Many teens try alternatives to cigarettes

Product types vary dramatically among ethnic groups

Teens have been turning increasingly to electronic cigarettes (like the device shown here). But these tobacco products are still toxic and potentially addictive, government scientists point out.


Tobacco use is a very dangerous habit. Public-health officials are particularly concerned when teens experiment with tobacco because it can lead to a lifetime of addiction — and life-threatening disease. Yet despite knowing tobacco’s dangers, huge numbers of teens continue to experiment with it. The good news: Teen tobacco use in 2012, including cigarettes, dropped slightly from the year before. The bad news: Their use of many other tobacco products rose during the same 12 months.

The Centers for Disease Control and Prevention, or CDC, in Atlanta, Ga., asks large numbers of teens each year about their tobacco use. The most recent results, for 2012, show that cigarettes accounted for more than half of the tobacco use reported by the 26,650 students surveyed.

Slightly more than one in every 18 middle-school students reported using tobacco in the past 30 days, CDC found. Among those in high school, the rate was far higher — nearly one in every four teens. CDC scientists reported their findings Nov. 15 in Morbidity and Mortality Weekly Report.

Smoking harms health from the very first puff. Learn more.

Every day, another 3,800 U.S. teens smoke their first cigarette, according to a second recent report. Released in 2012 by the U.S. Surgeon General’s Office, it notes that more than 1,000 teens each day transition to becoming daily smokers.

“The vast majority of Americans who begin daily smoking during adolescence are addicted to nicotine by young adulthood,” according to Kathleen Sebelius. She’s Secretary of the Department of Health and Human Services, based in Washington, D.C. Her department runs the Surgeon General’s Office, CDC and the Food and Drug Administration (FDA).

By 2010, daily smoking among school kids had dropped to an average of 7.3 percent —from 16.8 percent in 1999, the recent Surgeon General’s report finds.

The new CDC survey shows this trend is continuing, although it’s slowing. Fourteen percent of high school students reported smoking cigarettes last year. Among middle school kids, cigarette smoking dropped last year to 3.5 percent (it had been 4.3 percent the year before).

What may surprise many people: Teens have been turning to a wide range of cigarette alternatives. And over just one year, there has been a sharp rise in the number of teens who use many of these other tobacco products.

Flavored smokes . . .

The fastest growth has been in teen use of electronic cigarettes, or e-cigarettes. These battery-powered devices disperse nicotine and other chemicals in an aerosol (a spray) that users inhale. Depending on the brand, e-cigarette aerosol sprays can contain flavorings that can be especially attractive to teens (such as fruit, mint and chocolate).

Between 2011 and 2012, e-cigarette use almost doubled among U.S. teens, CDC finds. Use remains low among all age groups: In the previous 30 days, just 1.1 percent of middle-school students and 2.8 percent of high-school teens reported using e-cigarettes. However, some two to three times as many students have tried e-cigarettes, even if it wasn’t recently. That’s according to a second new report by CDC, which was released on Sept. 6.

Video: Hear former U.S. Surgeon General Regina Benjamin explain to teens the risks posed by experimenting with tobacco. Credit: CDC

Because e-cigarettes don’t burn tobacco, many people — including kids — view them as safe. They aren’t. CDC notes that many e-cigarettes disperse chemicals that can irritate the lungs, that damage genes or that research has linked with causing cancer in animals.

Especially troubling, FDA does not regulate who can use e-cigarettes or what can be in them. FDA does regulate the minimum age of 18 for cigarette buyers (some states have raised it to 19). FDA also makes it illegal for manufacturers to advertise cigarettes to underage teens. But in most states, CDC finds, there is no legal minimum age for buying or using e-cigarettes.

As of 2012, the CDC estimated that 1.78 million school kids have at least tried e-cigarettes.

Many teens and young adults view smoking tobacco using a hookah (as here) safer than cigarettes. It’s not. Hookah smoke is just as toxic to the body. And hookah smokers still run the risk of becoming addicted to nicotine. shironosov/iStockphoto

Getting hooked by hookahs?

Teen experimentation with hookahs has also been rising. A type of water pipe, hookahs allow people to inhale smoke that is cooler and potentially less irritating to the throat and lungs than cigarette smoke. A 2010 survey found that 17 percent of U.S. high school seniors had used hookahs in the past year. (Boys were somewhat more likely than girls to have tried them.) Hookah use can be twice that high among college students, CDC notes.

CDC’s new teen survey finds that 1.3 percent of middle school teens used a hookah in the last month, as did four times that many high school teens. Again, boys were far more likely than girls to have used a hookah in the past 30 days.

