Public Release: 

Electronic cigarettes gaining in popularity among teens

Survey data also show many adolescents use more than one tobacco product

American Academy of Pediatrics

SAN DIEGO - Teens no longer smoke just cigarettes. They have branched out to using alternative tobacco products such as electronic cigarettes, hookahs and little cigars. In fact, e-cigarette use is rising rapidly among both cigarette smokers and nonsmokers, according to a study to be presented Sunday, April 26 at the Pediatric Academic Societies (PAS) annual meeting in San Diego.

"Electronic cigarettes are of great concern. They are highly addictive nicotine delivery devices, and the vapor can and does cause harm to lungs," said principal investigator Jonathan D. Klein, MD, MPH, FAAP, director of the AAP Julius B. Richmond Center of Excellence and associate executive director of the American Academy of Pediatrics (AAP).

Data for the national study were collected from 142 pediatric practices participating in a randomized, controlled trial to improve the quality of services to help teens stop smoking. Youths ages 14 and older who went to one of the practices for a checkup or a non-urgent sick visit in 2012-2014 were recruited to fill out a survey about their tobacco use. The questionnaire asked whether they had ever used cigarettes, e-cigarettes, hookahs, chewing tobacco or small cigars/cigarillos. Data from 10,405 teens were analyzed to identify trends in use.

Results showed traditional cigarettes were the most common tobacco product used by adolescents (22 percent of teens), followed by hookah (13 percent) and electronic cigarettes (10 percent).

E-cigarette use rose from 8 percent of teens in 2012 to 11 percent in 2014. Use of electronic cigarettes was especially high among those who also smoked traditional cigarettes (56 percent in 2014).

Hookah use was 9 percent to 10 percent for nonsmokers in each year, and fell among smokers from 62 percent in 2012 to 47 percent in 2014.

Rates of chewing tobacco and small cigar/cigarillo use did not change significantly over time.

"Adolescent use of alternative tobacco products is problematic among current smokers, as it may prolong or worsen nicotine addiction," Dr. Klein said. "It is also problematic among nonsmokers, as it may serve as a gateway to further tobacco use and nicotine addiction."

Gender and age group differences were found in the use of all four alternative tobacco products:

  • E-cigarettes were used more by older youths than younger teens, and more by males than females.
  • Hookah use was more prevalent among older youths. In 2014, nonsmoking females reported higher use than males.
  • Chewing tobacco use was higher in older teens and males.
  • Little cigars/cigarillos were used more by older adolescents and males.

"Our study shows that e-cigarette use is increasing rapidly, and this should be a wake-up call for regulating these devices along with all other tobacco products," Dr. Klein said. "In addition, tobacco screening, which should be performed at every clinical visit, needs to evolve to include questions about e-cigarettes and other alternative products."

Study author Julie Gorzkowski, MSW, will present "Trends in Youth Use of E-Cigarettes and Alternative Tobacco Products" from 9-9:15 a.m. PT Sunday, April 26. To view the study abstract, go to


This study was supported by a grant from the National Cancer Institute (R01-CA140576) and was conducted through the AAP Pediatric Research in Office Settings network.

The Pediatric Academic Societies (PAS) are four individual pediatric organizations that co-sponsor the PAS Annual Meeting - the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics. Members of these organizations are pediatricians and other health care providers who are practicing in the research, academic and clinical arenas. The four sponsoring organizations are leaders in the advancement of pediatric research and child advocacy within pediatrics, and all share a common mission of fostering the health and well-being of children worldwide. For more information, visit Follow news of the PAS meeting on Twitter at @PASmeeting and Facebook at Use hashtag #PASMEETING.

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