(46.0-56.2)
750
82.2
(77.3-86.4)
Multiracial
2,081
48.9
(44.6-53.3)
2,081
82.6
(79.4-85.5)
Grade
10
15,482
52.2
(50.1-54.4)
15,470
83.5
(82.1-84.8)
12
14,124
47.2
(45.5-49.0)
14,129
83.7
(82.4-85.0)
(continued)
5-8
Results of the 2023 California Youth Tobacco Survey
Table 5-9. Percentage of High School Respondents Who Believed That Close
Friends or Other Respondents Would Feel Negatively About Them
Smoking Cigarettes, by Demographics (continued)
Negative Views About
Negative Views About Vaping Smoking
Characteristic N % (95% CI) N % (95% CI)
LGBTQ+ status
LGBTQ+ 5,078 43.9
Non-LGBTQ+ 21,042 50.7
Unclear LGBTQ+ status 2,365 54.8
(41.0-46.9) 5,080 82.2 (79.9-84.4)
(48.9-52.5) 21,034 84.4
(49.5-60.0) 2,366 81.4
(83.2-85.6)
(77.5-85.0)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey.
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >> 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
5.6 Summary
Almost half of respondents who had never used vapes, cigarettes, and/or LCCs were
susceptible to one or more of these products. Susceptibility to these three products
combined was highest for individuals who identified their gender in another way than the
options listed in the survey, non -Hispanic multiracial respondents, LGBTQ+ respondents,
12th graders, and respondents with poor mental health. Susceptibility varied by product.
Differences in susceptibility by race and ethnicity also varied by product. In general,
LGBTQ+ respondents and respondents with poor or fair mental health were more
susceptible to tobacco use than their counterparts, regardless of product. Among high
school respondents who were currently vaping, the most commonly endorsed reason for
vaping was "to relax or relieve stress and anxiety." Respondents believed that adults who
were important to them held overwhelmingly negative views on vaping and smoking
cigarettes. When asked about the beliefs of their peers, only about half of respondents
reported that their peers would view vaping negatively, while almost all respondents
reported that their peers viewed smoking cigarettes negatively. While there was little
variation in perceptions about adults' opinions by gender identity, race/ethnicity, grade, and
LGBTQ+ status, there were differences in peers' views by these variables.
6. Tobacco Endgame Attitudes
As part of the survey, respondents were asked their opinions about several tobacco
endgame policies. They were asked how much they disagreed or agreed with the following
statements: (a) the sale of all tobacco products (e.g., cigarettes, cigars, chew, vapesl
should end; (b) smoking cigarettes, little cigars, or cigarillos in all public p|dC8s should end;
and (c) the sale of flavored tobacco (e.g., cigarettes, chew, cigars, and vapes that taste like
mint, fruit, candy, orliquor) should end. Response options were "strongly agree,""agree,"
"disagree," and "strongly disagree." Respondents were considered supporting these policies
if they responded "strongly agree" or "agree" and not supporting them if they responded
"disagree" or "strongly disagree."
Table 0-1 shows responses to these questions by vaping status and cigarette smoking
status. Overall, more than two-thirds of respondents supported these policies. The highest
support was for a public tobacco use ban (73.7%), followed by a flavored tobacco ban
/72.096l and tobacco sales ban (66.996). Respondents who had never vaped and never
smoked cigarettes tended to express more support for these bans than those who formerly
orcurrently vapedand smoked.
TabUe@-1. Agreement with Tobacco Endgame Policies Among High School
Respondents, by Vaping Status and Cigarette Smoking Status
Support for Complete
Tobacco Sales Ban'
Support for Public
Tobacco Use Ban2
Support for Flavored
Tobacco Sales Bans
Characteristic
N
%
(9596CI)
N
%
(9596CI)
N
%
(9596CI)
Overall
30,127
66.9
(65.7-68.1)
30,037
73.7
(72.4-74.9)
30,099
72.0
(71.1-72.9)
Veping status
Never
24,003
71.2
(70.2-72.3)
24,030
77.0
(75.8-78.1)
24,070
76.0
(761-77.8)
Former
3,904
53.7
(50.9-56.4)
3,983
64.8
(62.2-67.2)
3,903
57.4
(54.8-60.0)
Current
2,019
34.2
(30.1-38.3)
2,004
46.5
(42.1-58.9)
2,016
35.3
(31.1-39.6)
Cigarette
smoking status
Never
28,115
68.7
(67.6-69.7)
28,040
75.2
(74.0-76.4)
28,001
73.8
(72.0-74.7)
Former
1,560
42.6
(37.8-47.5)
1,550
53.1
(48.0-58.1)
1,559
47.1
(42.6-51.7)
Current
439
10.0
(13.0-I6.3)
435
I0.9
(23.1-37.4)
436
26.8
(20.1-34.4)
Note. [I = confidence interval.
1 Responded "strongly agree" or"agreo"to the statement "the sale of all tobacco products (e.g.,
cigarettes, cigars, chew, vepes)should end.^
z Responded "strongly agree" or^agree"to the statement "smoking cigarettes, little cigars, or
cigarillos inall public places should end."
o Responded "strongly agree" or "agree" to the statement "the sale of flavored tobacco (e.g.,
cigarettes, chew, cigars, and vaposthat taste like mint, fruit, candy, or liquor) should end."
6-1
Results of the 2023 California Youth Tobacco Survey
We examined support for tobacco endgame policies by demographics (Table 6-2). Female
respondents reported the highest level of support for all three bans, compared with other
gender categories. Within race/ethnicity categories, Asian respondents reported the highest
support across all three bans (75.5%, 82.6%, and 81.2%, respectively), and White
respondents reported the least support (60.1%, 69.8%, and 69.2%, respectively).
Respondents in the loth grade reported more support for all three bans (69.5%, 75.4%,
and 74.1%, respectively) than 12th-grade respondents did (64.0%, 71.7%, and 69.7%,
respectively). Non-LGBTQ+ respondents reported the highest support for all three bans
(68.6%, 75.3%, and 73.7%, respectively) and LGBTQ+ respondents reported the least
support (60.5%, 69.0%, and 67.0%, respectively).
Table 6-2. Agreement With Tobacco Endgame Policies Among High School
Respondents, by Demographics
Support for Complete
Tobacco Sales Ban'
Characteristic N
Overall
Gender identity
Male
Female
Identified in
another way
Declined to
answer
Race/ethnicity*
White
African
American or
Black
Hispanic
Asian
Other
Multiracial
Grade
10
12
0/0 (95% CI)
30,127 66.9 (65.7-68.1)
13,596 63.6 (61.8-65.5)
13,361 71.5 (69.9-73.0)
1,747 57.4 (54.0-60.8)
174 58.6 (44.5-71.7)
Support for Public
Tobacco Use Bane
Support For Flavored
Tobacco Sales Ban3
N % (950/0 CI) N % (950/0 CI)
30,037 73.7 (72.4-74.9) 30,099 72.0 (71.1-72.9)
13,572 71.3 (69.7-72.8)
13,318 77.8 (76.2-79.4)
1,738 63.5 (60.1-66.8)
170 66.4 (52.4-78.7)
13,587 71.2 (69.7-72.7)
13,348 74.2 (72.9-75.5)
1,744 64.5 (61.0-67.8)
173 63.2 (49.3-75.6)
7,202 60.1 (57.9-62.3) 7,181 69.8 (67.8-71.7) 7,199 69.2 (66.5-71.8)
662 67.9 (61.4-73.9) 661 72.7 (65.6-79.1) 663 71.1 (66.6-75.3)
16,204 68.4
(66.7-70.0)
3,108 75.5
(73.1-77.9)
764 66.4
(60.0-72.3)
2,120 63.8
(60.1-67.4)
16,149
73.9 (72.1-75.6)
3,102
82.6 (80.5-84.6)
760
71.6 (66.5-76.4)
2,118
72.9 (69.5-76.0)
16,181
71.9 (70.5-73.2)
3,105
81.2 (79.1-83.2)
762
71.5 (64.8-77.6)
2,123
70.2 (66.3-73.9)
15,769 69.5 (67.8-71.2) 15,728 75.4 (73.6-77.1) 15,751 74.1 (72.7-75.6)
14,358 64.0 (62.3-65.6) 14,309 71.7 (70.1-73.4) 14,348 69.7 (68.2-71.2)
(continued)
6-2
Results of the 2023 California Youth Tobacco Survey
Table 6-2. Agreement With Tobacco Endgame Policies Among High School
Respondents, by Demographics (continued)
Support for Complete
Tobacco Sales Ban'
Support for Public
Tobacco Use Bane
Support For Flavored
Tobacco Sales Ban3
Characteristic
N % (95% CI)
N % (95% CI)
N % (95% CI)
LGBTQ+ status
LGBTQ+
5,089 60.5 (58.2-62.7)
5,071 69.0 (66.7-71.3)
5,087 67.0 (64.7-69.2)
Non-LGBTQ+
21,103 68.6 (67.2-70.0)
21,055 75.3 (73.9-76.7)
21,086 73.7 (72.6-74.7)
Unclear
2,385 65.8 (62.5-69.0)
2,376 71.9 (69.2-74.6)
2,379 70.0 (66.8-73.1)
LGBTQ+
status
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey.
1 Responded 'strongly agree" or "agree" to the statement "the sale of all tobacco products (e.g.,
cigarettes, cigars, chew, vapes) should end."
z Responded "strongly agree" or "agree" to the statement "smoking cigarettes, little cigars, or
cigarillos in all public places should end."
3 Responded "strongly agree" or "agree" to the statement "the sale of flavored tobacco (e.g.,
cigarettes, chew, cigars, and vapes that taste like mint, fruit, candy, or liquor) should end."
6.1 Summary
Over two-thirds of high school respondents supported tobacco endgame policies. Support
was highest for a public use ban on tobacco. The second most popular endgame policy was
a ban on flavored tobacco products. Support for endgame policies was highest among
respondents who had never or formerly smoked cigarettes or used vapes and among
respondents who identified as female. Some differences existed by race/ethnicity for each
ban, but support was over 60% for all race/ethnicity groups and all endgame policies
measured. Tenth -grade respondents supported the bans more than 12th-grade respondents,
and non-LGBTQ+ respondents supported the bans more than LGBTQ+ respondents and
respondents of unclear LGBTQ+ status.
6-3
7. Geographic Differences
This chapter examines geographic differences. We only examined whether differences were
significant for counties and county groupings to make sense of the large number of
estimates provided by dividing the state into these groups. For these comparisons, we
compared individual counties and county groups to the state average for each outcome
using independent two sample t-tests with unequal variance.
7.1 Rurality
To capture tobacco use by rurality, students were divided into three categories based on the
locations of their schools. The categories were obtained from the National Center for
Education Statistics using school address.10 Further information on this variable is available
in Appendix A. Table 7-1 presents prevalence of current any tobacco use and current use of
specific tobacco products by rurality. Current use was most prevalent among respondents
living in towns or rural settings (9.6%), compared with cities (6.9%) and suburban areas
(6.8%). Estimates for cities and suburban areas were similar. The same pattern was present
for current vaping, with higher prevalence estimates observed for towns or rural setting
(8.0%) and similar vaping prevalence estimates for cities (5.7%) and suburban areas
(5.3%). In general, this finding applies to all tobacco products included in the survey with
few exceptions. Current use of HTPs was identical for all areas. In addition, use of hookah
was very similar across all categories of rurality (0.9% town or rural settings, 0.7% cities,
and 0.7% suburban areas).
Table 7-1. Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Rurality
Tobacco
Product
City Suburban Town or Rural
N % (95% Cl) N % (95% Cl) N % (95% Cl)
Any tobacco use
11,637
6.9
(5.9-8.0)
12,853
6.8
(5.6-8.3)
6,476
9.6
(7.5-12.0)
Vapes
11,626
5.7
(4.8-6.8)
12,835
5.3
(4.3-6.4)
6,469
8.0
(6.2-10.1)
Cigarettes
11,628
1.1
(0.7-1.6)
12,844
1.0
(0.7-1.4)
6,471
1.9
(1.2-2.7)
LCCs
11,634
0.7
(0.5-1.0)
12,844
0.4
(0.3-0.6)
6,473
1.0
(0.6-1.5)
Cigars
11,628
0.9
(0.6-1.2)
12,848
0.6
(0.4-0.9)
6,471
1.3
(0.9-1.9)
Hookah
11,637
0.7
(0.3-1.2)
12,853
0.7
(0.4-1.2)
6,476
0.9
(0.4-1.6)
Smokeless
11,637
0.4
(0.2-0.8)
12,853
0.3
(0.2-0.5)
6,476
1.1
(0.6-1.9)
HTPs
11,637
0.5
(0.3-0.8)
12,853
0.5
(0.3-0.8)
6,476
0.5
(0.1-1.1)
(continued)
10 National Center for Education Statistics. (n.d.). Education demographic and geographic estimates.
Retrieved March 1, 2023, from htt a: ncE s.ed._gov/pro ra sled�eJCeogra�hicLLocaleBoundaries
7-1
Results of the 2023 California Youth Tobacco Survey
Table 7-1. Prevalence of Current Use of Tobacco Products Among High School
Respondents, by Rurality (continued)
City Suburban Town or Rural
Tobacco
Product N % (95% CI) N % (95% CI) N % (95% CI)
Nicotine 11,637 0.8 (0.6-1.1) 12,853 1.1 (0.7-1.5) 6,476 1.7 (1.2-2.2)
pouches
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos; CI = confidence interval.
Table 7-2 presents intentions to quit vaping in the next 30 days among respondents who
currently vaped by rurality. Respondents who currently vaped and were living in suburban
areas were most likely to report intending to quit (42.0%), and those living in a city were
least likely to report this intention (35.7%).
Table 7-2. Percentage of Respondents Who Reported Intending to Quit Vaping in
the Next 30 Days Among High School Respondents Who Were
Currently Vaping, by Rurality
Characteristic
Intending to Quit
N % (950/0 CI)
Overall
2,099
38.8
(34.3-43.3)
Rurality
City
755
35.7
(29.2-42.5)
Suburban
793
42.0
(34.1-50.3)
Town or rural
551
38.3
(32.6-44.2)
Note. CI = confidence interval.
Estimates7.2 County -Level
In addition to analyses by rurality, because the 2023 CYTS was designed to enable county -
level prevalence estimates for tobacco use, we also examined tobacco use by county or
county grouping. Figure 1 displays the counties that were combined into county groups. The
individual counties that compose each county grouping are listed in a footnote of Table 7-3.
7-2
Results ofthe 2023 California Youth Tobacco Survey
Figure 1. Map of County Groups
Table 7-3 presents these results for ever and current use of any tobacco product. The p-
values in the table represent comparisons with the state average. The five counties with the
highest level of any tobacco aver use were Shasta (41.296), county group A /37.896\,
county group D /36.496\, Butte (33.296), and county group C /29.396\. The five counties
with the lowest prevalence of ever use were Tulare County (15.096), Contra Costa (15.596),
Merced (16.206), Los Angeles (10.69/6), and Santa C|dn] (17.596).
