E-Cigarette Use Triples Among Middle and High School Students

E-cigarette use among middle and high school students tripled from 2013 to 2014, 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. Use of more traditional tobacco products such as cigarettes and cigars has declined over the past few years. But overall – tobacco use rates have remained about the same: 24.6% among high school students and 7.7% among middle school students.

Using the answers to questionnaires from the National Youth Tobacco Study, the report found that the percentage of high school students who used e-cigarettes rose from 4.5% in 2013 to 13.4% in 2014, increasing from about 660,000 to about 2 million students. Among middle school students, the percentage who used e-cigarettes rose from 1.1% in 2013 to 3.9% in 2014, increasing from about 120,000 to about 450,000 students. Students were counted as e-cigarette users if they had used one on at least one day in the past 30 days.

The study was published April 16, 2015 in Morbidity and Mortality Weekly Report.

E-cigarettes look like regular cigarettes, but they are operated by battery. An atomizer heats a solution of liquid, flavorings, and nicotine that creates a mist that is inhaled. Experts warn that nicotine in any form is even more dangerous for children and teenagers than it is for adults.

“We want parents to know that nicotine is dangerous for kids at any age, whether it’s an e-cigarette, hookah, cigarette, or cigar,” said CDC Director Tom Frieden, MD, MPH, in a statement. “Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use.”

The 2012 Surgeon General’s Report found that almost 90% of adult smokers first tried cigarettes as teens; and that about 3 of every 4 teen smokers continue into adulthood.

Hookahs, cigarettes, and other tobacco products

Hookah use almost doubled for middle and high school students from 2013 to 2014. A hookah is a bowl-shaped device with a pipe for inhaling tobacco smoke. Among high school students, hookah use rose from 5.2% in 2013 (about 770,000 students) to 9.4% in 2014 (about 1.3 million students). Among middle school students, hookah use rose from 1.1% in 2013 (120,000 students) to 2.5% in 2014 (280,000 students).

Cigarette use declined among high school students and remained basically unchanged for middle school students from 2011 to 2014. However, the decline was offset by the increases in e-cigarette and hookah use, so that there was no decline in overall tobacco use between 2011 and 2014.

In 2014, the products most commonly used among youth were:

  • E-cigarettes (13.4% of high school students; 3.9% of middle school students)
  • Hookah (9.4% of high school students; 2.5% of middle school students)
  • Cigarettes (9.2% of high school students; 2.5% of middle school students)
  • Cigars (8.2% of high school students; 1.9% of middle school students)
  • Smokeless tobacco (5.5% of high school students; 1.6% of middle school students)
  • Snus (1.9% of high school students; 0.5% of middle school students)
  • Pipes (1.5% of high school students, 0.6% of middle school students)

In addition, nearly half of all middle and high school students who used some form of tobacco also used at least 1 other type of tobacco product.

“In today’s rapidly evolving tobacco marketplace, the surge in youth use of novel products like e-cigarettes forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened,” said Mitch Zeller, J.D., director of FDA’s Center for Tobacco Products, in a statement. “These staggering increases in such a short time underscore why the FDA intends to regulate these additional products to protect public health.”

Regulating tobacco

The FDA regulates the use of cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco. The FDA has announced it is taking steps to regulate other tobacco products, including e-cigarettes, hookahs and some cigars as tobacco products, acting under its authority in the Family Smoking Prevention and Tobacco Control Act of 2009. The FDA has the authority to require that e-cigarettes be labeled with their ingredients, so the user knows what’s in them. It can also tell manufacturers how they can promote e-cigarettes. For example, new regulations could prohibit e-cigarette promotion and sale to youth – which is already being done in some states. But such regulations are not yet in place.

The American Cancer Society Cancer Action Network, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, is urging the FDA to work quickly to regulate all tobacco marketing aimed at youth.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared 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, 2011-2014. Published April 17, 2015 in Morbidity and Mortality Weekly Report. First author René A. Arrazola, MPH, Centers for Disease Control and Prevention, Atlanta, GA.


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