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 Among high school students, e-cigarette use jumped to 13.4 percent
in 2014 from 4.5 percent in 2013, according to the Centers for
Disease Control and Prevention. Cigarette use over the same period
fell to 9.2 percent from 12.7 percent, the largest year-over-year
decline in more than a decade.
Overall, tobacco use among high school students grew to 24.6 percent
from 22.9 percent.
The data sparked alarm among tobacco control advocates who fear
e-cigarettes will create a new generation of nicotine addicts who
may eventually switch to conventional cigarettes.
"Nicotine exposure at a young age may cause lasting harm to brain
development, promote addiction, and lead to sustained tobacco use,"
Dr. Tom Frieden, director of the CDC, said in a statement.
Mitch Zeller, director of the Food and Drug Administration's tobacco
division, said the data "forces us to confront the reality that the
progress we have made in reducing youth cigarette smoking rates is
being threatened."
But e-cigarette proponents argue that the CDC data could equally
suggest that smoking rates fell because young people took up
e-cigarettes instead of traditional cigarettes.
"There is no firm conclusion that one can draw from correlational
data," Jed Rose, director of the Center for Smoking Cessation at
Duke University Medical Center, said in an interview.
"But it is equally amenable to the interpretation that e-cigarettes
are diverting young people away from cigarettes."
The data was drawn from the 2014 National Youth Tobacco Survey which
showed current e-cigarette use, defined as use at least once in the
past 30 days, surpassed current use of every other tobacco product
for the first time.
It was not clear how many e-cigarette users were previously smokers
and had switched, or how many picked up e-cigarettes who would
otherwise not have smoked anything.
Altogether, 4.6 million middle and high school students were current
users of any tobacco product. Of those, 2.2 million used at least
two products.
The data showed hookah use nearly doubled to 9.4 percent from 5.2
percent, a disturbing trend since hookah smoking, in which smokers
inhale burned tobacco through a water pipe, carries many of the same
health risks as cigarette smoking.
An hour-long hookah smoking session involves 200 puffs, according to
the CDC, while smoking an average cigarette involves 20 puffs. The
amount of smoke inhaled during a typical hookah session is about
90,000 milliliters, compared with 500-600 milliliters inhaled from a
cigarette.
"Hookah is very bad and is not a safer alternative to cigarette
smoking because it has carbon monoxide and all sorts of
cancer-causing agents," Rose said. "It should not be confused with
smokeless forms of nicotine use."
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The CDC said nearly half the students used more than one tobacco
product. The most popular was e-cigarettes, followed by hookah.
Cigarettes came in third place followed by cigars, smokeless tobacco
and pipes.
Big tobacco companies, including Altria Group, Lorillard Tobacco Co
and Reynolds American Inc are all developing e-cigarettes, as are
many independent companies.
One of the biggest independents is Logic Technology, whose
president, Miguel Martin, said his company "spends a lot of time and
money to make sure children don't get access" to the company's
products.
The vast majority of Logic's sales go through brick-and-mortar
stores and it uses sophisticated age-verification technology for its
online sales. But not everyone uses this kind of technology.
"What this highlights is the need to work on the access issue," he
said. "There's no disagreement among responsible companies that
these products shouldn't go to kids."
Among middle school students, current e-cigarette use more than
tripled to 3.9 percent in 2014 from 1.1 percent in 2013, while
cigarette use remained unchanged, the CDC said.
Hookah use among middle school students jumped to 2.5 percent in
2014 from 1.1 percent in 2013. Overall tobacco use was 7.7 percent
for middle school students in 2014.
The Food and Drug Administration regulates cigarettes, cigarette
tobacco, roll-your-own tobacco and smokeless tobacco and expects to
publish a rule extending its authority to e-cigarettes, hookah and
other tobacco products in June.
"These staggering increases in such a short time underscore why FDA
intends to regulate these additional products to protect public
health," Zeller said.
(Editing by Bernadette Baum)
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