Table 7-3. Prevalence of Ever and Current Use mfAny Tobacco Products Among
High School Respondents, by County Grouping
Ever Use
Current Use
Characteristic
N
%
(95% CD)
N
%(95%
CD)
Overall
30,966
21.6
(20.3-22.9)
30,966
7.3
(6.5-8.1)
County Group
County group A
810
37.8*
(32.3-43.4)
810
16.4*
(13.2-I0.1)
County group B
1,126
27.1
(28.7-34.2)
1,126
11.6
(6.9-17.8)
County group C
491
29.3
(19.6-40.6)
491
12.3*
(8.9-16.3)
County group D
1,498
364*
(262-47.6)
1,408
17.4*
(9.1-28.8)
County group E
607
20.8
(13.0-30.6)
607
5.5f
(2.1-11.4)
Alameda
622
20.9
(12.4-31.9)
622
7.71
(3.0-15.5)
7-3
Results of the 2023 California Youth Tobacco Survey
Table 7-3. Prevalence of Ever and Current Use of Any Tobacco Products Among
High School Respondents, by County Grouping (continued)
Ever Use
Current Use
Characteristic
N
% (95% CI)
N
% (95%
CI)
Butte
815
33.2*
(24.3-43.2)
815
15.4*
(7.5-26.8)
Contra Costa
472
15.5*
(8.7-24.7)
472
2.8t*
(0.2-11.7)
Fresno
348
22.9
(19.4-26.7)
348
6.4t
(0.4-26.1)
Imperial
868
21.9
(18.5-25.7)
868
6.1
(4.6-7.9)
Kern
572
25.2*
(21.0-29.9)
572
7.1
(5.3-9.3)
Kings
947
23.9
(17.1-31.9)
947
7.3
(4.8-10.6)
Los Angeles
1,300
16.6*
(12.5-21.5)
1,300
5.0*
(3.2-7.5)
Madera
925
18.7*
(15.2-22.6)
925
4.2*
(2.4-6.6)
Merced
1,181
16.2*
(11.7-21.6)
1,181
4.5*
(2.4-7.6)
Orange
1,075
23.2
(17.0-30.4)
1,075
9.5
(5.7-14.7)
Placer
966
23.3
(17.8-29.6)
966
9.3
(6.8-12.4)
Riverside
725
24.1
(17.9-31.3)
725
7.3
(3.8-12.4)
Sacramento
1,434
19.1
(15.8-22.7)
1,434
5.6
(3.5-8.4)
San Bernardino
524
26.4
(19.8-33.8)
524
9.0
(5.8-13.1)
San Diego
1,100
24.1
(19.6-29.0)
1,100
9.0
(5.7-13.4)
San Francisco
212
21.6
(14.1-30.7)
212
6.Ot
(0.1-34.3)
San Joaquin
907
23.1
(18.6-28.0)
907
8.1
(5.0-12.2)
San Luis Obispo
1,251
29.2*
(21.9-37.3)
1,251
12.4*
(8.5-17.2)
San Mateo
1,101
20.4
(12.7-30.1)
1,101
7.4t
(3.3-13.8)
Santa Barbara
1,786
20.9
(18.4-23.7)
1,786
6.0
(3.5-9.4)
Santa Clara
1,056
17.5
(12.2-23.8)
1,056
5.8
(3.4-9.1)
Santa Cruz
662
20.9t
(9.4-37.2)
662
9.2t
(2.6-22.1)
Shasta
1,022
41.2*
(35.1-47.5)
1,022
16.8*
(14.0-19.9)
Solano
568
28.5*
(21.9-35.7)
568
8.8
(6.0-12.3)
Sonoma
168
26.5
(21.7-31.7)
168
10.5t
(0.2-49.2)
Stanislaus
1,131
24.8
(20.4-29.6)
1,131
7.9
(5.3-11.3)
Tulare
962
15.0*
(10.8-20.2)
962
4.2*
(2.6-6.5)
Ventura
909
21.2
(13.6-30.6)
909
7.9t
(3.6-14.7)
Yolo
825
21.2
(15.7-27.6)
825
7.3
(5.9-9.0)
Note. County group A includes Del Norte, Humboldt, Lake, Lassen, Mendocino, Modoc, Plumas,
Siskiyou, Tehama, and Trinity counties. County group B includes Colusa, Glenn, Sutter, and Yuba
counties. County group C includes Alpine, Amador, Calaveras, El Dorado, Inyo, Mariposa, Mono,
Nevada, Sierra, and Tuolumne counties. County group D includes Marin and Napa counties. County
Group E includes Monterey and San Benito counties. CI = confidence interval.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >- 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
* p < 0.05. P-values compare the estimate for each individual county or county grouping with the
state average prevalence for that outcome, using independent two sample t-tests with unequal
variance.
7-4
Results of the 2023 California Youth Tobacco Survey
For current use of any tobacco, the five counties with the highest prevalence were county
group D (17.4%), Shasta (16.8%), county group A (16.4%), Butte (15.4%), and San Luis
Obispo (12.4%). The five counties with the lowest current use prevalence were Contra
Costa (2.8%), Tulare (4.2%), Madera (4.2%), Merced (4.5%), and county group E (5.5%).
Estimates for Contra Costa and county group E should be interpreted with caution due to
small sample sizes.
In addition to conducting analyses for any tobacco use, we also examined current use of all
products included in the survey by county or county group. Tables 7-4a, 7-4b, and 7-4c
present these estimates. Butte County (13.9%) had the highest prevalence of current
vaping, and Contra Costa County (2.5%) had the lowest prevalence of current vaping, but
both estimates should be interpreted with caution given limited precision (Table 7-4a).
For current cigarette smoking, county group D (6.0%) had the highest prevalence, and
Tulare and Sacramento (both 0.4%) had the lowest prevalence of cigarette smoking. For
current LCC use, San Francisco County (3.2%) had the highest prevalence of current use,
and Santa Barbara (0.1%) had the lowest prevalence. For cigars, San Francisco County had
the highest current use estimate (3.2%), but this estimate should be interpreted with
caution given limited precision (Table 7-4b). Tulare had the lowest prevalence (0.2%).
For hookah, county group C (2.0%) had the highest current use prevalence, and Madera,
Yolo, Merced, and Solano had the lowest prevalence (0.1%). For smokeless tobacco use,
county group A (2.1%) had the highest current prevalence, and Kings County (0.1%) had
the lowest prevalence of use. For HTP use (Table 7-4c), county group A (1.5%) had the
highest prevalence of current use, and Madera, Kings, Santa Cruz, Ventura, and Contra
Costa had the lowest prevalence (0.1%).
7-5
Results of the 2023 California Youth Tobacco Survey
Table 7-4a. Prevalence of Current Use of Vapes, Cigarettes, and LCCs Among High
School Respondents, by County Grouping
Vanes Ciaarettes LCCs
Characteristic
N
% (95% CI)
N
% (95% CI)
N
% (95% Cl)
Overall
30,930
5.9
(5.3-6.5)
30,943
1.2
(0.9-1.5)
30,951
0.6
(0.5-0.8)
County Group
County group A
810
13.3*
(10.7-16.4)
810
2.7*
(1.3-4.9)
810
2.1*
(1.1-3.5)
County group B
1,124
9.4
(5.6-14.6)
1,124
1.9
(0.7-4.0)
1,125
1.8*
(0.7-3.7)
County group C
491
9.7*
(5.7-15.2)
490
2.1
(0.6-5.3)
490
0.9
(0.0-4.7)
County group D
1,497
12.8t*
(6.0-23.0)
1,496
6.0t*
(2.6-11.6)
1,496
1.0
(0.4-2.1)
County group E
607
4.6t
(1.5-10.7)
607
0.5*
(0.1-1.5)
607
0.9
(0.2-2.8)
Alameda
622
6.5t
(2.5-13.1)
622
2.1t
(0.5-5.6)
622
0.9
(0.2-2.9)
Butte
815
13.9t*
(5.7-26.7)
815
2.7t
(0.7-6.7)
814
0.6
(0.1-1.9)
Contra Costa
471
2.5t
(0.1-12.9)
472
0.5*
(0.0-2.3)
472
-
-
Fresno
347
5.1t
(0.5-18.8)
347
1.0
(0.3-2.3)
348
1.7t
(0.2-6.1)
Imperial
868
5.7
(4.7-6.8)
868
0.7
(0.1-2.2)
868
0.2
(0.0-2.1)
Kern
572
5.8
(4.7-7.2)
572
1.3t
(0.1-5.9)
572
1.3t
(0.1-5.3)
Kings
945
5.9
(3.6-8.9)
946
0.6*
(0.1-1.7)
945
0.8
(0.2-1.9)
Los Angeles
1,298
3.5*
(2.2-5.3)
1,297
0.5*
(0.1-1.3)
1,299
0.2*
(0.0-0.6)
Madera
922
3.lt*
(1.1-6.8)
924
0.7t
(0.0-8.0)
925
0.5
(0.1-1.4)
Merced
1,180
3.2*
(1.8-5.4)
1,180
1.1
(0.3-2.9)
1,180
1.2
(0.5-2.4)
Orange
1,072
7.2
(4.1-11.5)
1,074
2.2
(1.0-4.1)
1,075
1.0*
(0.6-1.6)
Placer
964
7.8
(5.2-11.1)
963
1.7
(0.9-2.9)
964
0.9
(0.5-1.5)
Riverside
722
6.2
(3.1-10.7)
724
0.5*
(0.1-1.3)
724
0.4
(0.1-1.3)
Sacramento
1,434
4.8
(2.8-7.5)
1,433
0.4*
(0.2-0.7)
1,434
0.4
(0.2-0.8)
San Bernardino
524
7.6
(5.3-10.5)
524
2.3t
(0.5-6.2)
524
0.7
(0.1-2.5)
San Diego
1,100
7.8
(4.9-11.6)
1,100
1.2
(0.3-2.8)
1,100
0.5
(0.1-1.4)
San Francisco
212
3.7t
(0.0-25.5)
212
2.7t
(0.0-18.7)
212
3.2t
(0.0-38.4)
San Joaquin
904
6.1
(3.8-9.1)
907
0.8
(0.3-1.5)
907
0.6
(0.2-1.6)
San Luis Obispo
1,248
10.0*
(6.8-13.9)
1,250
2.0*
(1.4-2.8)
1,251
1.4*
(0.8-2.1)
San Mateo
1,101
6.7t
(2.9-12.9)
1,101
1.6
(0.4-4.1)
1,101
0.3*
(0.1-0.8)
Santa Barbara
1,784
4.2*
(2.7-6.1)
1,784
1.1
(0.2-3.2)
1,785
0.1*
(0.0-0.3)
Santa Clara
1,056
5.2
(3.1-8.3)
1,056
0.6*
(0.2-1.5)
1,056
0.4
(0.1-1.2)
Santa Cruz
659
6.5t
(1.8-15.8)
661
3.Ot
(0.3-11.7)
662
0.4
(0.1-1.5)
Shasta
1,021
14.8*
(11.7-18.3)
1,022
2.6*
(1.5-4.0)
1,022
1.9*
(1.1-3.0)
Solano
568
7.7
(5.4-10.7)
568
1.0
(0.2-3.3)
567
0.4
(0.1-1.4)
Sonoma
168
10.0t*
(0.8-35.3)
168
2.3*
(1.2-4.1)
168
0.3t
(0.0-31.9)
Stanislaus
1,128
7.1
(4.9-9.8)
1,131
1.0
(0.4-2.0)
1,130
0.2*
(0.0-0.7)
Tulare
962
3.4*
(1.9-5.7)
961
0.4*
(0.1-1.1)
962
0.2*
(0.0-0.9)
Ventura
909
6.2t
(2.5-12.5)
909
1.2
(0.5-2.2)
909
0.9
(0.3-2.1)
Yolo
825
5.5
(3.9-7.5)
825
1.8
(0.6-4.1)
825
1.5*
(0.7-2.7)
Note. LCCs = little cigars
or cigarillos.
County group
A includes Del Norte,
Humboldt,
Lake,
Lassen,
Mendocino, Modoc, Plumas,
Siskiyou, Tehama, and
Trinity
counties. County group B includes Colusa,
Glenn, Sutter, and Yuba counties. County group C includes
Alpine,
Amador, Calaveras, El
Dorado,
Inyo,
Mariposa, Mono, Nevada, Sierra,
and Tuolumne counties. County group D includes Marin
and Napa
counties. County Group E includes Monterey and San Benito counties.
CI = confidence interval.
- The estimate has
been suppressed
due to small sample
sizes, specifically, a nominal or effective
sample
size less than 30.
For definitions of nominal and effective
sample
size,
see Appendix
A.
t The estimate should be interpreted
with caution given
concerns about precision.
The estimate meets one
or both of the following criteria: (a)
the absolute width of the
Korn-Graubard
confidence
interval for the
estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30
and > 0.05.
*p < 0.05. P-values
compare
the estimate for each
individual
county
or county grouping with
the state
average prevalence for that
outcome, using independent
two sample t-tests with unequal
variance.
7-6
Results of the 2023 California Youth Tobacco Survey
Table 7-4b. Prevalence of Current Use of Cigars, Hookah, and Smokeless Tobacco
Among High School Respondents, by County Grouping
Cigars Hookah Smokeless
Characteristic N % (95% CI) N % (95% CI) N % (95% CI)
Overall 30,947 0.8 (0.7-1.0) 30,966 0.7 (0.5-1.0) 30,966 0.5 (0.4-0.7)
County Group
County group A
810
2.3
(0.9-4.8)
810
1.4
(0.5-3.2)
810
2.1*
(1.0-3.7)
County group B
1,126
1.8
(0.8-3.6)
1,126
0.7
(0.1-1.9)
1,126
1.7*
(0.6-3.7)
County group C
491
1.3
(0.5-2.6)
491
2.0*
(0.9-3.8)
491
1.5
(0.5-3.6)
County group D
1,496
1.2
(0.6-2.0)
1,498
1.1
(0.6-1.8)
1,498
1.3
(0.3-3.7)
County group E
606
0.9
(0.1-3.8)
607
0.6
(0.3-1.1)
607
0.2
(0.0-1.8)
Alameda
621
0.9
(0.2-2.3)
622
0.6
(0.1-1.7)
622
0.3
(0.0-1.1)
Butte
815
0.6
(0.1-1.8)
815
0.9
(0.6-1.3)
815
1.1
(0.1-4.5)
Contra Costa
472
0.2*
(0.0-1.9)
472
-
-
472
0.4
(0.0-1.6)
Fresno
348
1.4
(0.2-4.6)
348
0.5t
(0.0-11.5)
348
0.5t
(0.0-11.5)
Imperial
868
0.3*
(0.0-1.5)
868
0.3
(0.0-3.1)
868
-
-
Kern
571
1.5t
(0.1-5.9)
572
1.0t
(0.0-5.8)
572
0.9t
(0.0-6.0)
Kings
946
0.9
(0.3-2.0)
947
0.4
(0.0-1.9)
947
0.1*
(0.0-0.6)
Los Angeles
1,298
0.4*
(0.1-0.9)
1,300
1.0
(0.3-2.5)
1,300
0.3
(0.1-1.1)
Madera
925
0.3*
(0.0-1.5)
925
0.1*
(0.0-0.6)
925
0.2
(0.0-3.2)
Merced
1,180
1.3
(0.4-3.0)
1,181
0.1*
(0.0-0.3)
1,181
0.3
(0.1-1.0)
Orange
1,075
1.0
(0.3-2.2)
1,075
0.7
(0.3-1.6)
1,075
0.6
(0.1-1.5)
Placer
964
1.7*
(1.3-2.3)
966
1.4*
(0.8-2.3)
966
1.4*
(1.0-2.0)
Riverside
724
0.6
(0.1-2.3)
725
1.0
(0.1-3.5)
725
0.7
(0.1-2.7)
Sacramento
1,434
0.5*
(0.2-0.9)
1,434
0.2*
(0.1-0.6)
1,434
0.2*
(0.0-0.5)
San Bernardino
524
1.1
(0.1-3.6)
524
0.9
(0.1-3.8)
524
0.9
(0.1-3.8)
San Diego
1,100
0.8
(0.3-1.9)
1,100
0.8
(0.1-2.8)
1,100
0.2*
(0.0-0.7)
San Francisco
211
3.2t
(0.0-38.3)
212
-
-
212
-
-
San Joaquin
907
0.2*
(0.0-0.9)
907
0.8
(0.3-1.7)
907
0.2
(0.0-1.6)
San Luis Obispo
1,249
2.1*
(1.1-3.5)
1,251
0.6
(0.2-1.2)
1,251
0.6
(0.2-1.2)
San Mateo
1,101
0.8
(0.4-1.6)
1,101
0.6
(0.2-1.4)
1,101
0.3
(0.0-0.9)
Santa Barbara
1,784
0.6
(0.2-1.5)
1,786
0.2*
(0.1-0.6)
1,786
0.4
(0.2-0.7)
Santa Clara
1,056
0.7
(0.1-2.2)
1,056
0.5
(0.1-1.5)
1,056
0.5
(0.1-1.2)
Santa Cruz
661
0.8
(0.1-2.9)
662
0.2
(0.0-2.0)
662
0.4
(0.0-2.0)
Shasta
1,022
1.9
(0.6-4.3)
1,022
1.0
(0.6-1.5)
1,022
1.9*
(0.7-4.3)
Solano
568
0.8
(0.2-1.9)
568
0.1*
(0.0-1.2)
568
0.4
(0.0-1.6)
Sonoma
168
1.6t
(0.0-89.6)
168
-
-
168
0.3t
(0.0-38.1)
Stanislaus
1,131
1.1
(0.3-2.7)
1,131
0.4
(0.1-1.2)
1,131
0.5
(0.2-1.0)
Tulare
961
0.2*
(0.0-1.4)
962
0.3
(0.1-1.0)
962
0.2*
(0.0-0.8)
Ventura
909
1.3
(0.5-2.9)
909
0.4
(0.0-1.3)
909
-
-
Yolo
825
1.3*
(0.8-1.8)
825
1.1
(0.6-1.8)
825
0.6
(0.1-2.3)
Note. County group A includes Del Norte, Humboldt, Lake, Lassen, Mendocino, Modoc, Plumas, Siskiyou,
Tehama, and Trinity counties. County group B includes Colusa, Glenn, Sutter, and Yuba counties. County
group C includes Alpine, Amador, Calaveras, El Dorado, Inyo, Mariposa, Mono, Nevada, Sierra, and
Tuolumne counties. County group D includes Marin and Napa counties. County Group E includes Monterey
and San Benito counties. CI = confidence interval.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample
size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one
or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the
estimate is >- 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30
and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than 130% of the
estimate.
