Teens Are Switching to Electronic Cigarettes as Tobacco Decline Stalls

The widespread switch from regular to electronic cigarettes among teens has alarmed public health officials, who say nicotine in any form can harm brain development.

The generation long decline in use of tobacco among teenagers has stalled, but habits are changing as teens are moving away from regular cigarettes to electronic ones, for reasons that may have to do with price as much as health.

Data released today by CDC show that in 2015, 4.7 million US middle and high school students were using a tobacco product, which includes e-cigarettes under the public health agency’s definition. There has been no change in the overall use of tobacco products from 2011 to 2015, based on data collected in the National Youth Tobacco Surveys, but there has been a dramatic shift in which products teenagers use.

E-cigarettes are by far the most popular product among both high school and middle school students, with 12.8% of girls and 19% of boys using them in high school. In middle school, 4.8% of girls and 5.9% of boys used e-cigarettes. By contrast, regular cigarettes are used by 7.7% of high school girls and 10.7% of high school boys; 2.2% of girls and 2.3% of boys use regular cigarettes in middle school.

Teenagers call the practice “vaping” instead of smoking, but it’s not clear the preference for e-cigarettes has anything to do with health. High cigarette taxes in most states have had their desired effect, as teenagers are staying away from the product. But instead, they are turning to a different vehicle to deliver nicotine, which is highly addictive and may have harmful effects on brain development.

While some see e-cigarettes as a helpful tool for long-term smokers trying to quit, other health experts are alarmed at their soaring popularity among youth. “It is critical that comprehensive tobacco control and prevention strategies for youths address all tobacco products and not just cigarettes,” the authors wrote in today’s report.

Experts who took part in a session on tobacco control at the recent meeting of the American College of Cardiology were divided on this point, with K. Michael Cummings, PhD, MPH, of the Medical University of South Carolina firmly in the camp that the harm outweighed any potential benefit.

There has been great concern that increased availability of marijuana, which is now legal for recreational use in several states, would mean that teens would turn to this drug instead. However, a study by Johns Hopkins released in September 2015 found that overall use among teens was actually down.

E-cigarettes remain easily available and states are still figuring out how or whether to tax them. A survey of states in 2015 found that 22 were weighing some form of tax, but many were unsure how to proceed.


Singh T, Arrazola RA, Corey CG, et al. Tobacco use among middle and high school students—United States, 2011-2015. MMWR. 2016; 65(14):361-367.

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