ATLANTA -- Current electronic cigarette use among middle and high school students tripled from 2013 to 2014, according to data published by the Centers for Disease Control & Prevention (CDC) and the U.S. Food & Drug Administration's (FDA) Center for Tobacco Products (CTP) in the latest Morbidity & Mortality Weekly Report (MMWR).
Findings from the 2014 National Youth Tobacco Survey show that current e-cigarette use (use on at least 1 day in the past 30 days) among high school students increased from 4.5% in 2013 to 13.4% in 2014, rising from approximately 660,000 to two million students. Among middle school students, current e-cigarette use more than tripled from 1.1% in 2013 to 3.9% in 2014—an increase from approximately 120,000 to 450,000 students.
This is the first time since the survey started collecting data on e-cigarettes in 2011 that current e-cigarette use has surpassed current use of every other tobacco product overall, including conventional cigarettes.
E-cigarettes were the most-used tobacco product for non-Hispanic whites, Hispanics and non-Hispanic other races, while cigars were the most commonly used product among non-Hispanic blacks.
Hookah smoking roughly doubled for middle and high school students, while cigarette use declined among high school students and remained unchanged for middle school students. Among high school students, current hookah use rose from 5.2% in 2013 (about 770,000 students) to 9.4% in 2014 (about 1.3 million students). Among middle school students, current hookah use rose from 1.1% in 2013 (120,000 students) to 2.5% in 2014 (280,000 students).
The increases in e-cigarette and hookah use offset declines in use of more traditional products such as cigarettes and cigars. There was no decline in overall tobacco use between 2011 and 2014. Overall rates of any tobacco product use were 24.6% for high school students and 7.7% for middle school students in 2014.
In 2014, the products most commonly used by high school students were e-cigarettes (13.4%), hookah (9.4%), cigarettes (9.2%), cigars (8.2%), smokeless tobacco (5.5%), snus (1.9%) and pipes (1.5%).
Use of multiple tobacco products was common; nearly half of all middle and high school students who were current tobacco users used two or more types of tobacco products. The products most commonly used by middle school students were e-cigarettes (3.9%), hookah (2.5%), cigarettes (2.5%), cigars (1.9%), smokeless tobacco (1.6%), and pipes (0.6%).
Cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco are subject to FDA's tobacco control authority. The agency is finalizing the rule to bring additional tobacco products such as e-cigarettes, hookahs and some or all cigars under that same authority. Several states have passed laws establishing a minimum age for purchase of e-cigarettes or extending smoke-free laws to include e-cigarettes.
The CDC report concludes that "further reducing youth tobacco use and initiation is achievable through regulation of the manufacturing, distribution and marketing of tobacco products coupled with proven strategies. These strategies included funding tobacco control programs at CDC-recommended levels, increasing prices of tobacco products, implementing and enforcing comprehensive smoke-free laws and sustaining hard-hitting media campaigns."
The report also concludes that because the use of e-cigarettes and hookahs is on the rise among high and middle school students, "it is critical that comprehensive tobacco control and prevention strategies for youth focus on all tobacco products, and not just cigarettes."
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