Emi
Results of the 2023 California Youth Tobacco Survey
Table 7-4c. Prevalence of Current Use of Heated Tobacco Products and Nicotine
Pouches Among High School Respondents, by County Grouping
HTPs Nicotine Pouches
Characteristic N % (95% CI) N % (95% CI)
Overall 30,966 0.5 (0.3-0.7) 30,966 1.1 (0.9-1.3)
County Group
County group A
810
1.5*
(0.7-2.9)
810
3.3*
(1.4-6.2)
County group B
1,126
0.9
(0.3-1.8)
1,126
2.6*
(1.1-5.0)
County group C
491
0.5
(0.0-2.3)
491
2.7*
(1.4-4.8)
County group D
1,498
1.2*
(0.7-1.7)
1,498
4.8*
(2.5-8.4)
County group E
607
0.5
(0.0-2.6)
607
0.8
(0.2-2.2)
Alameda
622
0.9
(0.3-2.2)
622
0.6
(0.2-1.5)
Butte
815
0.5
(0.1-1.5)
815
1.3
(0.1-5.1)
Contra Costa
472
0.1*
(0.0-1.4)
472
0.1*
(0.0-1.0)
Fresno
348
-
-
348
1.0
(0.3-2.4)
Imperial
868
0.2
(0.0-1.9)
868
0.8
(0.2-2.3)
Kern
572
0.9+
(0.0-6.0)
572
1.7
(0.5-4.3)
Kings
947
0.1*
(0.0-0.8)
947
0.9
(0.3-2.3)
Los Angeles
1,300
0.6
(0.2-1.3)
1,300
0.8
(0.3-1.8)
Madera
925
0.1*
(0.0-0.4)
925
0.4*
(0.0-3.4)
Merced
1,181
0.2*
(0.0-0.5)
1,181
0.4*
(0.2-0.9)
Orange
1,075
0.6
(0.2-1.4)
1,075
1.6
(0.8-3.0)
Placer
966
0.8
(0.5-1.3)
966
2.5*
(1.4-4.1)
Riverside
725
1.0
(0.1-3.6)
725
1.2
(0.4-2.9)
Sacramento
1,434
0.2
(0.0-0.7)
1,434
0.3*
(0.0-1.2)
San Bernardino
524
0.2
(0.0-1.5)
524
0.8
(0.2-2.2)
San Diego
1,100
0.2
(0.0-0.7)
1,100
0.8
(0.3-1.8)
San Francisco
212
1.3t
(0.0-27.2)
212
0.7
(0.0-3.3)
San Joaquin
907
0.3
(0.0-1.0)
907
1.4
(0.2-5.1)
San Luis Obispo
1,251
0.5
(0.1-1.3)
1,251
2.0
(1.0-3.6)
San Mateo
1,101
0.2*
(0.0-0.6)
1,101
0.9
(0.6-1.3)
Santa Barbara
1,786
0.2*
(0.1-0.4)
1,786
0.7
(0.2-1.6)
Santa Clara
1,056
0.3
(0.0-1.1)
1,056
0.7
(0.2-1.8)
Santa Cruz
662
0.1*
(0.0-0.9)
662
1.3
(0.1-5.1)
Shasta
1,022
0.6
(0.2-1.6)
1,022
4.lt*
(1.9-7.4)
Solano
568
0.4
(0.0-1.5)
568
1.3
(0.2-4.3)
Sonoma
168
0.4t
(0.0-31.1)
168
2.1t
(0.0-81.6)
Stanislaus
1,131
0.4
(0.1-1.0)
1,131
0.6*
(0.3-1.1)
Tulare
962
-
-
962
0.6
(0.2-1.4)
Ventura
909
0.1*
(0.0-0.8)
909
0.8
(0.2-2.1)
Yolo
825
1.1*
(0.6-1.7)
825
1.7
(0.7-3.5)
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos.
County group A includes
Del Norte,
Humboldt, Lake, Lassen,
Mendocino, Modoc, Plumas, Siskiyou, Tehama, and Trinity
counties. County
group B includes Colusa,
Glenn, Sutter,
and Yuba
counties. County
group C includes Alpine, Amador,
Calaveras, El Dorado, Inyo, Mariposa, Mono, Nevada, Sierra, and Tuolumne counties.
County group D
includes Marin and Napa
counties. County Group E includes Monterey and San
Benito counties.
CI =
confidence interval.
- The estimate has been suppressed
due
to small sample
sizes, specifically, a nominal or effective
sample
size less than 30. For definitions of nominal and effective
sample size,
see Appendix
A.
t The estimate should be interpreted with caution given
concerns about precision. The estimate meets one
or both of the following criteria:
(a) the
absolute width of the Korn-Graubard confidence interval
for the
estimate is >_ 0.30 OR (b)
the absolute
width of the Korn-Graubard confidence
interval is
< 0.30
and > 0.05 and the relative
width of the Korn-Graubard confidence interval is
greater than
130% of the
estimate.
7-8
Results of the 2023 California Youth Tobacco Survey
For nicotine pouches, county group D (4.8%) had the highest prevalence of current use,
while Sacramento had the lowest use (0.3%).
7.3 Region
In addition to county -level estimates, we calculated regional estimates for ever and current
any tobacco use. Table 7-5 presents these estimates. For ever use, the Northern region had
the highest prevalence estimate (25.0%), and the Greater Bay Area had the lowest
prevalence (20.9%). In terms of current use, the Northern region had the highest
prevalence estimate (9.6%), and the Central region had the lowest estimate (6.4%).
Table 7-5. Prevalence of Ever and Current Use of Any Tobacco Products Among
High School Respondents, by Region
Ever Use
Current Use
Characteristic N
%
(95% CI)
N
%
(95% CI)
Overall
30,966
21.6
(20.3-22.9)
30,966
7.3
(6.5-8.1)
Region
Northern
7,424
25.0
(22.7-27.4)
7,424
9.6
(7.9-11.5)
Central
6,131
22.3
(20.7-24.1)
6,131
6.4
(5.0-8.0)
Greater Bay
7,873
20.9
(18.9-23.2)
7,873
7.0
(5.7-8.5)
Southern
9,538
21.1
(19.0-23.3)
9,538
7.2
(6.0-8.5)
Note. The Northern region of California includes the following counties: Alpine, Amador, Butte,
Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada,
Placer, Plumas, Sacramento, Shasta, Sierra, Siskiyou, Sutter, Tehama, Tuolumne, Trinity, Yolo, and
Yuba. The Central region includes the following counties: Fresno, Inyo, Kern, Kings, Madera,
Mariposa, Merced, Mono, Stanislaus, and Tulare. The Greater Bay Area includes Alameda, Contra
Costa, Marin, Monterey, Napa, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara,
Santa Cruz, and Solano, Sonoma. The Southern region includes the following counties: Imperial, Los
Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and
Ventura. CI = confidence interval.
Table 7-6 presents current tobacco prevalence estimates for the tobacco products included
in the 2023 CYTS, by region. For vaping, the Northern region (8.1%) had the highest
prevalence estimate, and the Central region (5.1%) had the lowest prevalence estimate.
The prevalence estimates for the remaining tobacco products varied little by region.
Results of the 2023 California Youth Tobacco Survey
Table 7-6. Prevalence of Current Use of Tobacco Products Among High School Respondents, by Region
Vapes
Cigarettes
LCCs
Cigars
Characteristic
N
%
(95% CI)
N
% (95% CI)
N
%
(95% CI)
N
% (95% CI)
Overall
30,930
5.9
(5.3-6.5)
30,943
1.2 (0.9-1.5)
30,951
0.6
(0.5-0.8)
30,947
0.8 (0.7-1.0)
Region
Northern
7,419
8.1
(6.6-9.8)
7,418
1.4 (1.0-1.9)
7,419
0.9
(0.6-1.2)
7,422
1.1 (0.9-1.5)
Central
6,121
5.1
(4.1-6.4)
6,125
1.0 (0.5-1.6)
6,127
1.1
(0.6-1.8)
6,127
1.1 (0.6-1.9)
Greater Bay
7,865
5.9
(4.7-7.2)
7,870
1.4 (1.0-2.0)
7,870
0.7
(0.4-1.1)
7,867
0.9 (0.5-1.3)
Southern
9,525
5.6
(4.7-6.7)
9,530
1.1 (0.7-1.6)
9,535
0.5
(0.3-0.7)
9,531
0.7 (0.5-1.0)
Hookah
Smokeless
HTPs
Nicotine Pouches
Characteristic
N
%
(950/0 CI)
N
% (950/0 CI)
N
%
(950/0 CI)
N
% (950/0 CI)
Overall 30,966 0.7 (0.5-1.0) 30,966 0.5 (0.4-0.7) 30,966 0.5 (0.3-0.7) 30,966 1.1 (0.9-1.3)
Region
Northern 7,424 0.9 (0.6-1.2) 7,424 1.0 (0.7-1.3) 7,424 0.6 (0.5-0.8) 7,424 1.7 (1.2-2.3)
Central 6,131 0.6 (0.2-1.4) 6,131 0.5 (0.1-1.4) 6,131 0.3 (0.0-1.1) 6,131 1.0 (0.6-1.4)
Greater Bay 7,873 0.4 (0.3-0.6) 7,873 0.4 (0.2-0.5) 7,873 0.5 (0.3-0.8) 7,873 1.0 (0.7-1.4)
Southern 9,538 0.8 (0.5-1.4) 9,538 0.5 (0.2-0.8) 9,538 0.5 (0.3-0.8) 9,538 1.0 (0.7-1.4)
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos. The Northern region of California includes the following counties:
Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Placer, Plumas,
Sacramento, Shasta, Sierra, Siskiyou, Sutter, Tehama, Tuolumne, Trinity, Yolo, and Yuba. The Central region includes the following
counties: Fresno, Inyo, Kern, Kings, Madera, Mariposa, Merced, Mono, Stanislaus, and Tulare. The Greater Bay Area includes Alameda,
Contra Costa, Marin, Monterey, Napa, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, and Solano, Sonoma.
The Southern region includes the following counties: Imperial, Los Angeles, Orange. CI = confidence interval.
VAIM7
Results ofthe 2023 California Youth Tobacco Survey
7.4 Summary
We compared tobacco prevalence estimates by rurality, region, and county or county group
for any tobacco use and the use of specific products. We found multiple differences. In
general, towns and rural settings tended to have higher tobacco use in comparison to cities
and suburban areas. Estimates varied by county. Estimates for specific products were
consistent across regions, with the exception of vaping, which was higher in the Northern
region of the state.
7-1
8= Marijuana Use
This chapter presents data on the prevalence ofever and current marijuana use across
demographic characteristics, the usual mode ofmarijuana use among respondents who
reported using more than one mode of administration, and marijuana and tobacco co -use.
Finally, this chapter presents data on secondhand exposure to marijuana smoke by
demographics and how respondents acquired marijuana. Measuring marijuana use in the
CYTS is important given high levels o[marijuana use among respondents who use tobacco
and the use of some tobacco products to consume marijuana (e.g., LCCs).
8.1 Marijuana Use
Table 8-1 presents the prevalence ofever and current marijuana use among high school
respondents by demographic characteristics. The rates of ever using marijuana (23.096) and
currently using rndr'udn8 (10.496) were higher than the rates of ever and currently using
tobacco (21.6% and 7.3%, respectively).
TabUe0-1. Prevalence mfMarijuana Use Among High School Respondents, by
Gender Identity, Race/Ethnicity, Grade, and LGBTQ+ Status
Ever Use Current Use
Characteristic
Overall
30,928
23.0
(21J-24.4)
30,920
10.4
(9.4-11.5)
Gender identity
Male
13,742
20.9
(19.1-23.7)
13,739
9.3
(8.3-10.5)
Female
13,513
242
(22.8-25J)
13,509
10.6
(93-12.1)
Identified inanother way
1,764
27.7
(23.7-32.0)
1,704
14.1
(113-173)
Declined toanswer
197
24.8
(10.5-34.6)
197
12.0
(6.4-21.4)
Race/ethnicity*
White
7,377
29.2
(27.1-31.4)
7,375
14.9
(13.3-10.5)
African American or Black
687
30.8
(25.8-36.3)
687
18.1
(13.2-23.8)
Hispanic
16,672
21.9
(20.5-23.3)
10,607
8.9
(7.8-10.0)
Asian
3,171
9.0
(7.2-11.1)
3,171
3.4
(2.4-4.5)
Other
785
17.3
(13.7-21.3)
785
9.2
(6.6-12.2)
Multiracial
2,166
29.2
(20.2-32.2)
2,165
13.9
(11.7-10.3)
Grade
10
16,229
17.7
(16.2-19.2)
16,226
7.2
(6.3-8.2)
12
14,099
28.9
(27.0-31.0)
14,094
14.0
(12.4-15.0)
U3DT0+statuo
LGBTQ+
5,141
34.6
(32.0-37.3)
5,140
18.0
(15.8-20.4)
Non-LGBTQ+
21,334
21.0
(19.7-22.4)
21,329
8.9
(7.9-10.0)
UndearLGBTV+ status
2,413
15.2
(12.7-17.9)
2,413
6.4
(5.0-8.0)
Note. LGDTQ+ = lesbian, gay, bisexual, transgemder,queer orquestioning; CI=confidence interval.
With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific
8-2
Results of the 2023 California Youth Tobacco Survey
We observed differences in marijuana use by demographics. Respondents who identified
their gender in another way (14.1%) and respondents who declined to answer gender
identity questions (12.6%) had a higher prevalence of current marijuana use than
respondents who identified as female (10.6%) or male (9.3%). African American or Black
respondents (18.1%) had the highest prevalence of current use of marijuana. Asian
respondents had the lowest rate of marijuana use (3.4%). The prevalence of current
marijuana use among 12th-grade respondents was almost twice that of 10th-grade
respondents (14.0% vs. 7.2%, respectively). Prevalence of current use among LGBTQ+
respondents was more than double (18.0%) that of non-LGBTQ+ respondents (8.9%) and
respondents of unclear LGBTQ+ status (6.4%).
The CYTS included questions designed to determine methods of using marijuana.
Respondents who reported ever using marijuana were asked how they had used it. Those
who endorsed ever using more than one type of marijuana product were asked, "During the
last 30 days, how did you usually use marijuana?" Table 8-2 presents the usual mode of
marijuana use among these respondents. Smoking (49.0%) was the most common mode of
use, followed by vaping (37.9%).
Table 8-2. Usual Mode of Marijuana Use Among High School Respondents Who
Reported Currently Using Multiple Marijuana Products
Usual Mode of Use
N = 3,444
Mode of Use % (950/0 CI)
Smoked
49.0
(45.4-52.6)
Ate
9.2
(7.7-10.9)
Drank
0.2
(0.1-0.5)
Dabbed
2.7
(1.7-3.9)
Vaped
37.9
(34.4-41.4)
Used in some other way
1.1
(0.5-2.0)
Note. CI = confidence interval.
8.2 Marijuana C
Table 8-3 further categorizes current marijuana use into current co -use of marijuana and
any tobacco product or current use of marijuana only. Overall, the prevalence for current
use of marijuana only (5.5%) was higher than current use of both marijuana and tobacco
(4.9%). When looking by gender identity, race/ethnicity and grade, this pattern generally
remained, but there were several exceptions. Respondents who identified their gender in
another way and those who declined to answer the gender question reported higher co -use
than use of marijuana only. The same was true for Asian respondents and those in the other
race category.
