Prevalence and Correlates of Tobacco and Nicotine Use Among Medicaid-Enrolled Youth Aged 12-20, 2021-2023

Tobacco and nicotine use remain important public health issues among youth in the United States, particularly those experiencing poverty or behavioral health disorders. Though Medicaid covers a large share of youth, there is little recent research identifying prevalence and correlates of tobacco and nicotine use within this population. Using 2021–2023 National Survey on Drug Use and Health (NSDUH) data, this study analyzes prevalence, use frequency, and correlates of use among Medicaid-enrolled youth aged 12–20. We found that 13% reported past-month use, with nicotine vaping (10.9%) more common than smoking (3.6%). Daily use was more prevalent among Medicaid-enrolled youth (5.4%) compared to privately insured youth (3.7%). Medicaid-enrolled and uninsured youth reported lower exposure to prevention messaging and lower perceived health risks than their privately insured peers. Use was higher among Medicaid-enrolled youth identifying as LGBTQ+, disabled, or in poor health. Among Medicaid-enrolled youth, those who used tobacco or nicotine were far more likely to have a mental health condition or other substance use disorder. Findings highlight the need for Medicaid and its stakeholders to tailor prevention and intervention strategies to correlates of use, including maximizing integration of tobacco/nicotine cessation with other behavioral health services and developing anti-tobacco/vaping messaging that reaches and impacts Medicaid-enrolled youth.