The use of electronic cigarettes among middle and high school students has been growing rapidly, a trend that public health officials worry could undermine decades of efforts to reduce youth smoking and could put more teenagers on a path toward conventional cigarettes.
According to new by the Centers for Disease Control and Prevention, the percentage of middle and high school students in the United States who have used e-cigarettes more than doubled from 2011 to 2012.
"The increased use of e-cigarettes by teens is deeply troubling," CDC Director Tom Frieden said in a statement announcing findings from the National Youth Tobacco Survey. "Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."
The survey showed that the percentage of high school students who reported ever using an e-cigarette jumped from 4.7 percent in 2011 to 10 percent in 2012. Nearly 3 percent of those students reported using an e-cigarette in the past 30 days, up from 1.5 percent a year earlier. Use also doubled among middle school students, the CDC reported.
Perhaps most troubling for public health advocates, the survey also found that more than three-quarters of middle and high school students who had used e-cigarettes within the past month had smoked conventional cigarettes during the same period.
The CDC's findings are in line with a more recent survey conducted in Florida, which showed that more than 4 percent of middle-schoolers and 12 percent of high-schoolers had tried e-cigarettes -- figures that have risen dramatically over the past two years. E-cigarette use has also been booming in Europe.
Anti-smoking activists say the rise in the popularity of e-cigarettes -- battery-powered devices that do not burn tobacco but rather deliver nicotine, flavor and other chemicals in the form of a vapor -- has happened in part because the devices are largely unregulated.
Although the Food and Drug Administration has long said it intends to expand its regulatory authority over tobacco products to include e-cigarettes, the agency has yet to do so.
"FDA needs to act and act quickly to get a handle both on the product and its marketing," said Matthew Myers, president of the Campaign for Tobacco Free Kids.
Without that kind of regulation, Myers said, e-cigarette companies have been free to spend huge sums on marketing and to adopt advertising practices previously used by big tobacco companies.
"We have seen e-cigarettes marketed using exactly the same images in exactly the same places that the cigarette industry used decades ago," he said. "Open a magazine, and you'll see beautiful women and young celebrities marketing e-cigarettes. Go to NASCAR, and you'll see cars sponsored by e-cigarettes."
Those efforts to "re-glamorize smoking," Myers said, threaten to undo the efforts to cut down on youth smoking in the United States and could potentially create a new generation of smokers.
Proponents of e-cigarettes reject comparisons to traditional cigarettes, arguing that they contain nowhere near the amount of harmful substances that smokers inhale when smoking tobacco. They also have argued that rather than creating a slippery slope that could lead nonsmokers toward other tobacco products, e-cigarettes have the potential to help people wean themselves off conventional cigarettes.
The FDA's Center for Tobacco Products plans to assert its authority over e-cigarettes, its director said Thursday, in part because, without regulation, the agency has little way of knowing how safe or unsafe they are, how much nicotine or other chemicals are being inhaled by users, and whether the devices can help people quit smoking traditional cigarettes or lead them to try other tobacco products.
"We don't yet understand the long-term effects of these novel tobacco products," Mitch Zeller, the FDA's top tobacco official, said in a statement. "These findings reinforce why the FDA intends to expand its authority over all tobacco products and establish a comprehensive and appropriate regulatory framework to reduce disease and death from tobacco use."