8-3
Results of the 2023 California Youth Tobacco Survey
Table 8-3. Prevalence of Current Marijuana -Only Use and Current Co -Use of
Marijuana and Any Tobacco Product Among High School Respondents,
by Gender Identity, Race/Ethnicity, and Grade
Co -Use of Marijuana
and Any Tobacco
Use of Marijuana Only Product
Characteristic N % (950/0 CI) % (950/0 CI)
Overall
Gender identity
Male
Female
Identified in another way
Declined to answer
Race/ethnicity*
White
African American or Black
Hispanic
Asian
Other
Multiracial
Grade
10
1W
LGBTQ+ status
LGBTQ+
Non-LGBTQ+
Unclear LGBTQ+ status
30,920 5.5 (4.9-6.3) 4.9 (4.3-5.5)
13,739
4.9
(4.3-5.7)
4.4
(3.7-5.1)
13,509
6.0
(5.0-7.2)
4.6
(3.9-5.4)
1,764
5.1
(3.5-7.2)
9.0
(6.6-11.9)
197
3.2t
(0.8-8.2)
9.4t
(4.0-17.9)
7,375
7.7
(6.7-8.8)
7.2
(6.1-8.3)
687
11.7
(7.4-17.3)
6.4
(4.1-9.4)
16,667
4.7
(4.1-5.5)
4.1
(3.5-4.9)
3,171
1.6
(1.0-2.4)
1.7
(1.1-2.6)
785
3.7
(2.0-6.0)
5.5
(3.1-8.9)
2,165
7.2
(5.6-9.2)
6.6
(5.0-8.6)
16,226
3.7
(3.0-4.6)
3.5
(2.9-4.1)
14,694
7.5
(6.7-8.4)
6.4
(5.5-7.5)
5,140 9.7
(7.9-11.9)
8.3 (6.7-10.1)
21,329 4.8
(4.1-5.4)
4.2 (3.6-4.8)
2,413 3.0
(2.1-4.2)
3.4 (2.4-4.6)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
Table 8-3 also compares co -use of marijuana and tobacco and marijuana -only use across
demographics. Among all gender identity categories, co -use was highest among
respondents who declined to answer the gender question (9.4%) or identified their gender
in another way (9.0%). In terms of race/ethnicity, co -use of marijuana and tobacco was
highest among White respondents (7.2%) compared to all other race/ethnicity categories.
Co -use was higher among 12th graders (6.4%) than among 10th graders (3.5%). Use of
8-4
Results ofthe 2023 California Youth Tobacco Survey
marijuana only was also higher for 12th graders /7.596\ than 10th graders /3.796\.
Marijuana -only use and co -use were both higher among LG8TQ+ respondents (9.796 and
8.396, respectively) than non-UGBTOf respondents (4.896and 4.296, respectively) or
respondents of unclear LGBTOf status (3.096 and 3.496, respectively).
Table 8-4 presents the prevalence of use ofvapea, cigarettes, and LCCa among respondents
who reported current marijuana use. Among respondents currently using marijuana, 39.1%
reported current|yvaping, 8.6% reported currently smoking cigarettes, and 5.296 reported
currently smoking LCCs.
Table 8-4. Prevalence of Current Co -Use mfMarijuana and Tobacco Among High
School Respondents Currently Using Marijuana, by Tobacco Product
Currently Used
Co -Use mfMarijuana and Tobacco
Tobacco Product N 9/b(95% CI)
Vapes 3,450 39.1 (35.4-43.0)
Cigarettes 3,450 8.6 (6.8-10.8)
UCCs 3,450 5.2 (4.1-6.6)
Note. LCCs = little cigars or cigarillos; CI = confidence interval.
8.3 Exposure to Secondhand Marijuana Smoke in Last 2 Weeks
The 2023 CYTS asked about high school respondents' exposure to secondhand marijuana
smoke in a car orroom in the last 2 weeks. The survey also asked about exposure to
marijuana arnohe outside, which includes being near someone who was smoking marijuana
outside of restaurant, outside of store, on a sidewalk, or at a park, playground, or beach
in the last 2 weeks.
Table 8-5 presents exposure to secondhand marijuana smoke by race/ethnicity. Overall,
21.396 of respondents reported being exposed to marijuana smoke in a car orroom, and
20.696 of respondents reported exposure outside in the last 2 weeks. Rates of exposure to
marijuana smoke in a car or room were highest among African American or Black
respondents (31.396) and lowest for Asian respondents (9.096). The rate of exposure to
secondhand marijuana smoke outside was highest among White respondents (34.896) and
lowest for Asian respondents (18.6%).
8-5
Results of the 2023 California Youth Tobacco Survey
Table 8-5. Prevalence of Last-2-Week Exposure to Marijuana Smoke in Car or
Room or Outside Among High School Respondents, by Race/Ethnicity
Exposure in Car or Room Exposure Outside
Characteristic
N
%
(95% CI)
N
% (95% CI)
Overall
30,880
21.3
(19.8-22.9)
30,606
31.1
(29.4-32.8)
Race/ethnicity*
White
7,371
29.2
(27.2-31.3)
7,300
34.8
(32.1-37.6)
African American or Black
687
31.3
(26.8-36.1)
678
30.5
(23.2-38.6)
Hispanic
16,639
18.8
(17.2-20.5)
16,491
31.7
(29.4-34.0)
Asian
3,171
9.0
(7.2-11.1)
3,155
18.6
(16.2-21.1)
Other
780
19.2
(14.9-24.1)
773
30.2
(23.1-38.1)
Multiracial
2,162
27.8
(24.9-30.9)
2,142
34.0
(30.4-37.9)
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific
Islander, and any race not captured by the survey.
Table 8-6 presents data on secondhand exposure to marijuana smoke in a car or room by
race/ethnicity and marijuana user status. Respondents who reported current users of
marijuana also reported greater exposure in a car or room (77.9%), relative to respondents
who reported former (38.0%) and never (11.0%) use. Patterns observed by user status
were consistent across race/ethnicity categories.
Table 8-6. Prevalence of Last-2-Week Exposure to Marijuana Smoke in Car or
Room Among High School Respondents, by Race/Ethnicity and
Marijuana Use Status
Never Use Former Use Current Use
Characteristic
N
% (95% Cl)
N
%
(95% Cl)
N
% (95% Cl)
Overall
23,133
11.0
(10.0-12.0)
4,303
38.0
(34.3-41.8)
3,444
77.9
(75.0-80.7)
Race/ethnicity*
White
4,975
15.3
(13.4-17.3)
1,140
41.5
(36.9-46.1)
1,256
84.0
(80.2-87.3)
African American
449
15.3
(10.6-21.1)
125
51.5
(36.7-66.1)
113
78.2
(70.6-84.6)
or Black
Hispanic
12,700
9.9
(8.7-11.1)
2,390
35.4
(30.4-40.7)
1,549
73.7
(68.8-78.3)
Asian
2,824
5.1
(3.7-6.8)
223
35.3
(27.1-44.1)
124
71.0
(56.2-83.2)
Other
624
10.3
(6.5-15.3)
83
38.1t
(21.7-56.8)
73
-
-
Multiracial
1,499
15.6
(12.9-18.5)
338
38.8
(30.0-48.1)
325
78.6
(70.0-85.8)
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific
Islander, and any race not captured by the survey.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample
size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one
or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the
estimate is >- 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30
and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than 130% of the
estimate.
8-6
Results of the 2023 California Youth Tobacco Survey
Table 8-7 presents data on secondhand exposure to marijuana smoke outside in the last 2
weeks by race/ethnicity and marijuana use status. Respondents who were currently using
marijuana reported higher exposure to marijuana smoke outside (64.8%) than those who
reported former (42.8%) or never (24.6%) use. Patterns observed by user status were
consistent across race/ethnicity categories.
Table 8-7.
Prevalence of Last-2-Week Exposure to Marijuana Smoke Outside
Among High School Respondents, by Race/Ethnicity and Marijuana
Use Status
Never Use
Former Use
Current Use
Characteristic N
% (95% Cl)
N
% (95% Cl)
N
% (95% Cl)
Overall
22,952
24.6 (22.9-26.4)
4,253
42.8 (39.3-46.3)
3,398
64.8 (60.2-69.3)
Race/ethnicity*
White
4,938
26.4 (24.0-29.0)
1,126
42.7 (36.5-49.1)
1,233
67.4 (63.1-71.5)
African American
442
25.8 (19.4-33.1)
123
40.5+ (25.9-56.4)
113
—
or Black
Hispanic
12,600
25.7 (23.3-28.2)
2,362
43.4 (38.1-48.8)
1,529
67.1 (62.5-71.5)
Asian
2,809
15.8 (13.6-18.1)
222
40.0 (30.4-50.3)
124
57.8 (45.6-69.2)
Other
616
23.6 (16.2-32.5)
82
45.3+ (29.6-61.7)
75
76.1 (60.3-88.0)
Multiracial
1,487
25.9 (21.7-30.5)
334
41.7 (32.8-51.0)
321
67.4 (58.7-75.2)
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey.
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample size less
than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
>_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate.
8.4 Acquisition of Marijuana
Table 8-8 presents how respondents who were currently using marijuana reported acquiring
marijuana. The most common method was buying it themselves (38.2%), followed by
someone giving it to them (27.0%). Of those who reported buying it themselves, the most
common method of buying it was from another person (44.9%) or from a store or
dispensary (38.3%).
8-7
Results of the 2023 California Youth Tobacco Survey
Table 8-8. Method of Acquiring Marijuana Among High School Respondents
Currently Using Marijuana
Overall
N = 3,417
Method
% (950/0 CI)
I ask someone to buy it for me
14.4
(12.4-16.5)
Someone gives it to me
27.0
(24.4-29.7)
I ask someone for it
7.4
(6.0-9.0)
I take it from someone
2.9
(1.8-4.5)
I grow my own
3.2
(2.1-4.8)
I get it some other way
6.8
(5.4-8.5)
I buy it myself*
38.2
(35.1-41.4)
From a store or dispensary
38.3
(32.5-44.5)
On the internet (including apps)
4.2
(2.2-7.1)
From a delivery service
5.6
(3.1-9.4)
From someone
44.9
(39.4-50.4)
Some other way
7.0
(4.7-10.0)
Note. CI = confidence interval.
* Numbers below this row represent the percentage of respondents endorsing each location among
those who reported buying their own marijuana.
8.5 Summary
Current use of marijuana was higher than current use of tobacco products. Current
marijuana use was highest among respondents who declined to answer gender questions or
identified their gender in another way. African American or Black respondents reported the
highest use among race/ethnicity categories, and 12th-grade respondents reported higher
use than respondents in 10th grade. LGBTQ+ respondents had the highest prevalence of
current use. The two most common modes of marijuana use were smoking and vaping.
The prevalence of current use of marijuana only was slightly higher than co -use of tobacco
and marijuana. Co -use was highest among White respondents, respondents who declined to
answer questions about gender identity, 12th graders, and LGBTQ+ respondents. Vaping
was the most common form of tobacco use among respondents co -using marijuana and
tobacco, followed by cigarettes and LCCs.
Exposure to marijuana smoke was higher outside than in a car or room and was highest for
respondents currently using marijuana. Exposure to secondhand marijuana smoke in a car
or room was highest among African American or Black respondents, and exposure outside
was highest among multiracial respondents. Among respondents currently using marijuana,
the most common method of obtaining marijuana among high school respondents was
buying it for themselves and, among those who purchased it, the most popular purchasing
source was from someone else.
8-8
w Changes in Tobacco Use Between 2022 and 2023
This chapter compares the prevalence of current tobacco use for high school students
between the 2022 and 2023 CYTS. When making comparisons, the reader should note that
COVID-19 resulted in fewer responding students than expected in 2022. As a result, the
confidence intervals for 2022 estimates tend to be wider than the confidence intervals for
2023 due to the differences in sample size. This hindered our ability to detect significant
changes between 2022 and 2023. There were no changes in question wording or other
aspects of the instrument that would affect the ability to compare responses to survey items
between 2022 and 2023.
w
1 Tobacco Product Use
Table 9-1 presents the prevalence of ever and current use for any tobacco use and all
tobacco products measured in both surveys. Current use of hookah increased, and ever and
current use of nicotine pouches increased.
Table 9-1. Prevalence of Ever and Current Tobacco Product Use by Year Among
High School Students
Ever Use Current Use
Tobacco Product
2022
N = 8,909
% (950/0 CI)
2023
N = 30,966
% (950/0 CI)
2022
N = 8,909
% (950/0 CI)
2023
N = 30,966
% (950/0 CI)
Any tobacco use
20.3 (18.4-22.2)
21.6 (20.3-22.9)
6.6 (5.4-8.1)
7.3 (6.5-8.1)
Vapes
17.6 (15.9-19.4)
18.3 (17.2-19.5)
5.6 (4.5-6.9)
5.9 (5.3-6.5)
Cigarettes
5.3 (4.3-6.6)
5.6 (4.9-6.5)
1.2 (0.7-2.0)
1.2 (0.9-1.5)
LCCs
2.1 (1.7-2.6)
2.3 (2.0-2.6)
0.6 (0.4-0.8)
0.6 (0.5-0.8)
Cigars
3.1 (2.4-3.9)
3.3 (2.9-3.7)
0.6 (0.4-0.8)
0.8 (0.7-1.0)
Hookah
2.2 (1.8-2.6)
2.5 (2.0-3.0)
0.4 (0.3-0.6)*
0.7 (0.5-1.0)*
Smokeless
1.3 (0.9-1.8)
1.5 (1.3-1.7)
0.3 (0.2-0.5)
0.5 (0.4-0.7)
HTPs
0.9 (0.6-1.2)
1.2 (1.0-1A)
0.3 (0.2-0.5)
0.5 (0.3-0.7)
Nicotine pouches
2.4 (1.9-2.9)*
3.1 (2.7-3.5)*
0.6 (0.4-0.9)*
1.1 (0.9-1.3)*
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos; CI = confidence interval.
* p < 0.05 for comparisons between 2022 and 2023.
w
2 Flavored Tobacco Product Use
Table 9-2 presents the prevalence of flavored tobacco use among high school respondents
who reported currently using each tobacco product. For cigarettes, flavored use refers to
using menthol cigarettes in the last 30 days. For all other products, flavored use refers
identifying a flavor other than tobacco or unflavored as the most commonly used flavor. The
survey asked questions about flavored tobacco use for all products except nicotine pouches.
9-1
Results of the 2023 California Youth Tobacco Survey
For products with sufficient sample sizes, the table presents analyses for both 2022 and
2023. There were no significant changes in flavored use of tobacco overall or for any
specific product between 2022 and 2023.
Table 9-2. Prevalence of Flavored Tobacco Product Use by Year Among High
School Students Who Were Currently Using Each Product
2022 2023
Tobacco Product N* % (95% Cl) N* % (95% Cl)
Any flavored 619 86.3 (82.3-89.7) 2,464 85.6 (82.6-88.2)
tobacco use*
Vapes 529 91.7 (88.9-93.9) 2,070 89.1 (85.8-91.9)
Cigarettes** 124 32.1 (19.2-47.3) 457 45.0 (36.4-53.9)
LCCs 55 55.2 (40.0-69.8) 232 50.1 (38.5-61.7)
Cigars 53 37.Ot (22.5-53.3) 294 49.9 (38.1-61.6)
Hookah 47 76.9t (59.4-89.5) 195 77.2 (60.8-89.2)
Note. LCCs = little cigars or cigarillos. Heated tobacco products, smokeless tobacco, and nicotine
pouches were excluded from this table due to the small proportion of respondents who endorsed
current use of these products in 2022 and/or 2023. CI = confidence interval.
* Includes use of vapes, cigarettes, LCCs, cigars, hookah, smokeless tobacco, and/or HTPs.
** Menthol was the only available flavor for cigarettes.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
9.3 Current Tobacco Use by Demographics
Table 9-3 shows changes in prevalence of current any tobacco use by year and gender
identity. There were no changes over time in any tobacco use.
