E-Cigarette Use Doubles Among Middle and High School Students

Researchers at the Centers for Disease and Control Prevention (CDC) and FDA using data collected in a national survey of U.S. middle school and high school students reported that ever- and current electronic cigarette use doubled from 2011 to 2012.

Electronic cigarettes, or e-cigarettes, are battery-powered devices that provide doses of nicotine and other additives to the user in an aerosol. The devices turn nicotine, which is highly addictive, and other chemicals into a vapor that is inhaled by the user. The cartridges in e-cigarettes can be flavored and contain ingredients such as propylene glycol or glycerol to produce the aerosols. Other potentially harmful components have also been used in some e-cigarette cartridges, including irritants, genetic toxins, and animal carcinogens. The FDA currently does not regulate e-cigarettes used for non-therapeutic purposes, though it is expected that the agency will promulgate regulations soon to address this gap.

In September 2010, the FDA issued a number of warning letters to electronic cigarette distributors for various violations of the Food, Drug, and Cosmetic Act including “violations of good manufacturing practices, making unsubstantiated drug claims, and using the devices as delivery mechanisms for active pharmaceutical ingredients.”

Earlier this year, CDC researchers had  reported that about 6 percent of all adults – not just smokers – tried an e-cigarette in 2011, which was double the number reported in 2010. In the September 6 report, the CDC and FDA researchers found that e-cigarette experimentation and recent use doubled among U.S. middle and high school students during 2011–2012 from 3.3 percent to 6.8 percent. This percentage reflects the estimated 1.78 million students having used e-cigarettes at one point as of 2012. Current e-cigarette use rose from 1.1 percent to 2.1 percent for the same group. Among high school students, experimentation with e-cigarettes rose from 4.7 percent to 10 percent during the same time frame.

Moreover, in 2012, an estimated 160,000 students who reported ever using e-cigarettes had never used conventional cigarettes. This has raised the specter that e-cigarettes could become a gateway to nicotine addiction. Some health officials have also expressed worries that e-cigarettes’ appeal to youth are partly based on aggressive national marketing, some of which are pitched by famous actors, directed at adults but seen by youths. Additionally, the cartridges can be flavored, which were banned in traditional cigarettes with the passage of the Family Smoking Prevention and Tobacco Control Act in 2009. As a result, the sharp rise among youths seems to mirror the uptake of the adult population.

The results of the CDC and FDA survey are a serious concern because the overall impact of e-cigarette use on public health remains uncertain. In youths, concerns include the potential negative impact of nicotine on adolescent brain development, as well as the risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products.