e-Cigs, hookah particularly attractive to teensWhile overall tobacco use among middle school and high school students declined slightly between 2011 and 2012 in the United States, the percentage of adolescents using e-cigarettes nearly doubled during that same time period according to data from the 2012 National Youth Tobacco Survey.“We found a big increase in middle school and high school students in emerging tobacco products,” said Brian King, PhD, senior scientific advisor for the Centers for Disease Control and Prevention’s Office on Smoking and Health. He added e-cigarettes and hookah led the way. When asked about e-cigarette usage in the last 30 days, middle school students participating in the National Youth Tobacco Survey (NYTS) had an increase from 0.6 percent in 2011 to 1.1 percent in 2012. In high school students, the rate rose from 1.5 to 2.8 percent. For all students grades 6-12, ‘ever’ usage – students reporting ever having tried an e-cig even if not a regular user – rose from 3.3 percent to 6.8 percent during the same time frame. Among high school students, ‘ever’ usage jumped from 4.7 percent in 2011 to 10 percent in 2012. Hookah use among high school teens also rose from 4.1 percent in 2011 to 5.4 percent in 2012. Drilling down further, the NYTS data found from 2011 to 2012 the use of e-cigarettes more than doubled for middle school males (0.7 percent to 1.5 percent), high school females (0.7 percent to 1.9 percent) and Hispanics in both age groups (middle school 0.6 percent to 2 percent; high school 1.3 percent to 2.7 percent). The information was published in September and November 2013 in the CDC’s Morbidity and Mortality Weekly Report.Although the numbers seem relatively small, King said they are troubling. First, nearly 90 percent of adult smokers in America began smoking by age 18 so trends in youth tobacco usage could have long-lasting public health consequences. Also, he explained, “A majority of the e-cigarette users are also using traditional cigarettes so there is a lot of dual use.” In fact, the data showed more than 75 percent of those using e-cigarettes also smoked conventional cigarettes.Often marketed as a safer alternative to traditional smoking, an e-cigarette is a battery-powered device that converts liquid nicotine and other additives into a vapor that is inhaled by the user. Sometimes referred to as ‘vaping,’ the solution cartridges can be purchased with varying amounts of nicotine … including none at all … mixed with flavorings. Although e-cigs mimic traditional smoking, the devices don’t use tobacco or tar. Still, the Food and Drug Administration has announced the intention to classify e-cigs as a tobacco product and to begin regulating their use. However, King noted, “We don’t know when or what that will entail.”King said that just because e-cigarettes don’t use tobacco doesn’t mean they are safe. “The nicotine, itself, is not without health risks,” he pointed out. “Studies have shown nicotine can have an adverse effect on brain development in youth.” And, he added, “Nicotine Is highly addictive.”As to why the jump in the number of middle school and high school students trying many of these emerging tobacco products, which also includes flavored little cigars, King said there are a number of likely reasons. First, it is still legally permissible to sell these items to minors in most states. Hookah cafes are popping up across the country and appeal to a sense of social connection. In the absence of legislation, e-cigarettes often are allowed to be used in locations where tobacco is restricted. And, King said, price is another factor. Typically, a disposable e-cig is significantly cheaper than a pack of conventional cigarettes, in part because states are still trying to figure out how to tax the devices and solution used in them. Then there is the flavor. Both hookah and e-cig solutions come in a wide variety of flavors ranging from ‘tobacco’ and ‘menthol’ to more youth-friendly options like bubble gum, gummy bears, cotton candy, white chocolate and waffles. King pointed out the FDA banned flavors, excluding menthol, years ago in traditional cigarettes and also stopped other marketing efforts to appeal to teens.“The tobacco industry will tell you they’re not specifically marketing to youth,” he said of advertising efforts around e-cigarettes. Yet, King pointed out, “Manufacturers are using methods to market that we haven’t seen in decades … the most notable of which is television.” King noted celebrity endorsements also are being used to glamorize the products. Additionally, a heavy social media presence keeps emerging tobacco products in front of youth.Currently, the CDC is relying on general tobacco cessation messages to cover these emerging products. King said healthcare providers also have an important role to play in educating young patients and serving as a deterrent to tobacco use in any form.“We know that health professionals … and physicians in particular … are an effective means to deliver credible health information about all tobacco products.”

Cigar Use Also RisingAmong high school students, cigar use also increased between 2011 and 2012, rising from 11.6 percent to 12.6 percent. According to the CDC, about one-third of cigar smokers are using flavored little cigars or cigarillos. While there was a 1 percent overall increase in the usage of cigars, the increase was much sharper among non-Hispanic black high school students. In this group, 16.7 percent reported smoking cigars in 2012 as compared to 11.7 percent in 2011. Furthermore, the 2012 figure was more than double the estimated usage in 2009 for non-Hispanic blacks.