Survey Shows Sharp Rise in Teen E-Cigarette Use

Juul e-cigarette device (Mylesclark96, Wikimedia Commons)

15 Nov. 2018. New data from a continuing survey of smoking among school-age children shows large increases in electronic cigarette use in high school and middle school children in just the past year. The data are reported today by Centers for Disease Control and Prevention, or CDC, and sparked a robust response from the Food and Drug Administration commissioner Scott Gottlieb.

Electronic cigarettes, or e-cigarettes, are battery-powered nicotine delivery devices, that heat a liquid containing nicotine, moisturizing and flavoring agents, as well as preservatives and artificial coloring. Makers of e-cigarettes often market the devices as safer alternatives to tobacco-burning cigarettes and sometimes as a technique to help tobacco smokers quit conventional cigarettes.

The data were collected as part of the National Youth Tobacco Survey, a continuing study conducted by CDC to document long-term trends in smoking in school-age children, and reported today in CDC’s Morbidity and Mortality Weekly Report. The results show the number of e-cigarette users in high school rose 78 percent to more than 3 million, or about 21 percent of all high school students, since the last survey in 2017. Even among middle school students, e-cigarette smoking jumped by 48 percent in the past year to 570,000 or about 5 percent of all middle school students.

Before 2017, says the CDC report, e-cigarette use by school-age children was declining, and the new marked increase in e-cigarettes is reflected in rising overall use of tobacco by this part of the population. Tobacco use of any kind among high-school students rose in the past year by 38 percent to 4 million, and among middle-schoolers, tobacco use increased by 29 percent to 840,000.

The CDC report authors point to aspects of e-cigarette design that appeal to school-age children for their new popularity. One company, Juul, designs e-cigarettes that resemble flash drives, making them easier to conceal. The authors note also that Juul devices transfer higher quantities of nicotine and use sweet flavors popular with children. An August 2018 report in Vox.com cites data showing large increases in Juul sales in the past 2 years, making up more than half of all units sold, while sales of other e-cigarette devices are declining.

Since June, FDA issued more than 1,300 warning letters and fines to retailers selling Juul devices to minors and in September — after receiving a preview of today’s data release — began a campaign to reduce teen e-cigarette use. Also in September, FDA asked e-cigarette manufacturers to voluntarily stop offering e-cigarette products in flavors considered attractive to children, limiting flavors to mint and menthol already associated with tobacco.

FDA Commissioner Scott Gottlieb says today in an agency statement, those voluntary steps do not go far enough. He asked FDA’s Center for Tobacco Products to revisit the policy and come up with new measures to prevent children from starting use of e-cigarettes, including stronger age restrictions and verification. While e-cigarettes should still be available for combustible cigarette smokers looking for alternatives, says Gottlieb, e-cigarettes should not be vehicles for recruiting non-smokers, particularly as children. And to reduce flavored options for tobacco, Gottlieb proposed new regulations prohibiting menthol flavored combustible cigarettes and cigars.

In the statement, Gottlieb notes that “the bottom line is this: I will not allow a generation of children to become addicted to nicotine through e-cigarettes. We won’t let this pool of kids, a pool of future potential smokers, of future disease and death, to continue to build. We’ll take whatever action is necessary to stop these trends from continuing.”

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