Fewer US teens using tobacco, but e-cigarettes' appeal on the rise

Cigarette smoking and use of other tobacco products fell for both middle-schoolers and high school students, the Centers for Disease Control reports. But teens' use of e-cigarettes nearly doubled in one year.

Fewer American middle- and high-schoolers are using tobacco-derived products, according to a report released Thursday by the Centers for Disease Control and Prevention. Among students who did report tobacco use, cigarettes remained by far the most popular product.

Use of tobacco among high school students fell from 24.3 percent in 2011 to 23.3 percent in 2012. Among middle-schoolers, the drop was from 7.5 percent to 6.7 percent. But shifting trends among less common products have focused attention on electronic cigarettes – smokeless nicotine vaporizers whose use nearly doubled among teens in just one year, the CDC reported.

It's still a small sliver of teens who use e-cigarettes – 1.1 percent of middle-schoolers and 2.8 percent of high schoolers – but the tobacco-less cigarettes are almost unregulated because they are not classified as "a tobacco product." Some public health experts speculate that teens may perceive them as safer than traditional cigarettes, and that marketing is raising teen awareness of e-cigarettes. Although some municipalities have banned sales to minors, there are no restrictions on marketing that targets children, the Boston Globe reports.

A growing segment of the e-cigarette industry does not support marketing to minors, Kip Schwartz, whose Washington, D.C., law firm represents a number of manufacturers and distributors, told the Washington Post. But some companies give their flavored e-cigarettes names – such as "Gummy Bear," "Candy Corn," and "Chick Magnet Cherry" – that seem targeted at the youth market. The US banned flavored paper cigarettes in 2009, amid arguments that flavors like chocolate, cherry, and clove were too appealing to young people.

According to the Chicago Tribune, a federal appeals court has empowered the US Food and Drug Administration to regulate e-cigarettes as if they were tobacco products, and the FDA is at work on a regulation whose contents have not been disclosed.

Only three states – North Dakota, New Jersey, and Utah – currently include e-cigarettes in their public and workplace smoking bans, along with about 100 cities.

A 2009 FDA study found that e-cigarettes release carcinogens and other toxins, but the absence of tar and carbon monoxide may make them healthier and less damaging to smokers' lungs than traditional cigarettes. Some e-models are designed to look just like cigarettes, but in place of the tobacco they hold a slender battery, and in place of the filter they have a refillable reservoir of liquid that includes nicotine, propylene glycol, glycerin, and flavorings. When a user inhales, a pressure-triggered atomizer delivers a warm burst of vapor from the filter end while an LED light ignites the tip.  

Those nearby will see a curl of vapor resembling smoke, and they may detect a brief sweet smell, but they are otherwise unobtrusive, allowing smokers to enjoy the uninterrupted company of nonsmokers, even indoors.

"We feel very strongly that we not be taxed and regulated as a tobacco product because our goal as an industry is to distinguish ourselves from traditional tobacco cigarettes," Eric Criss, president of the Electronic Cigarette Industry Group, told the Tribune. "We believe there's a ladder of harm. Cigarettes are at the top of that, and our goal is to get people to move down that ladder."

While the CDC report indicates that e-cigarettes are rising in popularity among teens, that rise is commensurate with a drop in their use of bidis, small string-wrapped Indian cigarettes that enjoy occasional surges in popularity in the US. The report showed decreases in tobacco use across all age and ethnic groups except for high-school-age African-American boys, whose use of hookahs, pipes, and especially cigars spiked in 2012. Otherwise, boys' rates of smoking dropped more dramatically than girls'.

The CDC report comes as the nation approaches the 50th anniversary of the first US Surgeon General's report on the dangers of smoking. In 1964, Luther L. Terry rocked the world's perception of smoking when he said it had been identified as a cause of certain cancers in men, a likely cause of lung cancer in women, and the most important cause of chronic bronchitis. But, cautioned the report, the "tobacco habit should be characterized as an habituation rather than an addiction."

Today tobacco is considered highly addictive, and authorities say smoking remains the leading cause of preventable death and disease in the US, killing more than 1,200 Americans a day. Every day, more than 2,000 youths and young adults become daily smokers, according to the CDC.  

A 2011 report from the University of Michigan's Monitoring the Future project found that the US had the second-lowest rate of teen smoking (12 percent) compared with their peers in 36 European countries. (At 10 percent, only Iceland had a lower rate, and the average rate in Europe was 28 percent, more than twice that of the US.) But in a surprising twist, that same study found that US students had the third-highest rate of marijuana use (16 percent compared with Europe's 6 percent) and the highest use rates of all other illicit drugs, including hallucinogens and amphetamines.