Cigarette use among middle school and high school students is on the decline, but public health experts at the Centers for Disease Control and Prevention are concerned about other ways that tobacco and nicotine use is rising among kids.

Electronic cigarettes, hookahs and dissolvable tobacco were all more popular in 2012 than in 2011, according to data CDC researchers published this week in the Morbidity and Mortality Weekly Report. Cigar smoking has also become more prevalent among high school students.

Overall, 6.7% of middle schoolers and 23.3% of high schoolers were using tobacco in 2012. In 2011, the corresponding figures were 7.5% and 24.3%.

Those figures are based on surveys of roughly 25,000 students in grades 6 through 12 who participated in the National Youth Tobacco Survey. Students were considered current tobacco users if they had smoked a cigarette, cigar, pipe, hookah, electronic cigarette, bidis (thin, hand-rolled cigarettes) or kreteks (clove cigarettes) or used smokeless tobacco, dissolvable tobacco, or snus (a powdered tobacco) at least once in the last 30 days.


Here’s what the researchers found:

Cigarettes were the most popular form of tobacco or nicotine among middle school students, with 3.5% of kids in grades 6 through 8 saying they had smoked a cigarette in the previous 30 days. That was followed by cigars (2.8% used them), pipes (1.8%), smokeless tobacco (1.7%), hookahs (1.3%), electronic cigarettes (1.1%), snus (0.8%), bidis (0.6%), kreteks (0.5%) and dissolvable tobacco (0.5%).

Cigarettes were also the most popular item among high schoolers, with 14% of students in grades 9 through 12 reporting they had smoked one within the last 30 days. Cigars came in a close second, with 12.6% of students saying they smoked them recently. In addition, 6.4% of high schoolers used smokeless tobacco, 5.4% used hookahs, 4.5% used pipes, 2.8% used electronic cigarettes, 2.5% used snus, 1% used kreteks, 0.9% used bidis and 0.8% used dissolvable tobacco.

Though overall tobacco use was down, the authors of the report flagged the rising popularity of products other than cigarettes that are not regulated by the Food and Drug Administration. In the case of cigars, they noted that some of the items in that category were “similar to cigarettes in terms of appearance, but depending on their weight, can be taxed at lower rates and legally sold with certain flavors that are banned from cigarettes.” The lower prices and option of flavors probably make them especially appealing to teens, they wrote.


Electronic cigarettes and hookas were also called out as having particular appeal to teens because they are cheaper and because they are seen as “safer” than conventional cigarettes, the researchers wrote. In September, the CDC reported that an estimated 1.78 million children and teens used e-cigarettes in 2012.

“This report raises a red flag about newer tobacco products,” Dr. Tom Frieden, director of the CDC, said in a statement. “Cigars and hookah tobacco are smoked tobacco – addictive and deadly.”

Paying attention to tobacco use among middle and high school students is important because 90% of today’s adult smokers began smoking by the time they were 18 years old, according to the research team from the CDC’s Office on Smoking in Health. They reiterated the importance of programs aimed at preventing tobacco use among teens, including taxes to make the products more expensive, laws requiring schools and other public places to be 100% smoke-free, quit lines and other programs to help people kick the habit, and media campaigns that publicize the health dangers of smoking.

The CDC says that every day, more than 2,000 kids and young adults in America become daily smokers, and that more than 1,200 people die as a result of their smoking habit.


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