Table 9-3. Prevalence of Current Any Tobacco Use by Year and by Gender
Identity Among High School Students
2022
2023
Gender identity N
% (95% Cl)
N
% (95% Cl)
Overall 8,909
6.6 (5.4-8.1)
30,966
7.3 (6.5-8.1)
Male 3,951
6.1 (4.8-7.6)
13,750
6.5 (5.7-7.5)
Female 3,841
5.9 (4.5-7.6)
13,537
7.0 (6.1-8.0)
Identified in another way 533
10.1 (6.7-14.4)
1,767
12.5 (9.8-15.5)
Declined to answer 55
9.4t (3.7-18.9)
198
15.6 (8.4-25.5)
Note. CI = confidence interval.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
9-2
Results of the 2023 California Youth Tobacco Survey
Table 9-4 shows the prevalence of current vaping, cigarette smoking, and LCC smoking by
year and gender identity. There were no significant changes over time in current vaping,
cigarette smoking, or LCC use.
Table 9-4. Prevalence of Current Vaping, Cigarette Smoking, and LCC Smoking
by Year and by Gender Identity Among High School Students
Gender
Identity
Male
Female
Identified in
Another
Way
Declined to
Answer
Vapes
2022 2023
5.2 (4.2-6.5) 5.1 (4.4-5.8)
5.1 (3.8-6.7) 6.0 (5.1-6.9)
7.3 (4.5-10.9) 8.6 (6.8-10.8)
Cigarettes LCCs
2022 2023 2022 2023
1.0 (0.5-1.7) 1.1 (0.8-1.5) 0.6 (0.3-0.9)
1.0 (0.5-2.0) 0.7 (0.5-1.1) 0.3 (0.1-0.6)
3.6 (2.0-5.9) 5.2 (3.6-7.2) 2.4 (1.2-4.3)
5.9t (1.8-13.6) 2.3+ (5.8-21.9) 3.8t (0.5-12.6) 1.5 (0.2-5.1)
0.5 (0.4-0.7)
0.3 (0.2-0.5)
3.9 (2.5-5.6)
0.7 (0.2-1.8)
Note. LCCs = little cigars or cigarillos. CI = confidence interval.
- The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective sample
size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one
or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the
estimate is >: 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30
and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than 130% of the
estimate.
Table 9-5 shows changes in current any tobacco use across all race/ethnicity groups
between 2022 and 2023. From 2022 to 2023, there were no significant changes in the
prevalence of current any tobacco use by race and ethnicity.
Table 9-5. Prevalence of Current Any Tobacco Use by Year and by Race/Ethnicity
Among High School Students
2022 2023
Race/Ethnicity*
N
% (95% CI)
N
% (95% CI)
Overall
8,909
6.6 (5.4-8.1)
30,966
7.3 (6.5-8.1)
White
1,935
10.2 (7.0-14.1)
7,386
10.7 (9.4-12.2)
African American/Black
396
5.8 (3.1-9.8)
688
7.9 (5.4-11.1)
Hispanic
5,014
5.6 (4.6-6.7)
16,691
6.3 (5.5-7.1)
Asian
705
3.5 (1.9-5.9)
3,172
3.3 (2.5-4.2)
Other
231
7.4 (4.0-12.2)
786
8.4 (5.2-12.8)
Multiracial
617
7.3 (4.6-10.8)
2,168
9.5 (7.7-11.7)
Note. CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific
Islander, and any race not captured by the survey. The table also shows the individual categories that
make up "other" race. American Indian or Alaska Native respondents are not shown due to a small sample
size.
9-3
Results of the 2023 California Youth Tobacco Survey
Table 9-6 displays changes over time in the prevalence of current vaping, cigarette smoking,
and LCC smoking by race and ethnicity. We did not find any significant increases by
race/ethnicity for these products, with one exception. There was a significant increase in
cigarette smoking among high school students who identified as being of some other race
not listed in the survey between 2022 and 2023.
Table 9-6. Prevalence of Current Vaping, Cigarette Smoking, and LCC Smoking
by Year and Race/Ethnicity Among High School Students
Vapes
Cigarettes
LCCs
Race/
Ethnicity
2022
2023
2022
2023
2022
2023
White
9.1
(6.4-12.5)
8.7
(7.6-9.9)
2.6
(1.2-5.0)
2.3
(1.6-3.1)
0.5
(0.2-1.0)
0.6
(0.3-0.9)
African
5.2
(3.0-8.5)
5.4
(2.9-9.0)
1.7
(0.5-4.3)
1.4
(0.2-4.5)
1.2
(0.3-3.3)
0.7
(0.1-1.9)
American/
Black
Hispanic
4.6
(3.7-5.6)
5.1
(4.4-5.9)
0.7
(0.5-1.1)
0.7
(0.5-0.9)
0.6
(0.3-0.9)
0.7
(0.5-0.9)
Asian
3.2
(1.7-5.5)
2.7
(2.1-3.4)
0.4
(0.1-1.3)
0.6
(0.3-1.2)
0.1
(0.0-0.6)
0.4
(0.1-0.9)
Other
5.7t
(2.7-10.4)
6.1
(3.1-10.5)
0.1
(0.0-0.7)*
1.8
(0.7-3.8)*
0.6
(0.1-2.5)
0.7
(0.1-1.9)
Multiracial
5.4
(3.5-8.0)
7.6
(5.9-9.6)
2.0
(0.9-3.8)
2.1
(1.3-3.3)
0.9
(0.3-2.3)
0.8
(0.3-1.7)
Note. LCCs = little cigars or cigarillos.
* p < 0.05 for comparisons between 2022 and 2023.
With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are included in
the other race category: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and any
race not captured by the survey. The table also shows the individual categories that make up "other" race.
American Indian or Alaska Native respondents are not shown due to a small sample size.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one or both
of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the estimate is
>_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30 and > 0.05 and the relative
width of the Korn-Graubard confidence interval is greater than 130% of the estimate.
Table 9-7 shows changes over time in any tobacco use and the use of specific tobacco
products by grade. For specific products, there was significant increase in hookah use
among 12th graders. For 1Oth graders, there was a significant increase in use of smokeless
tobacco. Current use of nicotine pouches increased over time among both 1Oth and 12th
graders.
9-4
Results of the 2023 California Youth Tobacco Survey
Table 9-7. Prevalence of Current Tobacco Use by Year and by Grade Among High
School Students
Grade 10
Grade 12
2022
2023
2022
2023
N = 5,002
N = 16,255
N = 3,907
N = 14,711
Tobacco Product % (95% CI)
% (95% CI)
% (95% CI)
% (95% CI)
Any tobacco use 5.1 (3.9-6.5)
5.3 (4.6-6.2)
8.3 (6.5-10.4)
9.4 (8.2-10.8)
Vapes 4.2 (3.2-5.4)
4.3 (3.7-5.0)
7.2 (5.6-9.1)
7.6 (6.6-8.6)
Cigarettes 0.9 (0.5-1.5)
0.8 (0.5-1.1)
1.6 (0.9-2.7)
1.6 (1.2-2.1)
LCCs 0.6 (0.3-1.0)
0.6 (0.4-0.8)
0.6 (0.3-0.9)
0.7 (0.5-0.9)
Cigars 0.5 (0.2-0.9)
0.7 (0.5-1.0)
0.7 (0.4-1.0)
1.0 (0.7-1.3)
Hookah 0.4 (0.2-0.6)
0.4 (0.3-0.6)
0.5 (0.2-0.8)*
1.0 (0.6-1.6)*
Smokeless 0.2 (0.1-0.4)*
0.6 (0.4-0.9)*
0.4 (0.2-0.7)
0.4 (0.2-0.6)
HTPs 0.3 (0.1-0.7)
0.5 (0.3-0.7)
0.2 (0.1-0.5)
0.5 (0.3-0.9)
Nicotine pouches 0.5 (0.3-0.7)*
0.9 (0.7-1.2)*
0.7 (0.4-1.1)*
1.2 (0.9-1.5)*
Note: HTPs = heated tobacco products; LCCs
= little cigars or cigarillos; CI = confidence interval.
*p < 0.05 for comparisons between 2022 and
2023.
Table 9-8 shows changes over time in any
tobacco use by LGBTQ+ status. There was no
significant increase in any tobacco use by LGBTQ+ status over time.
Table 9-8. Prevalence of Current Any Tobacco Use by Year and by LGBTQ+
Status Among High School Students
2022
2023
LGBTQ+ Status* N
% (95% CI)
N
% (95% CI)
Overall 8,909
6.6 (5.4-8.1)
30,966
7.3 (6.5-8.1)
LGBTQ+ 1,513
10.8 (7.9-14.2)
5,146
11.4 (9.5-13.6)
Non-LGBTQ+ 6,084
5.2 (4.1-6.4)
21,360
6.4 (5.6-7.2)
Unclear LGBTQ+ Status 688
6.3 (4.0-9.5)
2,414
5.3 (4.0-6.8)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* Respondents who reported (a) their gender identity as transgender or "something else" and/or (b)
identified their sexual orientation as gay or lesbian, bisexual, "something else," or "don't know what
this question means" were considered LGBTQ+. Respondents who identified as female or male and
straight (that is, not gay or lesbian) were considered non-LGBTQ+. Respondents who responded (a)
unsure for gender identity and straight for sexual orientation or (b) male, female, or unsure for
gender identity and unsure or "don't know" for sexual orientation were considered to have unclear
LGBTQ+ status.
Table 9-9 shows changes over time in vaping, cigarettes smoking, and LCC smoking by
LGBTQ+ status. There were no significant changes over time.
Results of the 2023 California Youth Tobacco Survey
Table 9-9. Prevalence of Current Vaping, Cigarette Smoking, and LCC Smoking
by Year and LGBTQ+ Status Among High School Students
LGBTQ+ Vapes Cigarettes LCCs
Status 2022 2023 2022 2023 2022 2023
LGBTQ+ 8.2 (5.8-11.2) 9.1 (7.7-10.7) 3.0 (1.7-4.9) 2.5 (1.8-3.3) 1.1 (0.6-1.8) 1.6 (1.1-2.2)
Non- 4.6 (3.7-5.8) 5.1 (4.5-5.9) 0.6 (0.3-1.1) 0.9 (0.6-1.2) 0.3 (0.2-0.5) 0.4 (0.3-0.5)
LGBTQ+
Unclear 4.8 (2.9-7.5) 4.0 (2.8-5.4) 2.2 (0.9-4.2) 1.1 (0.6-1.8) 1.4 (0.4-3.6) 0.4 (0.2-0.8)
LGBTQ+
Status
Note. LCCs = little cigars or cigarillos.
Table 9-10 shows changes over time in any tobacco use by general mental health status.
There was no significant change in any tobacco use by mental health status over time.
Table 9-10. Prevalence of Current Any Tobacco Use by Year and by General
Mental Health Among High School Students
2022 2023
General mental health N % (95% CI) N % (95% CI)
Overall 8,909 6.6 (5.4-8.1) 30,966 7.3 (6.5-8.1)
Good to excellent 5,429 5.0 (4.0-6.3) 19,149 5.9 (5.1-6.7)
Fair 2,014 6.8 (5.0-9.1) 7,155 7.2 (6.0-8.7)
Poor 1,019 12.6 (9.9-15.8) 3,107 14.8 (12.3-17.6)
Note. CI = confidence interval.
Table 9-11 shows changes over time in current any tobacco use by rurality. We did not find
any significant changes for any tobacco use by rurality over time.
Table 9-11. Prevalence of Current Any Tobacco Use By Year and Rurality Among
High School Students
2022 2023
Rurality N % (95% CI) N % (95% CI)
Overall 8,909 6.6 (5.4-8.1) 30,966 7.3 (6.5-8.1)
City 4,178 6.6 (5.0-8.6) 11,637 6.9 (5.9-8.0)
Suburban 3,852 6.1 (4.3-8.4) 12,853 6.8 (5.6-8.3)
Town or rural 1,887 9.1t (2.8-20.6) 6,476 9.6 (7.5-12.0)
Note. CI = confidence interval. Cities are defined as large territories located inside urbanized areas and
principal cities. Suburbs are territories outside of principal cities but inside urbanized areas. Towns or rural
areas are territories inside an urban cluster or rural territories. See Appendix A for additional information.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets one
or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval for the
estimate is >: 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is < 0.30
and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than 130% of the
estimate.
9-6
Results of the 2023 California Youth Tobacco Survey
9.4 Marijuana i
Table 9-12 presents marijuana use and marijuana/tobacco co -use estimates over time.
There were no significant changes in ever marijuana use, current marijuana use, current
marijuana -only use (current use of marijuana but not reporting current use of any tobacco
product), or current co -use of marijuana and tobacco (reporting current use of marijuana
and one or more tobacco products).
Table 9-12. Prevalence of Ever and Current Marijuana Use and Marijuana Co -Use
by Year Among High School Students
2022 2023
Marijuana Use Category N % (950/0 CI) N % (950/0 CI)
Marijuana use
Ever marijuana use
8,904
21.4 (19.0-23.9)
30,928
23.0 (21.7-24.4)
Current marijuana use
8,904
8.8 (7.2-10.5)
30,920
10.4 (9.4-11.5)
Marijuana/ tobacco co -use
Use of marijuana only
8,905
4.5 (3.8-5.4)
30,920
5.5 (4.9-6.3)
Co -use of marijuana and any tobacco
8,905
4.2 (3.3-5.4)
30,920
4.9 (4.3-5.5)
Note. CI = confidence interval.
9.5 Summary
We found a few changes in specific types of tobacco product use in certain groups. We
found an increase in current cigarette smoking over time among students who identified as
non -Hispanic other race. We found an increase in current hookah use among 12th graders,
current smokeless tobacco use among loth graders, and current nicotine pouch use for
students in both grades. However, due to the effects of COVID-19 on the 2022 CYTS data
collection and changes in methodology between 2022 and 2023, we recommend
interpreting these differences with caution. Findings for flavored tobacco use over time
should be interpreted with particular caution, given that the 2023 CYTS asked about "most
commonly used" flavor, as opposed to all flavors used in the past 30 days, for all products
except cigarettes. For interpretations of comparisons of flavored tobacco use between 2022
and 2023 within the context of SB 793, please see the Conclusions section of the report.
�m
10. Sth-Grade Tobacco Use
The following chapter summarizes key tobacco use data for 8th-grade respondents. Due to
differences in the prevalence of use of tobacco products and the sampling approach
between middle and high schools (8th-grade respondents were undersampled), data for
8th-grade respondents are presented separately.
10.1 Tobacco Use among Sth-Grade Respondents
Table 10-1 presents the prevalence of ever and current use of tobacco among 8th-grade
respondents. The prevalence of current tobacco use was lower for 8th-grade respondents
(3.2%) than high school respondents (7.3%). As with high school respondents, among 8th-
grade respondents, current vaping was the most common form of current tobacco use (2.5%
of 8th-grade respondents), followed by nicotine pouches (0.6%) and cigarettes and cigars
(both 0.4%).
Table 10-1. Prevalence of Tobacco Use Among 8th-Grade Respondents
Tobacco Product
N
Ever Use
% (95% CI)
N
Current Use
% (95% CI)
Any tobacco use
10,789
11.4
(9.9-13.1)
10,789
3.2
(2.5-3.9)
Vapes
10,778
9.3
(7.9-10.8)
10,777
2.5
(1.9-3.3)
Cigarettes
10,785
2.4
(1.9-3.0)
10,784
0.4
(0.3-0.5)
LCCs
10,785
1.0
(0.8-1.3)
10,784
0.3
(0.2-0.4)
Cigars
10,785
1.3
(0.9-1.8)
10,785
0.4
(0.2-0.5)
Hookah
10,789
1.3
(0.7-2.1)
10,789
0.3
(0.2-0.5)
Smokeless
10,789
1.0
(0.8-1.3)
10,789
0.3
(0.2-0.5)
HTPs
10,789
0.9
(0.6-1.4)
10,789
0.2
(0.1-0.4)
Nicotine pouches
10,789
1.8
(1.4-2.5)
10,789
0.6
(0.4-0.8)
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos. CI = confidence interval.
Table 10-2 presents current tobacco use prevalence among 8th-grade respondents by
demographics. Current tobacco use was highest among 8th-grade respondents who
identified their gender in another way (6.8%). Among race/ethnicity categories, multiracial
respondents reported the highest current use (5.9%), and Asian respondents reported the
lowest (0.7%). LGBTQ+ respondents reported the highest current use (6.9%), followed by
respondents of unclear LGBTQ+ status (2.5%) and non-LGBTQ+ respondents (2.4%).
