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More U.S. Teens Try E-Cigarettes, Hookahs: Report

THURSDAY, Nov. 14 (HealthDay News) -- The rapidly growing use of electronic cigarettes, hookahs and other smoking alternatives by middle school and high school students concerns U.S. health officials.

While use of these devices nearly doubled in some cases between 2011 and 2012, no corresponding decline has been seen in cigarette smoking, the U.S. Centers for Disease Control and Prevention reported Thursday.

"We have seen, between 2011 and 2012, a big increase in the percentage of middle- and high-school students who are using non-conventional tobacco products, particularly electronic cigarettes and hookahs," said Brian King, a senior scientific adviser in CDC's office on smoking and health.

These products are marketed in innovative ways on TV and through social media, he said. "So, it's not surprising that we are seeing this increase among youth," he added.

E-cigarettes and hookah tobacco come in flavors, which appeals to kids. And since hookahs are often used in groups, they also provide a social experience, which may be adding to their popularity, King said.

Teens may also believe that e-cigarettes are safer than tobacco, said Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. However, nicotine is addictive and can hamper the developing brains of teens.

"This paper shows that the return of nicotine advertising to TV and radio, combined with an aggressive social media presence and use of flavors is promoting rapid uptake of electronic cigarettes by youth," said Glantz.

The report, based on data from the 2012 National Youth Tobacco Survey, was published in the Nov. 15 issue of the CDC's Morbidity and Mortality Weekly Report.

King said efforts are needed to curb use of these tobacco products and prevent other teens from ever trying them. "We know that 90 percent of smokers start in their teens, so if we can stop them from using tobacco at this point, we could potentially prevent another generation from being addicted to tobacco," King noted.

Smoking is the leading cause of preventable death and disease in the United States, killing more than 1,200 people every day.

E-cigarettes simulate the experience of smoking without delivering smoke. They are shaped like cigarettes but users inhale a vaporized, nicotine-based liquid.

"Nicotine is an addictive drug that affects brain development, especially in adolescents, whose brains are still developing," he said.

According to the report, from 2011 to 2012 use of e-cigarettes among middle-school students rose from 0.6 percent to 1.1 percent. Their use by high school students jumped from 1.5 percent to 2.8 percent.

Over the same period, hookah use among high schoolers jumped from 4.1 percent to 5.4 percent, the researchers found.

Currently, electronic cigarettes, hookah tobacco, cigars and certain other new tobacco products are not regulated by the U.S. Food and Drug Administration.

The FDA has said it intends to classify these products as tobacco products, putting them under the agency's control.

The popularity of these new products hurts ongoing tobacco-prevention efforts, experts say. "This proliferation of novel tobacco products that are priced and marketed to appeal to kids are slowing our progress in reducing tobacco use among kids," said Danny McGoldrick, research director for Campaign for Tobacco-Free Kids.

"You have the marketing of electronic cigarettes that are using all the themes and tactics that have been used by cigarette companies for decades to market to kids, like flavors, the use of celebrities, the use of sports and entertainment, as well as glamour, sex and rebellion," he said.

This is why the FDA needs to assert jurisdiction over all tobacco products, McGoldrick said.

Cigar use is also rising among adolescents. Their use by black high school students rose from about 12 percent to nearly 17 percent from 2011 to 2012, and since 2009 has more than doubled, according to the report.

Cigars and cigarettes were smoked by about the same number of boys in 2012 -- more than 16 percent.

Cigars include so-called "little cigars," which are similar in size, shape and filter to cigarettes, King said. But since they are taxed at lower rates than cigarettes, they are more affordable. "You can buy a single, flavored little cigar for mere pocket change, which could increase their appeal among youth," he said.

Fruit and candy flavors, which are banned from cigarettes, are added to some of these little cigars, King said.

According to the CDC, about one in three middle- and high-school students who smoke cigars use flavored little cigars.

Every day, more than 2,000 teens and young adults start smoking. Smoking-related diseases cost $96 billion a year in direct health care expenses, according to the CDC.

More information

For more information on stopping smoking, visit the American Cancer Society.

SOURCES: Brian King, Ph.D., M.P.H., senior scientific advisor, Office on Smoking and Health, U.S. Centers for Disease Control and Prevention; Stanton Glantz, Ph.D., director, Center for Tobacco Control Research and Education, University of California, San Francisco; Danny McGoldrick, research director, Campaign for Tobacco-Free Kids, Washington, D.C.; Nov. 15, 2013, Morbidity and Mortality Weekly Report

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