E-Cigarettes, Hookahs Gain Popularity Among US Youth

Middle and high school students in the United States are using more non-conventional tobacco products, including electronic cigarettes and hookahs. At the same time they are not significantly decreasing their use of cigarettes, according to the Centers for Disease Control and Prevention (CDC).

In the November 15, 2013 issue of Morbidity and Mortality Weekly Report, the CDC reports that 3.5% of middle school students and 14% of high school students currently use cigarettes, while 6.7% of middle school students and 23.3% of high school students currently use some form of tobacco product. The information comes from the 2012 National Youth Tobacco Survey. After cigarettes, cigars are reported to be the second most commonly used tobacco product.

“This report raises a red flag about newer tobacco products,” said CDC Director Tom Frieden, MD, MPH. “Cigars and hookah tobacco are smoked tobacco – addictive and deadly. We need effective action to protect our kids from addiction to nicotine.”

The report shows that hookah use among high school students rose to 5.4% in 2012, from 4.1% in 2011. A hookah is a bowl-shaped device with a pipe for inhaling tobacco smoke. And it shows electronic cigarette use among middle school students rose to 1.1% in 2012, from 0.6% in 2011, and increased to 2.8% among high school students, from 1.5%. Electronic cigarettes are battery-operated devices that look like regular cigarettes. An atomizer heats a solution of liquid, flavorings, and nicotine that creates a mist that is inhaled.

In 2012, the report shows cigars were the most commonly used form of tobacco after cigarettes for middle school students (2.8%) and high school students (12.6%). In addition, African American high school students’ cigar use in 2012 increased dramatically, to 16.7%, from 11.7% in 2011 – and has more than doubled since 2009. Cigars include traditional premium cigars, cigarillos, and “little cigars,” which look like cigarettes, but are more affordable to teens because they are taxed at lower rates and can be sold individually, rather than by the pack. They also appeal to youth because they are often made with fruit and candy flavors that are banned from cigarettes. A CDC study published last month showed more than one-third of middle and high school students who smoke cigars smoke flavored little cigars.

Electronic cigarettes, hookahs, cigars and certain other new types of tobacco products are not currently subject to regulation by the US Food and Drug Administration (FDA). According to the CDC, the increase in the use of electronic cigarettes and hookahs could be due to an increase in marketing, availability, and visibility of these tobacco products and the perception that they may be safer alternatives to cigarettes. The FDA has announced it is taking steps to regulate products meeting the legal definition of a "tobacco product" to be subject to the Federal Food, Drug, and Cosmetic Act.

The CDC says its findings indicate that more efforts are needed to monitor and prevent all young people from taking up the use of both conventional and non-conventional forms of tobacco.

“A large portion of kids who use tobacco are smoking products other than cigarettes, including cigars and hookahs, which are similarly dangerous”, said Tim McAfee, MD, MPH, director of the CDC’s Office on Smoking and Health. “As we close in on the 50th anniversary of the first Surgeon General’s report on the dangers of smoking, we need to apply the same strategies that work to prevent and reduce cigarette use among our youth to these new and emerging products.”

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 Product Use Among Middle and High School Students – United States, 2011 and 2012. Published November 15, 2013 in Morbidity and Mortality Weekly Report. First author René A. Arrazola, MPH, Centers for Disease Control and Prevention, Atlanta, Ga.

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