Use of E-Cigarettes Rising Among Middle and High School Students

E-cigarettes remain the most commonly used tobacco products among middle and high school students in the US for the second year in a row, according to a report from the US Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration’s (FDA’s) Center for Tobacco Products.

Using the answers to questionnaires from the National Youth Tobacco Surveys, the report found that 16% of high school students and 5.3% of middle school students used e-cigarettes in 2015. That’s 3 million middle and high school students who used e-cigarettes in 2015, up from 2.46 million in 2014. Students were counted as e-cigarette users if they had used one on at least one day in the past 30 days. The report was published April 15, 2016 in Morbidity and Mortality Weekly Report.

E-cigarettes and related products can look like regular cigarettes, pens, or other common devices. They are operated by battery. An atomizer heats a solution of liquid, flavorings, and nicotine that creates a mist that is inhaled. Experts say exposure to nicotine is especially dangerous for young people because it can cause addiction, might harm brain development, and could lead to continued use of tobacco.

“E-cigarettes are now the most commonly used tobacco product among youth, and use continues to climb,” said CDC Director Tom Frieden, MD, MPH. “No form of youth tobacco use is safe. Nicotine is an addictive drug and use during adolescence may cause lasting harm to brain development.”

No decline in cigarette smoking

From 2014 to 2015, there was no significant change in the prevalence of cigarette smoking among middle and high school students. In 2015, 9.3% of high school students and 2.3% of middle school students reported smoking cigarettes, making cigarettes the second most used tobacco product among their age group.

According to the report, if current smoking rates continue, 5.6 million Americans currently younger than age 18 are predicted to die prematurely from a smoking-related disease. Approximately 80% of adult smokers first tried smoking by the age of 18; so keeping young people away from tobacco is critical.

Other forms of tobacco

In addition to e-cigarettes and cigarettes, high school students reported they used other tobacco products:

  • 8.6% smoked cigars
  • 7.2% used hookahs (water pipes for smoking tobacco)
  • 6% used smokeless tobacco
  • 1% smoked pipe tobacco
  • 0.6% smoked bidis (a type of small, imported cigarette)

After e-cigarettes and cigarettes, middle school students reported using these products:

  • 2% used hookahs
  • 1.8% used smokeless tobacco
  • 1.6% smoked cigars
  • 0.4% smoked pipe tobacco
  • 0.2% smoked bidis

Regulation needed

Overall, the use of any tobacco product by middle and high school students has not changed since 2011. The report shows that 4.7 million of these students used tobacco products in 2015, and more than 2.3 million of them used 2 or more types of tobacco products. The FDA has regulatory authority over cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco, but has not yet finalized its rules to regulate e-cigarettes, hookahs and some cigars.

“The FDA remains deeply concerned about the overall high rate at which children and adolescents use tobacco products, including novel products such as e-cigarettes and hookah,” said Mitch Zeller, JD, director of the FDA’s Center for Tobacco Products. “Finalizing the rule to bring additional products under the agency’s tobacco authority is one of our highest priorities, and we look forward to a day in the near future when such products are properly regulated and responsibly marketed.”

The American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society, has joined dozens of leading public health and medical organizations in calling for an end to the delays over finalizing FDA oversight of all tobacco products. The groups have urged the US House Appropriations Committee to reject proposals that would limit the FDA’s authority in this matter. And they have urged President Obama to promptly issue a final rule allowing for FDA oversight of all tobacco products, including e-cigarettes and cigars.

ACS CAN released a statement saying the data on youth smoking "underscores the crucial need for the FDA to regulate all tobacco products. The disappointing figures show that the rate of tobacco use among middle and high school students remains stalled, that large numbers of youth tobacco users regularly use multiple tobacco products, and that use of e-cigarettes is rapidly rising."

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Tobacco Use Among Middle and High School Students—United States, 2011-2015. Published April 15, 2016 in Morbidity and Mortality Weekly Report. First author Tushar Singh, MD, PhD, Centers for Disease Control and Prevention, Atlanta, GA.

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