E-cigarette use among teens is on the rise

Sweet flavors like candy crush, bubble gum and crème brulee are the reasons more than three million middle and high school students in the U.S. reported using e-cigarettes in 2017. The proportion of flavored tobacco product among current youth tobacco users increased to 64 percent in 2017 from 58 percent in 2016, reversing a downward trend in the previous year.

“Although characterizing flavors other than menthol in cigarettes is prohibited in the U.S., there are no restrictions on the marketing and sales of flavored non-cigarette tobacco products,” said Hongying (Daisy) Dai, Ph.D., associate professor, biostatistics, College of Public Health. “As a result, flavored non-cigarette tobacco products are widely available and flavoring has become one of the leading reasons for current tobacco use among youth.”

The trend was one of the results Dr. Dai recently published in a data analysis of the National Youth Tobacco Survey, a cross-sectional and school-based annual survey of middle school and high school students in the United States. The results were announced in a research letter last month in the Journal of the American Medical Association Pediatrics.

Dr. Dai assessed youth tobacco use for more than 78,000 students in the years 2014-2017. The results show that flavor use in other tobacco products decreased or leveled off, flavored e-cigarette use continued to increase from 2015 to 2017. This study also found that Caucasian high school girls who use more than one tobacco product had the highest risk of reporting flavored tobacco use.

“Flavored tobacco products could serve as a starter kit for smoking because adolescents often experiment with smoking in pursuit of curiosity and novelty,” she said.

One of the most popular e-cigarettes on the market is Juul, a company that is now worth $16 billion and accounts for 70 percent of e-cigarette sales. Juul looks like a flash drive, and one pod, or cartridge, of flavored liquids contains an amount of nicotine roughly equivalent to a pack of cigarettes, causing teenagers who have never smoked a cigarette to become swiftly addicted.

“It is troubling that flavored e-cigarette use continued to increase among youth,” Dr. Dai said. “The brain is still developing during the teen years and e-cigarette use could increase the subsequent risk of cigarette smoking and marijuana use among youth. Also, concerns have been raised about the potential inhalation toxicity of flavoring.”