Intended for healthcare professionals


E-cigarette use doubles among US middle and high school students

BMJ 2013; 347 doi: (Published 11 September 2013) Cite this as: BMJ 2013;347:f5543
  1. Michael McCarthy
  1. 1Seattle

Use of electronic cigarettes by US middle and high school students more than doubled from 2011 to 2012, the Centers for Disease Control and Prevention has reported.1

The CDC’s report says that the proportion of students in grades 6-12 who reported having ever used an e-cigarette rose from 3.3% in 2011 to 6.8% in 2012 (P<0.05).

The proportion who were current users (those who had used an e-cigarette on one or more days in the past month) rose from 1.1% to 2.1% (P<0.05).

The proportion of high school students who had ever used an e-cigarette rose from 4.7% to 10% from 2011 to 2012 (P<0.05), while current use among these older students rose from 1.2% to 2.8% (P<0.05).

Of those middle and high school students who had tried an e-cigarette in 2011 at least once, 9.3% reported never having smoked conventional cigarettes. Of those who had used an e-cigarette at least once in the past month, 76.3% reported being current smokers of conventional cigarettes.

E-cigarettes are battery powered devices that generate a nicotine containing vapor that can be inhaled by the user. The vapor is often flavored, which can make them more appealing to young people, and there is concern that e-cigarette use will lead young non-smokers to take up cigarettes or other tobacco products.

In a statement released with the report the CDC’s director, Tom Frieden, called the increasing use of e-cigarettes by young US students “deeply troubling.”

He said, “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.”

Currently the FDA regulates e-cigarettes if they are marketed for therapeutic purposes. Some products, for example, have been marketed as smoking cessation devices. Otherwise, the sale and use of e-cigarettes remains largely unregulated, and minors can easily obtain them.

However, the FDA is formulating new regulations that would extend its authority to regulate tobacco products, which currently applies only to conventional cigarettes, cigarette tobacco, roll your own tobacco, and smokeless tobacco. The new rules will expand the FDA regulatory authority to additional categories of tobacco products, such as e-cigarettes containing nicotine, but the agency said that it could not yet comment on the specifics of the proposed rules, which would have to undergo a period of public comment before being adopted.


Cite this as: BMJ 2013;347:f5543


  • News: E-cigarettes as good as patches in helping to reduce smoking, study concludes (BMJ 2013;347:f5505, doi:10.1136/bmj.f5505); Observations: Big Tobacco lights up e-cigarettes (BMJ 2013;346:f3418, doi:10.1136/bmj.f3418); Feature: Electronic cigarettes: medical device or consumer product? (BMJ 2012;345:e6417, doi:10.1136/bmj.e6417); Head to Head: Should electronic cigarettes be as freely available as tobacco? (BMJ 2013;346:f3845, doi:10.1136/bmj.f3845; 2013;346:f3840, doi:10.1136/bmj.f3840)


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