One out of 10 American high school students used electronic cigarettes in 2012, along with nearly 3% of middle school students, according to a new federal report. That's about double the rate of e-cigarette use in 2011 and translates into 1.78 million children and teens who have tried the battery-powered devices.
The sharp increase has public health experts worried. Electronic cigarettes contain the addictive chemical nicotine and traces of cancer-causing compounds called nitrosamines. The safety profile of the devices has not been fully studied, according to warnings from the Food and Drug Administration.
In addition, e-cigarettes are sold with cartridges that give them enticing flavors such as mint or chocolate, and health advocates fear they have the potential to turn teens on to regular cigarettes.
"The increased use of e-cigarettes by teens is deeply troubling," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said in a statement. "Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."
The new study, published in Friday's edition of the CDC's Morbidity and Mortality Weekly Report, is based on data from the National Youth Tobacco Survey. It found that 1.1% of students in grades 6 through 8 were using e-cigarettes at least once a month, as were 2.8% of students in grades 9 to 12.
Among these regular e-cigarette users, 76.3% also smoked traditional cigarettes. But the report's authors — from the FDA's Center for Tobacco Products and the CDC's Office on Smoking and Health — expressed particular concern about students who had used e-cigarettes but had not yet tried conventional cigarettes. The researchers estimated that 160,000 students across the country fell into that category.
"The risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products" among these students is a "serious concern," they wrote.
Cigarette smoking is responsible for more than 440,000 deaths each year, including 49,400 due to secondhand smoke, according to the CDC. Tobacco use is the No. 1 cause of preventable death in the U.S., and it contributes to cancers of the lung and other organs, cardiovascular disease and respiratory ailments.
Electronic cigarettes are not regulated by the FDA, though the agency has said it plans to bring them under its jurisdiction.
The American Lung Assn. has been a consistent advocate for FDA regulation of e-cigarettes.
"When you see cotton candy, bubble gum and atomic fireball flavors, there's no question these products are being marketed directly at kids," said Erika Sward, the group's vice president for national advocacy. "I think this data really shows our concerns are real."
E-cigarette manufacturers insist that they are not marketing the devices to minors.
Tom Kiklas, the chief financial officer of the Tobacco Vapor Electronic Cigarette Assn., said a federal appeals court ruled in 2010 that e-cigarettes were not medical devices and should instead be considered tobacco products. As such, their sale to minors is prohibited by law, and it's the responsibility of retailers to ensure that buyers are of legal age, he said.
"Kids aren't supposed to be buying any tobacco product," Kiklas said.
The American Thoracic Society, like the American Lung Assn., has criticized e-cigarette manufacturers for marketing their products as a means to help people quit smoking.
"These products are not approved by the FDA as smoking cessation devices," said society spokesman Gary Ewart.
If the FDA intends to restrict access to e-cigarettes before they take off with consumers, it's probably too late. One tobacco industry analyst from Wells Fargo Securities predicts Americans will spend $1.7 billion on e-cigarettes this year.
That means public health authorities should get busy, according to the authors of the new study.
"Given the rapid increase in use and youths' susceptibility to social and environmental influences to use tobacco, developing strategies to prevent marketing, sales, and use of e-cigarettes among youths is critical," they wrote.