Karen Kaplan / Los Angeles Times

LOS ANGELES — One out of 10 American high school students used e-cigarettes in 2012, along with nearly 3 in 100 middle-school students, according to a new federal report. That’s about double the rate of e-cigarette use in 2011.

The sharp increase has public health experts worried. Electronic cigarettes contain nicotine, an enticing flavor like mint or chocolate — and often cancer-causing compounds called nitrosamines, according to a 2009 analysis by the Food and Drug Administration.

“The increased use of e-cigarettes by teens is deeply troubling,” Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said in a statement. “Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”

The study, published in Friday’s edition of the CDC’s Morbidity and Mortality Weekly Report, is based on data from the National Youth Tobacco Survey. It found that 1.1 percent of students in grades 6 through 8 were using e-cigarettes at least once a month, as were 2.8 percent of students in grades 9 to 12.

Among these regular e-cigarette users, 76.3 percent also smoked traditional cigarettes. But the report’s authors — from the FDA’s Center for Tobacco Products and the CDC’s Office on Smoking and Health — seemed most concerned about the 20.3 percent of middle school students and 7.2 percent of high schoolers who had used e-cigarettes but not yet tried conventional cigarettes. The researchers estimated that 160,000 students across the country fell into that category.

“The risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products” among these students is a “serious concern,” they wrote.

A gateway?

One of the biggest concerns among health officials is the potential for e-cigarettes to become a path to smoking among young people who otherwise would not have experimented. The survey found that most students who had tried e-cigarettes had also smoked cigarettes.

But 1 in 5 middle school students who said they had tried e-cigarettes reported never having smoked a conventional cigarette, raising fears that e-cigarettes, at least for some, could become a gateway. Among high school students, 7 percent who had tried an e-cigarette said they had never smoked a traditional cigarette.

Frieden said the adolescent brain is more susceptible to nicotine, and the trend of rising use could hook young people who might then move into more harmful products like conventional cigarettes.

The sharp rise among students mirrored that among adult users, and researchers said it appeared to be driven, at least in part, by aggressive national marketing campaigns, some of which feature famous actors. (Producers say the ads are not aimed at adolescents.) E-cigarettes also come in flavors, which were banned in traditional cigarettes in 2009 and which health officials say appeal to young people.

“Kids love gadgets, and the marketing for these things is in your face,” said Gary Giovino, a professor of health behavior at the University at Buffalo.

He added that the rising use of e-cigarettes risked reversing societal trends in which smoking had fallen out of fashion.

Murray Kessler, chairman, president and chief executive of Lorillard Inc., a North Carolina-based tobacco company that owns Blu eCigs, said the rise in youth usage was “unacceptable,” adding that the company was “looking forward to a regulatory framework that restricts youth access” but that does not “stifle what may be the most significant harm-reduction opportunity that has ever been made available to smokers.”


Electronic cigarettes are not regulated by the FDA, though the agency has said it plans to bring the battery-powered devices under its jurisdiction. In the meantime, some cities are setting limits on their use.

If the idea is to nip e-cigs in the bud before they take off with consumers, it’s probably too late. One tobacco industry analyst from Wells Fargo Securities predicts Americans will spend $1.7 billion on e-cigarettes this year. That means experts at the FDA and CDC should get busy, the study authors wrote:

“Given the rapid increase in use and youths’ susceptibility to social and environmental influences to use tobacco, developing strategies to prevent marketing, sales, and use of e-cigarettes among youths is critical.”

The first study of teen use of electronic cigarettes shows middle and high school students smoking more of them — the rate doubled from 2011 to 2012, which is prompting concerns among health officials that the new devices could be creating as many health problems as they are solving.