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Teen use of e-cigarettes has tripled in one year

Karen Kaplan Los Angeles Times

The use of electronic cigarettes by high school students tripled from 2013 to 2014 – a surprising boom that threatens to wipe out hard-won gains in the fight against teen smoking, a new government report says.

The percentage of American high school students who smoked traditional cigarettes on a regular basis dropped from 15.8 percent in 2011 to 9.2 percent in 2014, according to a study by the Centers for Disease Control and Prevention.

But that drop has been more than offset by increases in e-cigarette use, which increased from 1.5 percent of high school students in 2011 to 13.4 percent in 2014, the study says.

The trend is similar to what’s happening in Washington. Last year, 30 percent of high school seniors in Spokane County reported using an e-cigarette within the previous 30 days, according to results of the state’s Healthy Youth Survey, which were released last month. At the same time, use of traditional cigarettes, which had been on the rise in recent years among Spokane County teens, fell to the lowest level in at least a decade among all groups surveyed: sixth-, eighth-, 10th- and 12th-graders.

E-cigarettes are now the most popular tobacco product used by both high school and middle school students, the federal data show. The Food and Drug Administration defines e-cigarettes as a tobacco product because they use nicotine.

As a result, overall tobacco use by high school students – including the use of cigars, pipes, hookahs, bidis, snus and other smokeless tobacco – has remained essentially flat, with nearly 1 in 4 students using some kind of tobacco product.

Among them is Dean Wilson, an 18-year-old who attends Polytechnic High School in Long Beach, California. Though he has tried regular cigarettes, he said he prefers “vaping” with e-cigarettes because they are new and trendy, and because they come in a variety of appealing flavors.

He also believes they are less dangerous than traditional cigarettes. “They supposedly have less nicotine,” he said.

Fellow student Jose Sanchez said he wouldn’t use any type of cigarette because he has asthma and smoking would interfere with his ability to play soccer. But he has certainly noticed his classmates using the electronic devices.

“They’re a lot more popular now,” he said. “People want to fit in.”

With their colorful designs and candy-store flavors, e-cigarettes – battery-powered devices that heat a nicotine solution into a vapor – seem perfectly designed to get children and teens hooked on nicotine, many public health experts say.

Some experts fear e-cigarettes are becoming a “gateway drug” that makes young people more inclined to try traditional cigarettes, cigars or other dangerous products.

“They’re like cigarettes on training wheels,” said University of California, San Francisco, tobacco researcher Stanton Glantz.

The new study, based on data from the National Youth Tobacco Survey and released Thursday in the CDC’s Morbidity and Mortality Weekly Report, doesn’t prove that hypothesis. But it isn’t exactly reassuring either.

The CDC study backs up a Monitoring the Future report released in December by the University of Michigan, which found that twice as many eighth- and 10th-graders had used e-cigarettes in the previous month than had smoked traditional cigarettes. E-cigarettes were also more popular among 12th-graders, 17 percent to 14 percent.

The Michigan report was the first to show that e-cigarettes had become teens’ tobacco product of choice.

When results of the Washington study were released last month, Dr. Joel McCullough, who leads the Spokane Regional Health District, called for stronger regulations on the sale and distribution of e-cigarettes. He noted increases in e-cigarette and marijuana use among Spokane County teens.

“We’ve got to ring the alarm bell because teens are indicating they don’t consider electronic cigarette and marijuana use to be risky,” McCullough said in a news release.

E-cigarettes’ appeal extends to students in middle schools, the new CDC study shows. In 2014, 3.9 percent of students in grades 6 through 8 were using e-cigarettes. That was well above the 2.5 percent rate for traditional cigarettes and for hookahs.

Among the high school crowd, hookahs were the second most popular form of tobacco, with 9.4 percent of students reporting current use. Regular cigarettes came in third, with a 9.2 percent use rate, followed by cigars at 8.2 percent.

Altogether, 24.6 percent of ninth- through 12th-graders were regularly using some kind of tobacco product in 2014.

That equates to more than 3.7 million teens. An additional 910,000 middle school students were regular tobacco users in 2014, or 7.7 percent of kids in this age group.

The speed with which electronic cigarettes have swept through schools has alarmed the nation’s health experts. In 2011, when the CDC first tracked their use, only 1.5 percent of high school students said they had used the devices in the previous 30 days. That rate tripled to 4.5 percent by 2013 before tripling again last year.

Glantz said he was particularly troubled because “the epidemic was building from the bottom up.”

Unlike traditional smoking, a habit that has trickled down from adults to kids, e-cigarettes seem to be gaining the strongest foothold with the youngest users and expanding upward, he said.

He added that psychology studies suggest that many kids who pick up e-cigarettes would never have tried traditional cigarettes.

“This is explosive growth,” he said. “If we were talking about the spread of any other toxic chemical it would be a public health crisis.”

Michael Siegel, a professor of community health sciences at Boston University’s School of Public Health, said public health advocates were drawing the wrong conclusion from the study.

“The CDC should be celebrating that we’re seeing a decline in youth smoking,” he said.

If vaping is a gateway to smoking regular cigarettes, he added, the data would have revealed an increase in their use.

“We’re getting kids off tobacco,” he said. “That’s the goal.”

The FDA has been trying to regulate e-cigarettes since 2009, first as medical devices and later as tobacco products. But legal challenges, a lack of clear-cut data on their health effects and other hurdles have slowed the effort.

“These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products.

Last year, the FDA said it intended to ban e-cigarette sales to minors and require manufacturers to put health warnings on the devices, as is required for traditional cigarettes. These rules have not yet been implemented because the FDA is still reviewing public comments on the issue.

The FDA’s proposal did not include other restrictions that might limit e-cigarettes’ appeal to young people, such as restrictions on advertising and flavorings.

A study published last year in the journal Pediatrics found that TV commercials for e-cigarettes had become so ubiquitous that by 2013, 80 percent of kids ages 12 to 17 had seen 13 such ads over the course of a year.

Another study published last year in the journal Tobacco Control tallied 7,700 flavors used in e-cigarettes, including graham cracker and Swedish fish.

Public health experts are particularly concerned about nicotine’s effect on teens. When an adolescent brain is exposed to nicotine, it alters the development of the prefrontal cortex, the part of the brain involved in planning and decision-making.

As a result, teen users of traditional or electronic cigarettes may suffer from attention problems, and when they get older they’ll face a heightened risk of cognitive impairments and psychiatric disorders, scientists say.

“Nicotine exposure at a young age may cause lasting harm to brain development,” said Dr. Thomas Frieden, director of the CDC.

Aruni Bhatnagar, a tobacco researcher at the University of Louisville and lead author of the American Heart Association’s statement on e-cigarettes, said he worried about cardiovascular damage as well.

“We’re concerned that there might be long-term cardiovascular consequences if someone starts (using nicotine) early in life,” he said. “It may have effects we don’t know. It may be just trading one problem for another.”

A Spokesman-Review staff writer and Los Angeles Times staff writer Ruben Vives contributed to this report.
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