Joel London, a spokesman from the CDC’s Office of Smoking and Health, said in a phone interview Monday that cigarette use is trending downward, though most other changes in data from 2012 were not statistically significant. He credited decreased use to increased prices for cigarettes, improved smoke-free laws and education campaigns like the CDC’s “Tips From Former Smokers.”

One alternative, though, is bolstering declining cigarette use.

E-cigarette use among all high school students tripled since 2011, London said. In the CDC survey, 4.5 percent of high school students reported using the smokeless cigarettes. Hookah and cigars also nabbed higher numbers of high school users, equal to 5.2 percent and 11.9 percent, respectively.

Although two thirds of the students surveyed said they did not use any tobacco products, Catawba County still outpaced the national survey in e-cigarette use. At the county level, 6 percent of respondents said they used the electronic alternative.

London said 36 states, including North Carolina, passed laws to bar kids from buying electronic cigarettes, but 14 states and the District of Columbia don’t similarly restrict young buyers. The smokeless option is also available on the Internet.