Hookah use can be quite social, with the same mouthpiece passed from person to person. Contributing to the impression that these are not as nasty as other tobacco products, hookahs can flavor the tobacco smoke being inhaled, giving it the taste of apple, mint, cherry, chocolate, coconut, licorice — even watermelon. Yet due to how hookahs are used, the smoke they deliver can be as toxic and addictive as a cigarette’s, CDC reports.

In fact, “The volume of smoke inhaled during a typical hookah session is about 90,000 milliliters, compared with 500 to 600 milliliters inhaled when smoking a cigarette,” CDC’s website observes. As a result, hookahs may actually deliver higher levels of toxic chemicals into a user’s lungs.

Cigars attract some groups

The new CDC teen survey found more than twice as many middle-school kids used cigars as smoked electronic cigarettes. Among older teens, cigar use was roughly four times as high as e-cigarette smoking. More than 12 percent of high school teens reported lighting up cigars, including almost 17 percent of boys and more than 8 percent of girls.

Cigar smoking rates were highest among non-Hispanic black high school students. In 2012, 16.7 percent of these teens reported using them in the past month. That is a 42 percent increase from 2011, and twice the rate of three years earlier. In fact, more black high school students now smoke cigars than cigarettes.

By contrast, only about 12 percent of white or Hispanic high-school students smoked cigars in 2012. This was about half as many as reported smoking cigarettes.

What’sa cigar’s appeal? Some are are taxed at lower rates than cigarettes, making them cost less. Moreover, the new CDC report says, cigars can be “legally sold with certain flavors that are banned from cigarettes.” This may boost their popularity among teens.

An epidemic

Tobacco use by children is now “epidemic” within the United States and the world, the U.S. Surgeon General’s Office notes. Teens who use cigarettes and other tobacco products will usually continue to smoke into adulthood. Among those adult smokers, half are projected to die 13 years earlier than nonsmokers.

However, studies suggest that people who don’t use tobacco before age 18 probably never will. So this gives public health officials a strong motivation to keep teens from experimenting with this powerful drug.

Power Words

addiction  An illness triggered by brain changes that occur after using some drugs. Persons with an addiction will feel a compelling need to use a drug (which can be alcohol, the nicotine in tobacco, a prescription drug or an illegal chemical such as cocaine or heroin), even when the user knows that doing so carries a risk of severe health or legal consequences. (For instance, even though 35 million Americans try to quit smoking each year, fewer than 15 out of 100 succeed. Most begin smoking again within a week, according to the National Institute on Drug Abuse.)

adolescence A transitional stage of physical and psychological development that begins at the onset of puberty, typically between the ages of 11 and 13, and ends with adulthood.

aerosol  A tiny particle released in a fine spray or formed when gases or moisture trap tiny bits of solid matter. Some may remain airborne for weeks until they are destroyed, glom onto a surface with which they collide or are washed from the air by rain.

cancer  The rapid, uncontrolled growth of abnormal cells. It can lead to tumors, pain and death.

e-cigarette (short for electronic cigarette) Battery-powered devices that disperse nicotine and other chemicals as tiny airborne particles that users can inhale. They were originally developed as a safer alternative to cigarettes that users could use as they tried to slowly break their addiction to the nicotine in tobacco products.

epidemic  A widespread outbreak of an infectious disease or undesirable phenomenon that sickens or affects many people in a community at the same time.

ethnicity  The background of an individual based on cultural practices that tend to be associated with country (or region) of origin, religion, politics or some mix of these.

gender  The sex of an individual: whether it is male versus female.

gene  A segment of DNA that codes, or holds instructions, for producing a protein. Offspring inherit genes from their parents. Genes influence how an organism looks and behaves.

high school  A designation for grades nine through 12 in the U.S. system of compulsory public education. High-school graduates may apply to colleges for further, advanced education.

hookah  A water pipe used to cool smoke — usually tobacco smoke — that will be inhaled. According to the U.S. Centers for Disease Control and Prevention, “hookah smoking carries many of the same health risks as cigarettes.”

middle school  A designation for grades six through eight in the U.S. educational system. It comes immediately prior to high school. Some school systems break their age groups slightly different, including sixth grade as part of elementary school and then referring to grades seven and eight as “junior” high school. 

nicotine  A colorless, oily chemical found in the leaves of tobacco and certain other plants. It is highly addictive, making it hard to quit the use of cigarettes and other tobacco products.

survey  (in statistics) A questionnaire that samples the opinions, practices (such as dining or sleeping habits), knowledge or skills of a broad range of people. Researchers select the number and types of people questioned in hopes that the answers these individuals give will be representative of others of the same age; social, economic, ethnic or other group; or region.

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