Much progress has been made in recent years in the public health fight against cigarettes, but new evidence suggests that US teens might be picking up electronic cigarettes as fast as they are dropping traditional tobacco.
A new study from Centers for Disease Control and Prevention (CDC) researchers found that use of e-cigarettes among both middle and high school students nearly doubled between just 2013 and 2014.
"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, JD, director of the US Food and Drug Administration's Center for Tobacco Products, in a CDC press release.
E-cigs are battery-powered devices that heat a nicotine solution to produce a vapor the user inhales. Nicotine is the primary addictive chemical in tobacco. Research on the safety of e-cigs has not been definitive, said Jeffrey M. Schussler, MD, an interventional cardiologist at Baylor Heart and Vascular Hospital and Baylor University Medical Center at Dallas, in an interview with dailyRx News.
"Tobacco use in any form is dangerous for your health, and in particular your cardiovascular health," Dr. Schussler said. "Using e-cigarettes as a tool to try to quit smoking is potentially helpful, but there is cause for concern about the rise in new users (especially children and teens) of nicotine products of any kind. There is little research available about the long term side effects that the use of these products may produce in anyone, but particularly in a person who is still not fully grown."
To explore teen use of tobacco products, the study authors, led by René A. Arrazola, MPH, of the CDC's National Center for Chronic Disease Prevention and Health Promotion, looked at data from the 2011 to 2014 National Youth Tobacco Surveys. These were in-school surveys given yearly to over 20,000 middle and high school students across the US.
Students were asked about their current use of tobacco products — if they had used the products at least one day during the past 30 days.
Arrazola and team found that from 2013 to 2014, current use of e-cigs among high school students nearly tripled — from 4.5 percent in 2013 to 13.4 percent in 2014. A similar trend was seen among middle schoolers, as 1.1 percent reported current use of e-cigs in 2013 and 3.9 percent did so in 2014.
This represented a rise from around 660,000 high school e-cig users in 2013 to 2 million users in 2014 and a rise from around 120,000 middle school users to 450,000 users, the CDC noted.
Current hookah use also saw a jump among students, nearly doubling between 2013 and 2014. In 2013, 5.2 percent of high school students reported being current hookah users. That figure rose to 9.4 percent in 2014. The rate of current hookah smokers among middle schoolers increased from 1.1 percent in 2013 to 2.5 percent in 2014.
A hookah is a tobacco pipe with a long tube that draws smoke through a chamber filled with water.
Although Arrazola and team did find that use of traditional cigarettes and other products like snus and cigars declined from 2011 to 2014, the drop was not big enough to overcome the increases seen in use of newer products. Because of this, the overall rates of current use of any tobacco product hovered at around 24 percent of high schoolers.
“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 R. Frieden, MD, in a press release. “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.”
Methods that have worked to reduce teen use of conventional cigarettes (like regulation of marketing and distribution) should be used in efforts to reduce use of newer products, Arrazola and team said.
"Because use of emerging tobacco products (e-cigarettes and hookahs) is increasing among middle and high school students, it is critical that comprehensive tobacco control and prevention strategies for youths should address all tobacco products and not just cigarettes," the study authors wrote.
This study was published online April 16 in the CDC's Morbidity and Mortality Weekly Report. The authors disclosed no funding sources or conflicts of interest.