The use of electronic cigarettes (e-cigarettes) by middle and high school students may be an epidemic, according to the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). More than 20% of high school students report using e-cigarettes on a regular basis, almost double the number from 2017.
The new data comes from the 2018 National Youth Tobacco Survey, a joint effort from the FDA and CDC to track youth tobacco use over time. The results would ordinarily be released in 2019, but the sharp rise in e-cigarette use prompted the agencies to publish the numbers early in Morbidity and Mortality Weekly Report (November 16, 2018).
"These new data show that America faces an epidemic of youth e-cigarette use, which threatens to engulf a new generation in nicotine addiction," Alex Azar, secretary of the U.S. Department of Health and Human Services, stated in a press release. "By one measure, the rate of youth e-cigarette use almost doubled in the last year, which confirms the need for FDA's ongoing policy proposals and enforcement actions."
Reversing downward tobacco trends
The FDA and CDC have partnered to conduct the National Youth Tobacco Survey for more than a decade. In June, the agencies reported that the number of U.S. middle and high school students who use tobacco products had significantly dropped since 2011. The latest survey findings, however, indicate a reverse to that trend.
From 2017 to 2018, tobacco use of any kind increased 38% for high school students and 29% for middle school students. This was due to a dramatic rise in e-cigarette use over the past year.
In 2018, more than 3 million high school students used an e-cigarette within the past 30 days, up from 2 million students in 2017 and just 220,000 students in 2011. About 570,000 middle school students used an e-cigarette within the past 30 days, up from 60,000 in 2011.
High school students are also using e-cigarettes more frequently. Almost 30% of high-school e-cigarette users reported vaping with an e-cigarette at least 20 of the past 30 days.
"The markedly accelerating rate of e-cigarette use among U.S. youth within the past year is a cause for grave concern," CDC Director Robert Redfield, MD, stated in a press release. "E-cigarette use is unsafe among youth, and it's critical that we implement proven strategies to protect our nation's youth from this preventable health risk."
Concern about flavored e-cigarettes
The report authors attributed the sudden rise in e-cigarette use to the increase in popularity of small e-cigarettes shaped like a USB flash drive, including JUUL. These types of e-cigarettes are discreet, have high amounts of nicotine, and come in fruit and candy flavors, the FDA noted.
Nearly 68% of high school e-cigarette users vaped with a flavored e-cigarette, up from 61% in 2017. The use of menthol- or mint-flavored e-cigarettes rose to 51% among current users, and almost 40% of these students exclusively use e-cigarettes.
"The data also show that kids not only choose flavored products more often than adults do but also that flavors are a major reason they use these products in the first place," Azar stated. "Flavors increase the likelihood of kids' progression from experimentation to regular use, and a portion of them will go on to use combustible tobacco products, with huge added dangers of tobacco-related disease."
Taking regulatory action
The FDA has taken a number of steps to curtail youth e-cigarette use, including limiting the sale of flavored e-cigarettes to age-restricted stores, pursuing a ban on menthol in cigarettes, and cracking down on retailers who sell tobacco products to minors. Furthermore, FDA Commissioner Scott Gottlieb, MD, appears poised to continue using the agency's regulatory power to reverse these trends.
"These increases must stop," Dr. Gottlieb stated in a press release. "And the bottom line is this: I will not allow a generation of children to become addicted to nicotine through e-cigarettes."
