Study finds cigars, e-cigarettes, hookahs becoming more popular with youth

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Cigarette use among middle-school and high-school students is on the decline, but public health experts at the federal 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 percent of middle school students and 23.3 percent of high school students were using tobacco in 2012. In 2011, the corresponding figures were 7.5 percent and 24.3 percent.

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 tobacco or nicotine form among middle-school students, with 3.5 percent of kids in grades 6 through 8 saying they had smoked a cigarette in the previous 30 days.

Then came cigars (2.8 percent used them), pipes (1.8 percent), smokeless tobacco (1.7 percent), hookahs (1.3 percent), electronic cigarettes (1.1 percent), snus (0.8 percent), bidis (0.6 percent), kreteks (0.5 percent) and dissolvable tobacco (0.5 percent).

Cigarettes were also the most popular item among high-school students, with 14 percent of students in grades 9 through 12 reporting they had smoked one within the last 30 days. Cigars were a close second, with 12.6 percent of students saying they smoked them recently.

In addition, 6.4 percent of high school students used smokeless tobacco, 5.4 percent used hookahs, 4.5 percent used pipes, 2.8 percent used electronic cigarettes, 2.5 percent used snus, 1 percent used kreteks, 0.9 percent used bidis and 0.8 percent used dissolvable tobacco.

Though overall tobacco use was down, the report authors flagged the rising popularity of products other than cigarettes that are unregulated by the Food and Drug Administration.

In the case of cigars, they noted that some 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 hookahs 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.

Paying attention to tobacco use among middle- and high-school students is important because 90 percent 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 percent smoke-free, quit lines and other programs to help people kick the habit, and media campaigns that publicize the health dangers of smoking.


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