E-cigarette use triples among students in just one year

Current e-cigarette use among middle and high school students tripled from 2013 to 2014, according to the Center for Tobacco Products (CTP) Findings from the 2014 National Youth Tobacco Survey show that current e-cigarette use among high school students increased from approximately 660,000 to 2 million students. Among middle school students, current e-cigarette use more than tripled fan 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 race while cigars were the most commonly used product among non-Hispanic blacks.

“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 Frieden, M.D., M.P.H. “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.”

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(about 770,000 students) to about 1.3 million students. Among middle school students, current hookah use rose from 120,000 students) to 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.

Cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco are currently subject to FDA’s tobacco control authority. The agency currently 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, both of which could help further prevent youth use and initiation.

“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, J.D., director of FDA’s Center for Tobacco Products. “These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health.”

Today’s 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.

The 2012 Surgeon General’s Report found that about 90 percent of all smokers first tried cigarettes as teens; and that about three of every four teen smokers continue into adulthood. To learn more about quitting and preventing children from using tobacco, visit www.BeTobaccoFree.gov.

For broadcast-quality video and audio clips featuring FDA’s Center for Tobacco Products Director Mitch Zeller speaking about the findings from the 2014 National Youth Tobacco Survey, visit http://dmr.homefrontdc.com/697/ctp-nyts-findings.

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.

40% of Middle and High Schoolers Smokers Used Flavored Little Cigars or Flavored Cigarettes

More than 40 percent of middle and high schoolers who smoke use flavored little cigars or flavored cigarettes

Flavored little cigar smokers less likely to think about quitting tobacco use

More than two out of every five middle and high school students who smoke report using either flavored little cigars or flavored cigarettes, according to a report by the Centers for Disease Control and Prevention published in the Journal of Adolescent Health. This article, using data from the 2011 National Youth Tobacco Survey (NYTS), is the first to measure how many American youth are using flavored little cigars and flavored cigarettes.

The study also shows that among youth cigar smokers, almost 60 percent of those who smoke flavored little cigars are not thinking about quitting tobacco use, compared with just over 49 percent among all other cigar smokers.

“Flavored or not, cigars cause cancer, heart disease, lung disease, and many other health problems.  Flavored little cigars appeal to youth and the use of these tobacco products may lead to disfigurement, disability, and premature death,” said CDC Director Tom Frieden, MD, MPH. ”We need to take comprehensive steps to reduce all tobacco use for all of our youth.”

The study found that 35.4 percent of current youth cigarette smokers reported using flavored cigarettes, which could include menthol cigarettes or flavored little cigars that students mistook for flavored cigarettes. In 2009, the Family Smoking Prevention and Tobacco Control Act was enacted and prohibited the use of flavors, except menthol, in cigarettes. However, flavored little cigars are still manufactured and sold with candy and fruit flavorings.

“Little cigars contain the same toxic and cancer-causing ingredients found in cigarettes and are not a safe alternative to cigarettes,” said Tim McAfee, MD, MPH, director of the CDC’s Office on Smoking and Health. “Many flavored little cigars appear virtually indistinguishable from cigarettes with similar sizes, shapes, filters, and packaging.”

In addition to offering a wide variety of flavors that appeal to young people, little cigars are taxed at a lower rate than cigarettes at the state level. Little cigars have become more popular in recent years; sales increased 240 percent from 1997 to 2007, with flavored brands making up almost 80 percent of the market share.

Smoking remains the leading cause of preventable death and disease in the United States.  The health consequences of tobacco use include heart disease, multiple types of cancer, pulmonary disease, adverse reproductive effects, and the exacerbation of chronic health conditions.Smoking and exposure to secondhand tobacco smoke kill an estimated 443,000 Americans each year.  And for every one death, there are 20 people suffering from a smoking-related disease.  In addition to the cost in human life, smoking has been estimated to cost $193 billion annually in direct health care expenses and lost productivity.  And 99 percent of all smokers start before they’re 26 years old.

Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services such as certain services to quit smoking that are covered with no additional costs. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more. Open enrollment in the Marketplace began October 1 and ends March 31, 2014. For those enrolled by December 15, 2013, coverage starts as early as January 1, 2014.