Respondents who rated their mental health status as poor reported higher current use
(9.7%) than those who rated their mental health fair (3.4%) or good to excellent (2.0%).
10-1
Results of the 2023 California Youth Tobacco Survey
Table 10-2. Prevalence of Current Use of Any Tobacco Among 8th-Grade
Respondents, by Gender Identity, Race/Ethnicity, LGBTQ+ Status,
and Mental Health Status
Current Use
Characteristic
N
% (950/0 CI)
Overall
10,789
3.2
(2.5-3.9)
Gender identity
Male
4,854
2.1
(1.6-2.9)
Female
4,357
3.6
(2.7-4.7)
Identified in another way
722
6.8
(3.5-11.8)
Declined to answer
109
4.3t
(1.0-11.5)
Race/ethnicity*
White
2,355
3.2
(1.8-5.1)
African American or Black
267
1.3
(0.4-3.1)
Hispanic
5,683
3.5
(2.7-4.6)
Asian
1,142
0.7
(0.2-1.7)
Other
420
2.3
(0.7-5.5)
Multiracial
870
5.9
(3.5-9.2)
LGBTQ+ status
LGBTQ+
1,548
6.9
(4.6-10.0)
Non-LGBTQ+
7,251
2.4
(1.8-3.1)
Unclear LGBTQ+ status
1,069
2.5
(1.3-4.3)
Mental health status
Good to excellent
6,966
2.0
(1.4-2.6)
Fair
2,027
3.4
(2.4-4.7)
Poor
1,100
9.7
(7.0-13.0)
Note. LGBTQ+ = lesbian, gay, bisexual, transgender, queer or questioning; CI = confidence interval.
* With the exception of Hispanic, all ethnicities are classified as non -Hispanic. The following groups are
included in the other race category: American Indian or Alaska Native, Native Hawaiian or other
Pacific Islander, and any race not captured by the survey. The table also shows the individual
categories that make up "other" race.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
10.2 Flavored C
Table 10-3 presents the prevalence of flavored tobacco use among current vapers.
Consistent with the findings for high school respondents (Chapter 2), the use of flavored
vapes (91.9%) was prevalent among 8th-grade respondents who currently vaped.
Results of the 2023 California Youth Tobacco Survey
Table 10-3. Prevalence of Flavored Tobacco Use Among 8th-Grade Respondents
Currently Using Each Tobacco Product
Tobacco Product
N
Flavored Product Use
% (95% CI)
Any of the below*
430
89.4
(83.4-93.7)
Vapes
375
91.9
(88.2-94.8)
Cigarettes**
65
68.5t
(51.5-82.5)
LCCs
44
68.4
(56.0-79.1)
Cigars
44
54.6
(41.1-67.6)
Hookah
42
83.0
(68.2-92.8)
Smokeless
33
51.8
(42.0-61.6)
HTPs
36
—
—
Note. HTPs = heated tobacco products; LCCs = little cigars or cigarillos; CI = confidence interval.
* As the sample size for the subgroup for each product varies, estimates for each product may be
greater than that of "any of the below."
** Menthol was the only available flavor for cigarettes.
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >- 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
Vapor10.3 Exposure to Secondhand and Tobaccoin Last 2
Weeks Among 8th-Grade Respondents
Table 10-4 reports 8th-grade respondents' exposure to secondhand vapor and tobacco
smoke in a car or room, outside, and in MUH. Among 8th-grade respondents, 20.3% had
been exposed to vapor in a car or room, and 31.8% had been exposed to vapor outside in
the last 2 weeks. Exposure to tobacco smoke in a car or room was lower (15.2%) than
exposure to vaping in a car or room, but exposure to tobacco smoke outside was higher
(54.3%) than outside exposure to vapor. Of the 35.3% of 8th-grade respondents who lived
in MUH, 49.2% reported smoke intruding into their unit rarely or more often in the last 6
months.
10-3
Results of the 2023 California Youth Tobacco Survey
Table 10-4. Prevalence of Last-2-Week Exposure to Vapor and Tobacco Smoke in
Car or Room, Outside, or Multiunit Housing Among Sth-Grade
Respondents Living in Multiunit Housing
Vapor Exposure Tobacco Smoke Exposure
Location of Exposure N % (950/0 Cl) N % (950/0 Cl)
In a car or room 10,765 20.3 (18.2-22.6) 10,771 15.2 (13.0-17.7)
Outside 10,634 31.8 (28.9-34.8) 10,634 54.3 (50.1-58.4)
In multiunit housing* N/A N/A N/A 3,038 49.2 (45.3-53.1)
Note. CI = confidence interval. This question was not asked for vapor exposure, so those cells are
marked not applicable or N/A.
* Only asked of respondents who reported living in a home attached to one or more other homes or a
building with two or more apartments. Exposure is defined as reporting smoke intrusion rarely,
sometimes, often, or most of the time in the last 6 months.
Eighth -grade respondents had lower rates of exposure to vapor in a car or room (20.3%)
and outside (31.8%) compared with high school respondents (29.0% and 36.5%,
respectively; see Chapter 4). Eighth -grade respondents' exposure to secondhand tobacco
smoke in a car or room (15.2%), outside (54.3%), or in MUH (49.2%) was similar to that of
high school respondents (14.1%, 51.1%, and 48.8%, respectively; see Chapter 4).
10.4 Access to Vapes and Cigarettes Among 8th-Grade Respondents
Table 10-5 shows methods of obtaining vapes (or pods or e-liquid) among 8th-grade
respondents reporting current vaping. The most commonly reported sources were buying
their own (26.2%) and being given a vape by someone else (22.2%). Of those who bought
their own, the most common purchasing source was from another person (45.1%).
Table 10-6 presents how 8th-grade respondents who were currently using cigarettes
reported obtaining them. Small sample sizes for some categories limit interpretation, but of
the methods available, the most commonly reported sources were someone giving them to
the respondent (38.6%), followed by the respondents buying their own (26.3%). Methods
of the respondent "buying them myself" were excluded from the table due to estimates
being suppressed, imprecise, or respondents not endorsing the response option.
Table 10-5. Method of Accessing Vapes (or Pods or e-Liquid) Among 8th-Grade
Respondents Who Were Currently Vaping
Overall
N = 366
Method % (950/0 Cl)
I ask someone to buy them for me 15.1 (11.2-19.8)
Someone gives them to me 22.2 (18A-26.7)
(continued)
om
Results of the 2023 California Youth Tobacco Survey
Table 10-5. Method of Accessing Vapes (or Pods or e-Liquid) Among 8th-Grade
Respondents Who Were Currently Vaping (continued)
Method
Overall
N = 366
% (950/0 CI)
I ask someone for them
15.5
(11.8-19.9)
I take them from someone
6.6
(3.2-11.7)
I get them some other way
14.4
(10.3-19.3)
I buy them myself*
26.2
(20.2-32.9)
From a gas station or convenience store
10.9t
(4.9-20.2)
From a grocery store
0.3
(0.0-1.8)
From a drugstore or pharmacy
4.5+
(0.7-14.2)
From a liquor store
0.3
(0.2-0.4)
From a tobacco or smoke shop
9.9t
(3.1-22.4)
From a vape shop
0.2
(0.0-0.9)
From a mall or shopping center kiosk/ stand
0.0
N/A
On the internet (including apps)
18.8
(11.5-28.0)
From someone
45.1t
(30.2-60.8)
Some other way
10.0t
(3.6-21.2)
Note. CI = confidence interval. N/A is used because a value of 0 does not have a confidence interval.
The value of 0 indicates that no participant endorsed that response option.
* Numbers below this row represent the percentage of respondents endorsing each location among
those who reported buying their own vapes.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >: 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
Table 10-6. Methods of Accessing Cigarettes Among 8th-Grade Respondents Who
Were Currently Smoking Cigarettes
Overall
N=64
Method % (950/0 CI)
I ask someone to buy them for me 3.4t (0.4-12.0)
Someone gives them to me 38.6 (28.1-50.0)
I ask someone for them 6.4t (2.8-12.2)
I take them from someone 13.3 (9.0-18.8)
(continued)
Ump
Results of the 2023 California Youth Tobacco Survey
Table 10-6. Methods of Accessing Cigarettes Among 8th-Grade Respondents Who
Were Currently Smoking Cigarettes (continued)
Overall
N=64
Method % (950/0 CI)
I get them some other way
I buy them myself
Note. CI = confidence interval.
26.3 (18.8-35.0)
— The estimate has been suppressed due to small sample sizes, specifically, a nominal or effective
sample size less than 30. For definitions of nominal and effective sample size, see Appendix A.
t The estimate should be interpreted with caution given concerns about precision. The estimate meets
one or both of the following criteria: (a) the absolute width of the Korn-Graubard confidence interval
for the estimate is >_ 0.30 OR (b) the absolute width of the Korn-Graubard confidence interval is
< 0.30 and > 0.05 and the relative width of the Korn-Graubard confidence interval is greater than
130% of the estimate.
10.5 Marijuana
Table 10-7 presents the prevalence of ever and current marijuana use among 8th-grade
respondents. The rates of ever using marijuana (8.5%) and currently using marijuana
(3.1%) were lower than rates reported by high school respondents (23.0% and 10.4%,
respectively; see Chapter 8).
Table 10-7. Prevalence of Marijuana Use Among 8th-Grade Respondents
Overall
Marijuana Use N % (95% CI)
Ever use 10,781 8.5 (7.1-10.1)
Current use 10,778 3.1 (2.2-4.1)
Note. CI = confidence interval.
Marijuana10.6 Exposure to Secondhand in Last 2 Weeks
Table 10-8 reports 8th-grade respondents' exposure to secondhand marijuana smoke in a
car or room and outside in the last 2 weeks. Respondents were considered exposed outside
if they reported having been near someone who was smoking marijuana outside of a
restaurant, outside of a store, on a sidewalk, or at a park, playground, or beach in the last 2
weeks.
Results of the 2023 California Youth Tobacco Survey
Table 10-8. Prevalence of Last-2-Week Exposure to Marijuana Smoke in Car or
Room or Outside Among 8th-Grade Respondents
Overall
Exposure N % (95% CI)
Exposure in car or room 10,764 11.0 (10.0-12.1)
Exposure outside 10,628 24.0 (20.7-27.6)
Note. CI = confidence interval.
Overall, 11.0% of 8th-grade respondents reported being exposed to marijuana smoke in a
car or room within the last 2 weeks. Fewer 8th-grade respondents reported exposure in a
car or room than high school respondents (21.3%; see Chapter 8). Less than a quarter of
8th-grade respondents (24.0%) reported being exposed outside; this figure was lower than
that reported for high school respondents (31.1%; see Chapter 8).
10.7 Summary
The prevalence of current tobacco use was lower for 8th-grade respondents than high
school respondents. Vaping was the most common form of use. Current tobacco use was
highest among 8th-grade respondents who identified their gender in another way and were
multiracial. Flavored tobacco use was high among respondents currently using tobacco
products, similarly to high school respondents. Among 8th-grade respondents, exposure to
secondhand vapor and smoke in a car or room and outside was lower than that of high
school respondents, but exposure to secondhand tobacco smoke was similar in a car or
room, outside, and in MUH. Respondents who vaped most frequently reported purchasing
their own vapes as their most common method of obtaining them. Eighth -grade
respondents who smoked cigarettes most commonly obtained them by being given them by
someone else. The prevalence of marijuana use among 8th-grade respondents was lower
than that of high school respondents, as was exposure to secondhand marijuana smoke.
10-7
11. Conclusion
overall, tobacco use among high school respondents remains low, with 7.3% reporting
having used any tobacco product in the last 30 days. Vapes continue to be the most
commonly used tobacco product, with 5.9% of high school respondents reporting using
them in the last 30 days.
Differences in tobacco use were observed when looking at gender identity, LGBTQ+ status,
race/ethnicity, general mental health, and experiences of discrimination. Polytobacco use
was highest among LGBTQ+ respondents and those who identified their gender in another
way. Two-thirds of high school respondents experienced one or more types of discrimination
in the last month, and experiences of discrimination were more commonly reported by
respondents who were currently using tobacco than those who weren't.
Quit attempts and intention to quit also varied by demographics. A higher proportion of
respondents with fair or good to excellent mental health status had attempted to quit in the
past year, and they also had higher intention to quit vaping in the next 30 days, compared
to those with poor mental health.
Flavored tobacco use remains high, with most respondents who were currently using
tobacco reporting flavored product use across gender identity, race/ethnicity, and grade.
The popularity of flavor types varied by product. Fruit was the most popular flavor for vapes
and almost half of cigarette smokers used menthol cigarettes.
The minimum legal age to purchase tobacco products, including vapes, in California is 21
years old, but many youth who reported current vaping also reported buying their own
vapes. Respondents reported buying vapes from other people, tobacco or smoke shops,
vape shops, and gas stations or convenience stores. Cigarette smokers also purchased their
cigarettes from gas station or convenience stores, tobacco or smoke shops, and from other
people. Of vapes, cigarettes, and flavored tobacco products, respondents perceived that it
was easiest to obtain vapes. Perceived access varied by location, with respondents reporting
that it was more difficult to obtain vapes, cigarettes, and flavored tobacco products from
stores than from the internet or another person. For vapes and cigarettes, perceived access
varied by respondents' vaping and smoking status.
Most high school respondents lived in homes with a complete ban on tobacco smoking and
vaping. About half of respondents who lived in MUH reported exposure to tobacco smoke in
their home in the last 6 months. Exposure to tobacco smoke and vapor was highest among
current smokers and vapers. When it came to exposure on social media, most respondents
did not have a favorite vaping ad and over half did not pay attention to these posts.
Exposure varied by smoking status.
Results of the 2023 California Youth Tobacco Survey
Susceptibility to future tobacco use varied by demographics and poor mental health was
associated with greater susceptibility. Susceptibility also appeared to be correlated with
peer tobacco use. The most commonly reported reason for vaping was to relax or relieve
stress and anxiety.
Overall, most high school respondents believed that adults would disapprove of them vaping
or smoking, and about half believed peers would disapprove. This varied by vaping and
smoking status, with a larger proportion of respondents who had never vaped or smoked
endorsing this belief. Over two-thirds of respondents supported tobacco endgame policies,
although this also varied by vaping and smoking status. Support was highest among
respondents who had never vaped or smoked.
Towns and rural settings tended to have higher tobacco use compared to cities and
suburban areas. Tobacco use outcomes varied widely across counties and county groups for
any tobacco use and the use of specific products. Estimates for specific products were
consistent across regions, with the exception of vaping, which was higher in the Northern
region of the state.
Current use of marijuana was more common that current use of tobacco, and use varied by
demographic categories. The usual mode of using marijuana was smoking, followed by
vaping. Among respondents currently using tobacco, the most commonly used tobacco
product was the vape. Respondents currently using marijuana most commonly obtained the
product by buying it themselves.
Results from 2023 were compared to 2022, and only a few significant differences were
found for specific tobacco products among members of specific racial/ethnic groups (non -
Hispanic other race) and for specific grades. These differences should be interpreted with
caution, given the impact of COVID-19 on the 2022 CYTS and changes in the methodology
of the CYTS between 2022 and 2023.
Finally, 8th-grade respondents were summarized separately. The prevalence of current
tobacco and marijuana use was lower for 8th-grade respondents than high school
respondents. Like high school students, vaping was the most common form of tobacco use,
and flavored product use was high among middle school students. Eighth -grade
respondents most commonly obtained vapes by purchasing them.
11.1 Implications
The results of the 2023 CYTS are in line with results from 2022. Rates of youth tobacco use
in California are generally low, but youth continue to vape. Marijuana use remains more
common than tobacco use. Exposure to secondhand smoke, vapor, and marijuana continues
to occur. This year, we examined differences in use, exposure, and beliefs across vaping
and smoking status, and found that differences exist.
11-2
Results of the 2023 California Youth Tobacco Survey
We did not find differences in tobacco use when comparing 2022 and 2023 data. Continued
monitoring of trends over time is recommended.
