Use of E-Cigarettes Rises Sharply Among Teenagers, Report Says
The New York Times
By Sabrina Tavernise
Kenny, a high school senior in Weston, Fla., likes to puff e-cigarettes during study sessions with friends after school. James, a senior in Fauquier County, Va., uses them outside at lunch with friends who do smoke tricks. Tom, a sophomore from Westchester County, uses them while hiking with friends.
E-cigarettes have arrived in the life of the American teenager.
Use of the devices among middle- and high school students tripled from 2013 to 2014, according to federal data released on Thursday, bringing the share of high school students who use them to 13 percent — more than smoke traditional cigarettes.
About a quarter of all high school students and 8 percent of middle school students — 4.6 million young people altogether — used tobacco in some form last year. The sharp rise of e-cigarettes, together with a substantial increase in the use of hookah pipes, led to 400,000 additional young people using a tobacco product in 2014, the first increase in years, though researchers pointed out the percentage of the rise fell within the report’s margin of error.
But the report also told another story. From 2011 to 2014, the share of high school students who smoked traditional cigarettes declined substantially, to 9 percent from 16 percent, and use of cigars and pipes ebbed too. The shift suggested that some teenage smokers may be using e-cigarettes to quit.
Smoking is still the single-biggest cause of preventable death in the United States, killing more than 480,000 Americans a year, and most scientists agree that e-cigarettes, which deliver the nicotine but not the dangerous tar and other chemicals, are likely to be far less harmful than traditional cigarettes.
The numbers came as a surprise and seemed to put policy makers into uncharted territory. The Food and Drug Administration took its first tentative step toward regulating e-cigarettes last year, but the process is slow, and many experts worry that habits are forming far faster than rules are being written. Because e-cigarettes are so new, scientists are still gathering evidence on their long-term health effects, leaving regulators scrambling to gather data.
In interviews, teenagers said that e-cigarettes had become almost as common at school as laptops, a change from several years ago, when few had seen them.
“It’s the healthy alternative taking over my school,” said Tom, a 15-year-old sophomore at a school in Westchester County, N.Y., who started vaping — the term for puffing on an e-cigarette — to kick a smoking habit. He said about 70 percent of his friends now vaped.
But opinions were mixed on why the devices had caught on. A significant share said they were using the devices to quit smoking cigarettes or marijuana, while others said they had never smoked but liked being part of the trend and enjoyed the taste. Two favorite flavors of teenagers interviewed were Sweet Tart and Unicorn Puke, which one student described as “every flavor Skittle compressed into one.”
James, 17, the senior in Virginia, said he and his friends started using e-cigarettes when he was 13, after his father abandoned the devices in a failed effort to quit smoking.
“It was something for us to do that was edgy and exciting,” said James, who asked that his last name not be used because he did not want his smoking habits to be on public display. He liked the smoke tricks that his friends had become good at, like blowing out the vapor so that it spun like a tornado. His favorite flavor is called Hawk Sauce, which he described as “a berry menthol kind of thing.”
He has never smoked cigarettes and said he could not imagine ever starting. “There’s a harshness to cigarettes,” he said. “Girls think they’re gross.”
E-cigarette use had grown exponentially in previous years, but from such a low base that the numbers had been relatively small. But last year’s rise, which was captured in the Centers for Disease Control and Prevention’s annual youth tobacco survey of about 20,000 schoolchildren, lifted e-cigarette use above that of traditional cigarettes, prompting an outcry from anti-tobacco advocates. They warned that e-cigarettes were undoing years of progress among the country’s most vulnerable citizens by making the act of puffing on a tobacco product normal again, and by introducing nicotine, an addictive substance, to a broad population of teenagers.
“This is a really bad thing,” said Dr. Thomas R. Frieden, the director of the C.D.C., who noted that research had found that nicotine harms the developing brain. “This is another generation being hooked by the tobacco industry. It makes me angry.”
But the numbers had a bright side. The decline in cigarette use among teenagers accelerated substantially from 2013 to 2014, dropping by 25 percent, the fastest pace in years.
The pattern seemed to go against the dire predictions of anti-tobacco advocates that e-cigarettes would become a gateway to cigarettes among youths, and suggested they might actually be helping, not hurting. The pattern resembled those in Sweden and Norway, where a rise in the use of snus, a smokeless tobacco product, was followed by a sharp decline in cigarette use.
“They’re not a gateway in, and they might be accelerating the gateway out,” said David B. Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies, an anti-tobacco group.
Some teenagers described vaping as an entirely different culture from cigarette smoking, and scoffed at the idea that it could be a way into cigarettes. Kenny, the senior from Florida, said students liked the mix-and-match accessories that a user could “personalize and call your own.”
“E-cigarettes appeal less towards the stereotypical longhaired stoners, and more towards sweatshirt-blue-jeans Silicon Valley programmer,” said Kenny, who asked that his last name not be published to keep his vaping habits private. “You can compare them to Apple computers.”
Selling e-cigarettes to minors is banned in many states, and the rule the F.D.A. proposed last year would ban it nationally.
But the proliferation of vape shops and equipment for sale online has made access easy, and some teenagers said they simply clicked a button to indicate they were over 18 to be able to order a starter kit. (E-cigarette equipment includes batteries that can be shaped like cigarettes or a cellphone; liquid reservoirs, known as tanks; cartridges; and battery chargers.)
Ethan deLehman, 17, a junior at a private school in Pennsylvania, said he used to ask seniors who were 18 to buy him e-cigarettes at convenience stores, but now he has equipment and buys his liquids on the Internet.
“You can just go online and click yes,” he said. He has used e-cigarettes to quit smoking, a habit he picked up to relieve the pressure over getting into college. His favorite flavors are Caramel Tobacco and Creamsicle.
A starter e-cigarette kit can begin around $40 and go up to $200 or more, with the fluid costing from $7 to $20 a bottle. That can be less expensive than smoking over the long run, particularly in states like New York where the cost of a pack of cigarettes is high, young people said. Alexander Wilson started smoking cigarettes when he was 15. He said that e-cigarettes helped him cut down and save money. “It’s cheaper over all for how much I smoke,” said Mr. Wilson, who lives in Frederick, Md.
He recalled seeing one of the e-cigarette devices for the first time. “I was like, ‘Dude, why do you have a light saber?’ ” he said. “And he was like, ‘No, that’s my e-cigarette.’ ”