Emerging Tobacco Products Gaining Popularity Among Youth

Increases in e-cigarette and hookah use show need for increased monitoring and prevention

Emerging tobacco products such as e-cigarettes and hookahs (water pipe) are quickly gaining popularity among middle- and high-school students, according to a report in this week’s Morbidity and Mortality Weekly Report.

While use of these newer products increased, there was no significant decline in students’ cigarette smoking or overall tobacco use. Data from the 2012 National Youth Tobacco Survey (NYTS) show that recent electronic cigarette use rose among middle school students from 0.6 percent in 2011 to 1.1 percent in 2012 and among high school students from 1.5 percent to 2.8 percent. Hookah use among high school students rose from 4.1 percent to 5.4 percent from 2011 to 2012.

The report notes that the increase in the use of electronic cigarettes and hookahs could be due to an increase in marketing, availability, and visibility of these tobacco products and the perception that they may be safer alternatives to cigarettes. Electronic cigarettes, hookahs, cigars and certain other new types of tobacco products are not currently subject to FDA regulation.  FDA has stated it intends to issue a proposed rule that would deem products meeting the statutory definition of a "tobacco product" to be subject to the Federal Food, Drug, and Cosmetic Act.

Another area of concern in the report is the increase in cigar use among certain groups of middle and high school students.  During 2011-2012, cigar use increased dramatically among non-Hispanic black high school students from 11.7 percent to 16.7 percent, and has more than doubled since 2009. Further, cigar use among high school males in 2012 was 16.7 percent, similar to cigarette use among high school males (16.3 percent).

“This report raises a red flag about newer tobacco products,” said CDC Director Tom Frieden, M.D., M.P.H. “Cigars and hookah tobacco are smoked tobacco – addictive and deadly. We need effective action to protect our kids from addiction to nicotine.”

It is important to note that the cigars category includes little cigars, many of which look almost exactly like cigarettes but are more affordable to teens because they are taxed at lower rates and can be sold individually, rather than by the pack.  Little cigars also can be made with fruit and candy flavors that are banned from cigarettes. A CDC study published last month showed more than one in three (35.9 percent) middle and high school students who smoke cigars use flavored little cigars.

“A large portion of kids who use tobacco are smoking products other than cigarettes, including cigars and hookahs, which are similarly dangerous,” said Tim McAfee, M.D., M.P.H., director of the CDC’s Office on Smoking and Health. “As we close in on the 50th anniversary of the first Surgeon General’s report on the dangers of smoking, we need to apply the same strategies that work to prevent and reduce cigarette use among our youth to these new and emerging products.”

Smoking remains the leading cause of preventable death and disease in the United States, killing more than 1,200 Americans every day. More than 8 million Americans live with a smoking-related disease.  Each day, more than 2,000 youth and young adults become daily smokers.  Smoking-related diseases cost Americans $96 billion a year in direct health care expenses, much of which come in taxpayer-supported payments.