Effective December 21, 2022, California SB 793 prohibits retailers from selling flavored
tobacco products, including mint and menthol flavors, in the state of California." This flavor
ban may affect use of these products in the future, but it did not appear to do so in 2023:
flavored tobacco use remains high (89.1% of vapers). One explanation for this finding is
that, with the exception of cigarettes, for each tobacco product, the survey asked about the
most commonly used flavor. We used that most commonly used flavor to categorize tobacco
use as flavored or unflavored. However, many of the participants who reported they most
often used unflavored tobacco likely also used flavored tobacco products in the past 30 days,
resulting in potential miscategorization. However, it was important to keep the wording of
this question over time to allow comparison across multiple years. Another possible
explanation is that the effects of tobacco control and other public health policies on behavior
may take up to 2 years to observe.12,13,14 Since SB 793 went into effect in December 2022,
and the 2023 CYTS data collection began in January 2023, future years of CYTS data
collection should continue to examine changes in flavored tobacco use over time to fully
capture any effects of this policy change. Also of note, the policy contains some exemptions
for hookah and shisha, pipe tobacco, and premium cigars, and does not include concept
flavors (e.g., "jazz")
About one-third of vapers and one -quarter of cigarette smokers reported buying their own
product, and gas stations/convenience stores, tobacco or smoke shops, and vape shops
were endorsed points of sale. Similarly, stores or dispensaries were endorsed as points of
sale for marijuana. Additional monitoring of underage sales and enforcement of ID checks
may be warranted.
Although tobacco use is relatively low, youth remain susceptible to future use and perceived
ease of access is high. Use, exposure, and susceptibility varied by demographics, mental
health status, and vaping/smoking status. Tobacco prevention and cessation programs may
benefit from being tailored to disproportionally affected populations.
This report found sufficient variation in county -level prevalence of tobacco use to warrant
further investigation. Of particular importance is determining the reasons why some
11 California Tobacco Control Branch. (2023, March 27). Frequently asked questions: California's
statewide flavored tobacco sales law. California Department of Public Health.
httos://www.cdph.ca.aov/Programs/CCDPHRLDC lCICTCBICDPH°/o20Document%20Librar /y Polic 1�Fla
voredTobaceoAndenthol/S 793 FA 2 0 final2.pdf
12 Dutra, L.M., Glantz, S.A., Arrazola, R.A., King, B.A. (2017). Impact of e-cigarette minimum legal
sale age laws on current cigarette smoking. Journal of Adolescent Health 62(5), 532-538.
13 Song, A.V., Dutra, L.M., Neilands, T.B., Glantz, S.A. (2015). Association of smoke -free laws with
lower percentages of new and current smokers among adolescents and young adults: An 11-year
longitudinal study. JAMA Pediatrics, 169(9), e152285.
14 Dutra, L. M., Farrelly, M., Gourdet, C., & Bradfield, B. (2022). Cannabis legalization and driving
under the influence of cannabis in a national US Sample. Preventive Medicine Reports, 27, 101799,
11-3
Results of the 2023 California Youth Tobacco Survey
counties have significantly lower ever and current tobacco use outcomes in comparison to
the state overall. Towns and rural areas continue to need tobacco control efforts, given
higher tobacco use prevalence estimates for these areas of the state.
11-4
Appendix A:
List of Terms
Marijuana
Any tobacco use: Use of one or more of the following products: vapes, cigarettes, little
cigars or cigarillos, cigars, hookah, smokeless tobacco, heated tobacco products, or nicotine
pouches.
Cigarettes: Definition from survey: "Cigarettes are sold in packs and cartons. Popular
brands include Marlboro, Newport, Pall Mall, Camel, and Winston."
Cigars: Definition from survey: "Big cigars, also called traditional, regular, or premium
cigars, are tobacco wrapped in a tobacco leaf. Popular brands are Macanudo, Romeo Y
]ulieta, Arturo Fuente, Cohiba, Davidoff, and Ashton, but there are many others."
Heated tobacco products (HTPs): For example, IQOS; also called heat -not -burn
products.
Hookah: Also called waterpipe or shisha.
Little cigars or cigarillos (LCCs): Definition from survey: "Little cigars, cigarillos, and
filtered cigars are wrapped in tobacco leaf or brown paper containing tobacco. They are
smaller than big cigars and may be flavored. Popular brands include Swisher Sweets,
Backwoods, Dutch Masters, Captain Black, Prime Time, White Owl, Black & Mild, Phillies
Blunts, Zig Zag, and Cheyenne."
Marijuana: Definition from survey: "Marijuana (including joints, blunts, vapes, and edibles)
is commonly known as cannabis, weed, pot, hash, grass, THC, or CBD. It can be smoked
(joint, blunt, bong), vaped in a wax pen, eaten (baked goods, candies), drank (tea, cola,
alcohol), or dabbed." The term marijuana (instead of cannabis) is used throughout this
report, as youth were asked specifically about their marijuana use in the survey instrument.
Nicotine pouches: Products like Zyn, On, or Velo.
Smokeless tobacco: Chewing tobacco, snuff, snus, dip, or dissolvable tobacco.
Tobacco smoker: This term was used to examine exposure to smoked tobacco (cigarettes
or LCCs) by tobacco smoker (cigarettes or LCCs) status. For this variable, respondents who
reported current use of cigarettes or LCCs were classified as current tobacco smokers.
Respondents who reported ever use of either of these products but using neither product in
the last 30 days were considered former tobacco smokers. Respondents who reported never
use of both cigarettes and LCCs were considered never tobacco smokers.
A-1
Appendix A — List of Terms
Vapes: Definition from survey: "These products are sometimes called by their brand names
(e.g., Puff Bar, Bang Bar, JUUL) or by terms such as e-cigarettes, vape pens, personal
vaporizers and mods, e-cigars, e-pipes, e-hookahs, and hookah pens."
Product Use Definitions
Current use: Use of a product within the last 30 days.
Ever use: Response of "yes" to a question about ever using a product.
Flavored tobacco use: Use of tobacco products that tasted like menthol or mint; cooling,
ice, or frosty; clove or spice; fruit; an alcoholic drink (such as wine, cognac, margarita, or
other cocktails), a nonalcoholic drink (such as coffee, soda, energy drinks, or other
beverages); candy, chocolate, desserts or other sweets. See separate definition for
cigarettes.
Former tobacco use: Use of a tobacco product, but not within the last 30 days.
Intention to quit vaping: Plan to quit using vapes in the next 30 days.
Menthol cigarette use: Response of "yes" to the following survey item: "Menthol
cigarettes are cigarettes that taste like mint. Common brands include Newport, Salem, and
Kool. Were any of the cigarettes you smoked in the last 30 days flavored, such as menthol?"
Never tobacco use: Response of "no" to ever using any tobacco products.
Polytobacco use: Use of two or more tobacco products within the last 30 days.
Quit attempt for vaping: One or more attempts to completely stop using vapes in the last
12 months.
Tobacco -marijuana co -use: Use of marijuana and at least one tobacco product within the
last 30 days.
Created Variables and Other Definitions
Race/Ethnicity
Hispanic: Response of eyes" to the question "Are you of Hispanic or Latino/Latina origin,"
regardless of race(s) reported.
Non -Hispanic single race (African American or Black, Asian, White): Response of `ono"
to the Hispanic ethnicity question and report of African American or Black, Asian, or White
when asked "How do you describe yourself?"
Non -Hispanic multiracial: Response of "no" to the Hispanic ethnicity question and report
of two or more races.
Non -Hispanic other race: Response of "no" to the Hispanic ethnicity question and report
of one of the following: some other race (i.e., a race not listed), American Indian or Alaska
A-2
Appendix A — List of Terms
Native (AI/AN), or Native Hawaiian or other Pacific Islander (NHOPI). AI/AN and NHOPI
respondents were included in this category due to small sample sizes for these two groups.
When possible, values were displayed for these groups individually (separate from
respondents who endorsed other race).
Gender Identity
Gender: Options for gender identity in the survey were "male," "female," "transgender,"
"something else," and "I'm not sure yet." Responses were recoded so that "transgender,"
"something else," and "I'm not sure yet" were collapsed into a single category called
"identified in another way." A fourth category, "declined to answer," was created for
respondents who skipped this question. Respondents who did not reach this question were
assigned a value of missing for this variable.
Sexual orientation: Options for sexual orientation in the survey were "gay or lesbian";
"straight, that is, not gay or lesbian"; "bisexual"; "something else"; "I'm not sure yet"; or
"don't know what this question means."
LGBTQ+ status: This variable was defined by combining responses to survey items about
gender identity and sexual orientation (see response options above). Respondents who did
not provide enough information to be included in any of the below categories were assigned
a value of missing for LGBTQ+ status.
LGBTQ+: Respondents who reported their gender identity as transgender or "something
else" and/or selected one of the following responses for their sexual orientation:
• Gay or lesbian
• Bisexual
• "Something else"
• "Don't know what this question means"
Non-LGBTQ+: Respondents who reported"
• their gender identity as male or female; and
• their sexual orientation as "straight, that is, not gay or lesbian."
Unclear LGBTQ+ status: Respondents who did not provide enough information about their
gender identity and/or sexual orientation to classify their LGBTQ+ status. This included those
who selected
• "I'm not sure yet" for gender identity and reported their sexual orientation as
"straight, that is, not gay or lesbian;" or
• male, female, or "I'm not sure yet" for gender identity and responded "I'm not sure
yet" or "don't know what this question means" for sexual orientation.
Rurality
We used the National Center for Education Statistics (NCES) definition of rurality to code all
respondents based on the rurality of their school's location. NCES divides school locations
A-3
Appendix A — List of Terms
into 12 categories.15 We collapsed these 12 categories into three categories: city, suburb,
and town or rural area.
City: Respondent's school is in an area classified by NCES as a small, midsize, or large city.
City is defined as a territory inside an urbanized area and inside a principal city, and size is
determined by population.
Suburb: Respondent's school is in an area classified by LACES as a small, midsize, or large
suburb. Suburb is a territory outside of a principal city and inside an urbanized area, and
size is determined by population.
Town or rural area: Respondent's school is in a fringe, distant, or remote town or rural
area. Town is defined as a territory inside of an urban cluster, and the type of town is based
on distance from an urbanized territory. Rural area is defined as a census -defined rural
territory, and the type of rural area is based on distances from urbanized areas and urban
clusters.
Other
Adult disapproval of smoking: Respondent's indication that adults important to them
would feel negatively (negative and very negative as opposed to positive or very positive)
about the respondent smoking.
Adult disapproval of vaping: Respondent's indication that adults important to them would
feel negatively (negative and very negative as opposed to positive or very positive) about
the respondent vaping.
Peer disapproval of smoking: Respondent's indication that other respondents at their
school would view smoking cigarettes negatively (negative and very negative as opposed to
positive or very positive).
Peer disapproval of vaping: Respondent's indication that other respondents at their
school would view vaping negatively (negative and very negative as opposed to positive or
very positive).
Complete home ban on vaping: Response of "vaping is not allowed anywhere or at any
time inside my home" when asked about rules about vaping inside the home.
Complete home ban on tobacco smoking: Response of "smoking cigarettes or other
tobacco products is not allowed anywhere or at any time inside my home" when asked
about rules about smoking cigarettes or other tobacco products inside the home.
Discrimination: This variable measures experiences of discrimination in the last month.
Response options were "almost every day," "at least once a week," "a few times," or
15 National Center for Education Statistics. (n.d.). Education demographic and geographic estimates.
Retrieved March 1, 2023, from htt s:lnces.ed. gy ro rarr�s ed� eo raphicLLocalQBoundaries
A-4
Appendix A — List of Terms
"not at all." The individual items were modified for youth from the Everyday Discrimination
Scale.16 The original scale does not specify a period for experiences, but we added one
based on confusion about the original wording of the item during cognitive testing. Although
these items are traditionally analyzed as a scale, to characterize experiences of youth in the
sample in depth, we included responses to individual items in this report. Respondents who
endorsed any listed experience of discrimination, consistent with the original scale, were
asked to attribute their experiences to one or more factors. Respondents were coded as
attributing the discrimination to a specific characteristic if they endorsed that characteristic,
regardless of whether they also endorsed other characteristics.
Secondhand smoke: Smoke released from smoking a cigarettes, little cigar, or cigarillo.
Exposure to secondhand tobacco smoke in a car or room: Being in a car or room
when someone was smoking a cigarette, little cigar, or cigarillo in the last 2 weeks.
Exposure to secondhand tobacco smoke outside: Being near someone who was
smoking a cigarette, little cigar, or cigarillo outside of a restaurant; outside of a store; at a
park, playground, or beach; or on a sidewalk in the last 2 weeks.
Exposure to secondhand tobacco smoke in multiunit housing: Among respondents
who indicated living in multiunit housing, answering "rarely," "sometimes," "often," or "most
of the time" (as opposed to "never") to the question "In the past 6 months, how often has
tobacco smoke from somewhere else in and around the building you live in come into your
unit?"
Secondhand vapor: Aerosol released from using an e-cigarette or other vaping device.
Exposure to secondhand vapor in a car or room: Being in a car or room when someone
was using a vape in the last 2 weeks.
Exposure to secondhand vapor outside: Being near someone who was using a vape
outside of a restaurant, outside of a store, on a sidewalk, or at a park, playground, or beach
in the last 2 weeks.
General mental health: Assessed by asking, "In general, how would you rate your mental
health?" Response options were coded as good to excellent ("good," "very good," or
Ixexcellent") versus fair or poor.
Living in multiunit housing: Response of "a one -family house attached to one or more
houses," "a building with two apartments," or "a building with three or more apartments" to
the question, "Which of the following options best describes where you live most of the
time?" Other response options were "a mobile home," "a one -family house detached from
any other house," a "boat, RV, van, etc.," or "I do not have permanent housing."
16 Williams, D. R, Yu, Y., Jackson, a. S., & Anderson, N. B. (1997). Racial differences in physical and
mental health: Socioeconomic status, stress, and discrimination. Journal of Health Psychology, 2(3),
335-351.
A-5
Appendix A — List of Terms
Perceived ease of access: Respondents were coded as perceiving easy access to
cigarettes, vapes, marijuana, and alcohol if they responded `somewhat easy" or "very easy"
(as opposed to `somewhat difficult" or "very difficult") when asked, "If you wanted to get
the following products from a store, how easy or difficult would it be?" This coding scheme
was also applied to responses to the same questions that were asked about access from the
internet or someone else.
Susceptible to future tobacco use (three -item measure): Response of "definitely yes,"
"probably yes," or "probably not" to all three of these questions: "If one of your best friends
offered you [a tobacco product never used by the respondent], would you use it?"; "Do you
think you will try [a tobacco product never used by the respondent] soon?"; and "Do you
think you will use [a tobacco product never used by the respondent] in the next year?"
Not susceptible to future tobacco use (three -item measure): Response of `definitely
not' to all three of these questions "If one of your best friends offered you [a tobacco
product never used by the respondent], would you use it?"; "Do you think you will try [a
tobacco product never used by the respondent] soon?"; and "Do you think you will use [a
tobacco product never used by the respondent] in the next year?"
Definitions for Analytic Terms
Korn-Graubard confidence interval: Unlike Wald confidence intervals, Korn-Graubard
confidence intervals do not assume that the confidence interval is linear; this assumption
tends to be violated for very small and very large prevalence estimates. As a result, Korn-
Graubard confidence intervals are more accurate than Wald ("linear") confidence intervals
for small and large estimates. Korn-Graubard confidence intervals are commonly used for
small prevalence estimates produced by survey data.17,18
Nominal sample size: The number of observations in the sample.
Effective sample size: Effective sample size is calculated as P x (1 P) where p is the
prevalence estimate and se is the standard error of the prevalence estimate.
17 Brown, L., Cai, T., & DasGupta, A. (2001). Interval estimation for a binomial proportion. Statistical
Science, 16(2), 101 - 133.
18 Korn, E. L. & Graubard, B. I. (1998). Confidence intervals for proportions with small expected
number of positive counts estimated from survey data. Survey Methodology, 24(2), 193-201.
A-6
Appendix I
Survey Methodology of 2023 California
Survey Administration
The California Youth Tobacco Survey (CYTS), formerly the California Student Tobacco
Survey (CSTS), was conducted every 2 years between 2001 and 2020, excluding 2013 and
2014. RTI International is conducting the CYTS annually between 2022 and 2024. After the
2024 data collection, the survey will return to a biennial schedule. The methodology used to
obtain the CSTS and CYTS are very similar, with one exception. In 2022, RTI opted to add
private school students to the CYTS population in order to increase representation of all 8th-,
10th-, and 12th-grade students in the state of California in the CYTS. As a result, the CYTS
samples both private and public school students.
The 2023 CTYS was designed to produce state- and county group -level estimates for
tobacco use. The 2022 and 2024 CYTS were designed to produce state -level estimates for
various tobacco use outcomes. In 2023, there were 35 counties and county groups; 30
individual counties had a sufficient student and school population that they did not need to
be combined with other counties. The remaining 28 counties were smaller and were
combined to form the remaining five county groups.
This appendix provides a brief overview of survey methodology for the 2023 CYTS.
Additional detail on survey methods can be found in the Technical Report on Analytic
Methods and Approaches Used in the California Youth Tobacco Survey 2023 by
Russell et al.19
StrategySampling
RTI implemented a probability -based study design to produce a set of respondents who
were representative of California's racially, ethnically, culturally, and geographically diverse
student population. The sample was a stratified two -stage design. The primary sampling
units were schools; the secondary sampling units were classrooms. All students in selected
classrooms were invited to participate. The sampling methodology is based on procedures
developed by the Centers for Disease Control and Prevention (CDC) for the Youth Risk
Behavior Survey and state Youth Tobacco Surveys. Some text in this document, starting
with the section "Description of Sampling Methodology," was adapted from the Youth
Tobacco Survey Methodology Report prepared for the CDC Office on Smoking and Health.20
11 See Russell et al., 2023.
20 Office on Smoking and Health. (2018). State Youth Tobacco Survey methodology report. U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health.
B-1
Appendix B—
Survey Methodology of2O23 California Youth Tobacco Survey
Thirty-five county groups were formed. Counties with fewer than 15high schools and
middle schools were grouped with other smaller counties. Thirty of the 35 county groups are
individual counties.
The sample was designed to yield an analytical clataset that could be used to make county
group -level population estimates with adequate precision for high school (10th and 12±h
grade), and state -level population estimates, with adequate precision, for the following
groups: high school (10th and 12th grade) and middle school (8th grade) students, each
grade individually, and Asian American, Black, Hispanic, and White students.
The 2O2]CYTS sample was designed tocollect data from 375 schools and 42,676students,
and to have minimum Of1Oschools ineach county group. The sample goals were based
Onassumed school response rate, student response rate, and school eligibility rate. We
collected data from 356schools and 41,755students. Nineteen ufthe 35 county groups had
10 or more responding schools. Thirty of the 35 county groups had eight or more
responding schools. The sampling methodology used for the 202]CYTS and the 2022CYTS
is similar, with the exception of the county -level sampling components, which were not
present inthe 2O22design.
Participation
To promote participation in CYTS, schools were given a $500 gift card for administering the
survey. Teachers primarily acted as proctors for the survey. In some cases, other school
staff proctored. Proctors were provided with directions for administering the survey. RTI
staff were available to answer questions from proctors.
The 2023 CYTS was administered online during the school day. The online survey included
programmed skip logic to reduce respondent burden and took median of 18.8 minutes to
complete. Afew questions in the survey were mandatory; these asked about respondents'
willingness to participate in the survey and grade level. The remaining survey questions
were not mandatory, although a message appeared ifthe question was unanswered. The
respondent could move forward and skip the question after encountering the message.
Respondent participation was voluntary and anonymous. Consent procedures were
consistent with school district guidelines. With approval of the institutional review board, we
used passive consent for all schools. Parent consent forms were distributed to respondents
(to take home) 1 week before the survey. Forms were available in Spanish and additional
languages, as needed. Respondents were also asked to give their assent to participate in
the survey.
Survey Sample of 2023 CYTS
Table B-1 provides information about the number ofschools and respondents who
participated in the 2023 survey for middle and high school respondents. Of the 563 public
Appendix B —
Survey Methodology of 2023 California Youth Tobacco Survey
and private schools sampled, 542 were eligible to participate. These eligible schools were
composed of 506 public schools and 36 private schools. A total of 359 private and public
schools participated. The small number of private schools affected our ability to make
county -level analyses, so we dropped them from the dataset. The remaining 356 public
schools had one or more responding students. Dividing this number by the 506 eligible
public schools resulted in a 70.4% school response rate. Of the 508 schools, 96 included 8th
grade but not 10th or 12th grade (i.e., middle schools), 246 contained grades 10 and 12 but
not grade 8 (i.e., high schools), and 14 contained all three grades (i.e., combined middle
and high schools).
Table B-1. Numbers of Schools and Respondents, Middle School vs. High School,
Participating in 2023 CYTS*
High School Only Middle and High
Middle School (10th and 12th School (8th, 10th,
Number Only (8th Grade) Grades) and 12th Grades) Total
Number of schools 96 246 14 356
Number of 10,789 30,966 N/A 41,755
respondents
* Only includes public school respondents in the analytic sample (who consented to participate in the
survey and had valid responses).
The 2023 CYTS sample included 49,805 students. Because some schools opted to perform a
census, 49,818 students started the survey. Of these students, 2,406 declined to consent.
Of the remaining 47,412 cases, 4,728 students were dropped because they completed less
than 50% of the items in the survey that could not be skipped (i.e., items not subject to
skip patterns), and 750 were dropped because they provided low -quality responses (three
or more of the following: reported that they had not been honest in their responses,
reported that they often provided funny and fake responses in surveys, missed one or both
attention checks, and selected "prefer not to answer" for 25% of their responses). After
excluding these participants, 41,934 valid responses remained. After dropping 179 private
school students, 41,755 surveys remained; the student response rate was therefore 83.8%.
The overall response rate was 59.0% (70.4%*83.8%). Of the 41,755 surveys, 10,789 were
obtained from 8th-grade students, 16,255 were obtained from 10th-grade students, and
14,711 were obtained from 12th-grade students. Less than 2% (1.5%) of participants in the
analytic sample opted to complete the survey in Spanish rather than English.
RTI designed the 2023 survey to provide consistent wording with the 2022 CYTS, much of
which was consistent with the prior rounds of the CSTS. Such consistency allows for
comparable prevalence estimates of tobacco use among youth in California over time. The
final survey, which was created in English and translated by professional translators into
B-3
Appendix B —
Survey Methodology of 2023 California Youth Tobacco Survey
Spanish, included the following categories of items: consent and basic demographics,
vaping, cigarettes, cigars and little cigars or cigarillos, other tobacco products, marijuana,
alcohol, tobacco cessation, the behaviors of influential others, influences at school, personal
opinions, exposure to social media, mental health (including experiences of discrimination),
and more sensitive demographic questions. Accounting for the skip logic built into the
survey, the 2023 survey consisted of a maximum of 182 items and a minimum of 77 items.
Surveys were available in English and Spanish.
When updating the survey for 2023 data collection, RTI made slight modifications to guide
survey flow and improve user experience. These changes included prompts to ensure only
students in the intended grades completed the survey and guidance for questions about
both Hispanic origin and race. Such changes were in response to, respectively, feedback
from survey proctors and open text responses received for questions on race in the 2022
survey. Exit -screen language was also slightly adjusted. RTI also updated vaping brands
listed based on trends in use and updated some product descriptions to ensure consistency
between CTPP data collection efforts such as the Teens, Nicotine, and Tobacco survey (e.g.,
adding "tightly rolled" to the description of cigars).
At CTPP's request, RTI added items to collect details on Native Hawaiian or other Pacific
Islander origin, five additional locations where respondents encountered secondhand smoke
and vapor (asked for each of tobacco products, vapes, and marijuana products), and
tobacco cessation method used during the most recent quit attempt. To capture more detail
on vaping dependence, RTI added the four -item PROMIS-E dependence scale.21 In addition
to a measure asking product users about the vape brand they use most often, RTI added a
measure to collect all vape brand names that respondents note as currently popular,
regardless of vaping user status. The survey also now includes an additional question about
perceived peer usage of tobacco products.
In light of the passage of California Senate Bill 793 (SB 793), the CYTS 2023 wanted to
track change in flavored product access by California youth. Thus, RTI added flavored
tobacco products to existing items about the perceived ease of access to specific products
from, respectively, a store, the internet, or someone else. To minimize participant burden
and match CTPP's priorities, these items replaced questions about alcohol access that had
been included in the 2022 CYTS.
Four questions were removed between the 2022 and 2023 administrations of the CYTS. RTI
removed an item about how often respondents attended school in the last 30 days. This
item added to track asynchronous learning due to COVID-19 but is no longer needed. A
two -series question on asthma status was also removed to reduce participant burden. Due
21 Morean, M., Krishnan -Sarin, S., & O'Malley, S. S. (2018). Comparing cigarette and e-cigarette
dependence and predicting frequency of smoking and e-cigarette use in dual -users of cigarettes and
e-cigarettes. Addictive Behaviors, 87, 92-96. !Lttp51LLdoLorqL1Q,.1015/ ,q beh.2018.060027 LA
B-4
Appendix B—
Survey Methodology of2O23 California Youth Tobacco Survey
to changes in California policies about reduced and free lunch (all students were offered free
lunch regardless of income in 2023\, RTI also removed the question on receipt ofa free or
reduced cost school lunch as a measure of socioeconomic status.
The data are weighted. The statistician created the weights based on nonresponse
probability (namely, differences between those who responded and those who did not) and
the degree to which the sample reflects the demographic makeup of California. These
weights enabled us to adjust analyses for nonresponseand to create accurate state and
county estimates. The weighting procedure is described in the Technical Report for the
California Youth Tobacco Survey2U23. This report includes weighted prevalence estimates
with 95% confidence intervals.
The technical report also contains information on the criteria that we used to determine
whether we labeled specific estimates as imprecise or suppressed them entirely. Estimates
were labeled aaimprecise ifthey met one orboth ofthe following criteria: (a)the absolute
width of the Korn-Graubard confidence interval for the estimate is �: 0.30 OR /bl the
absolute width of the Korn-Graubard confidence interval is < O.]O and > 0.05 and the
relative width of the Korn-Graubard confidence interval isgreater than 13U96ofthe
estimate. Some estimates were suppressed due tosmall sample sizes, specifically, a
nominal or effective sample size less than 30. For definitions ofKorn-Gnauband confidence
intervals and nominal and effective sample size, see Appendix A.
When comparing 2023 and 2022 CYTS data, it is important to note that the COVID-19
pandernionegatively affected 2022student-|eve| response rates, which affected the ability
to make some estimates with sufficient precision in 2022. In 2O23,the survey methodology
was updated toenable the production ofcounty-level estimates.
To measure the ability of the 2023 CYTS to sample the racial/ethnic makeup of the state of
California, we compared the racial/ethnic makeup of the CYTS sample to the corresponding
race/ethnidtydata provided by the California Department ofEducation (COE).
Race/ethnicity categories ufCYTS are similar to those used by CDE.
In CYTS, the racial/ethnic background Ofrespondents was determined using two primary
questions. The first asked about Hispanic or Latino/Latina origin (i.e., ethnicity) and the
second asked respondents to indicate how they describe themselves (i.e., race) by marking
all that apply: African American or B|8Ch, Arn8hCdn Indian or Alaska Native, Asian, Native
HawaiianorotherPacificIs|ander,VVhihe,orOther.The"other"cabegoryindudedatextbox
for entering a free -text response. We imputed race using respondents' free -text responses,
based on the U.S. Census's definition of which groups fall into each racial category.
Appendix B —
Survey Methodology of 2023 California Youth Tobacco Survey
We matched categories used by CDE, with one exception—CDE did not include the category
non -Hispanic other race. Because we dropped private schools from the analytic sample, we
did not include them in Table B-2. Table B-2 lists the categories provided by CDE and the
corresponding categories for the 2023 CYTS, when available (with the exception of non -
Hispanic other race).
Table B-2. Percentage of Race/Ethnicity Categories in CYTS and CDE Enrollment
Data for Public School Students Included in the 2023 CYTS Samples
Control of
School Race/Ethnicity Category
CDE Totals
N (%)
CYTS Respondents
N (%)
Public African American not Hispanic
69,695
5.1
956
2.3
American Indian or Alaska Native
6,448
0.5
240
0.6
Asian*
131,441
9.6
3,578
8.6
Filipino
36,087
2.6
738
1.8
Hispanic or Latino
750,125
55.0
22,374
53.6
Pacific Islander**
6,203
0.5
156
0.4
White not Hispanic
303,718
22.3
9,760
23.4
Two or more races not Hispanic
50,684
3.7
3,046
7.3
Not reported or other race,*** not
8,682
0.6
907
2.2
Hispanic
Total
1,363,084
100.0
41,755
100.0
Note. CDE = California Department of Education; CYTS = California Youth Tobacco Survey. CDE
enrollment data were restricted to schools that were considered eligible to participate in CYTS.
Race/ethnicity data are unweighted and should not be compared with weighted estimates
throughout this report.
* Does not include respondents who identified as Filipino.
** Includes Pacific Islanders for CDE and Native Hawaiians or other Pacific Islanders for CYTS.
*** "Not reported or other race" is terminology from CDE. For the CYTS data in the table, this
category only includes respondents who reported non -Hispanic other race (i.e., race not captured by
the survey). For purposes of this table, these groups are considered equivalent, even though CYTS
respondents who did not report their race or ethnicity are excluded from the table.
The estimates included are unweighted. The percentage of each race/ethnicity was similar
between CYTS and CDE enrollment data for all categories. In terms of differences, fewer
non -Hispanic African American students (2.3%) participated in the CYTS than are
represented in CDE enrollment statistics (5.1%). Compared to CDE enrollment figures, the
CYTS contains a larger percentage of students who identified as not Hispanic and reported
being a race not listed in the survey or identifying with two or more races.
The method of classifying race/ethnicity that was used in the 2023 CYTS has limitations. To
provide a greater understanding of the impact of CYTS's classification of race/ethnicity,
B-6
Appendix B —
Survey Methodology of 2023 California Youth Tobacco Survey
Table B-3 compares how individuals were labeled using CYTS's race/ethnicity definition and
how they responded to individual questions about Hispanic ethnicity and race in the survey.
Table B-3. Percentage of Labeled and Endorsed Race/Ethnicity
Race/Ethnicity Category Labeled Race/Ethnicity Category Endorsed
N= N=
41,628 (%) 41,755 (%)
White 22.3 (19.1-25.7) White 43.2 (40.1-46.3)
African American 5.1 (4.0-6.4) African American or 9.6 (8.2-11.1)
or Black Black
Hispanic 55.0 (50.4-59.5) Hispanic 54.9 (50.3-59.4)
Asian 9.7 (7.7-11.9) Asian 14.8 (12.5-17.3)
Other* 2.5 (1.8-3.4) Other 33.3 (30.9-35.6)
Multiracial 5.4 (4.9-6.0) American Indian or 6.3 (5.3-7.4)
Alaska Native
Native Hawaiian or 2.6 (2.3-2.8)
other Pacific Islander
Note. The percentage in endorsed does not add up to 100% because respondents could select more
than one response. Race/ethnicity data are unweighted and should not be compared with weighted
estimates throughout this report.
* Participants who reported being non -Hispanic and only one of the following races were combined
into a category labeled "other" due to small sample sizes: American Indian or Native American (n =
35, 0.3%), Native Hawaiian or other Pacific Islander (n = 50, 0.4%), and a race not listed in the
survey (n = 329, 2.1%).
Notably, CYTS assigns each respondent to one combined racial/ethnic category, while
respondents can endorse Hispanic ethnicity or not and can endorse more than one response
option for the question about race. For example, a large portion of respondents who
endorsed White or a race not listed in the survey also reported being Hispanic. Due to small
sample sizes, except for in Table 1-4b, respondents who reported being American Indian or
Alaska Native or Native Hawaiian or other Pacific Islander were combined with respondents
who endorsed a race that was not listed in the survey.
One benefit of the categorization used by CYTS is that the racial/ethnic category of all
individuals who endorse being Hispanic is Hispanic. This approach is helpful because many
of the individuals who identified as Hispanic selected 'other" race and entered a free -text
response indicating that they are Hispanic, as evidenced by 2.5% of respondents being
categorized as non -Hispanic other race in the analysis but 33.3% of respondents selecting
"other" for their race in the survey.
$379,000 $13,068.96 $3,184.87
$140,020 $4,828.27 $1,176.63
4 F-_-w I,", u