Kenny, a high school senior in Weston, Florida, likes to puff e-cigarettes during study sessions with friends after school. James, a senior in Fauquier County, Virginia, uses them outside at lunch with friends who do smoke tricks. Joe, a senior in Jackson, Mississippi, uses them in the morning before class as a coffee-flavoured way to pass the time.
E-cigarettes have arrived in the life of the American teenager.
Use of the devices among middle-and-high school students tripled from 2013 to 2014, according to federal data released last week, bringing the share of high school students who use them to 13% — more than smoke traditional cigarettes.
About a quarter of all high school students and 8% of middle school students — 4.6 million young people altogether — used tobacco in some form last year. The sharp rise of e-cigarettes, together with a substantial increase in the use of hookah pipes, led to 400,000 additional young people using a tobacco product in 2014, the first increase in years, though researchers pointed out the percentage of the rise fell within the report’s margin of error.
But the report also told another story. From 2011 to 2014, the share of high school students who smoked traditional cigarettes declined substantially, to 9% from 16%, and use of cigars and pipes ebbed too. The shift suggested that some teenage smokers may be using e-cigarettes to quit.
Smoking is still the single-biggest cause of preventable death in the United States, killing more than 480,000 Americans a year, and most scientists agree that e-cigarettes, which deliver the nicotine but not the dangerous tar and other chemicals, are likely to be far less harmful than traditional cigarettes.
The numbers came as a surprise and seemed to put policymakers into uncharted territory. The US Food and Drug Administration took its first tentative step toward regulating e-cigarettes last year, but the process is slow and many experts worry that habits are forming far faster than rules are being written. Because e-cigarettes are so new, scientists are still gathering evidence on their long-term health effects, leaving regulators scrambling to gather data.
In interviews, teenagers said that e-cigarettes had become almost as common at school as laptops, a change from several years ago, when few had seen them.
“It’s the healthy alternative taking over my school,” said a 15-year-old sophomore at a school in Westchester County, New York, who started vaping — the term for puffing on an e-cigarette — to kick a smoking habit. He said about 70% of his friends now vaped. But opinions were mixed on why the devices had caught on.
A significant share said they were using the devices to quit smoking cigarettes or marijuana, while others said they had never smoked but liked being part of the trend and enjoyed the taste. Two favourite flavours of teenagers interviewed were Sweet Tart and Unicorn Puke, which one student described as “every flavour Skittle compressed into one”.
Joe Stevonson, 18, a senior at a high school in Jackson, Mississippi, said he used e-cigarettes to quit smoking, after the habit started affecting his ability to play sports. He prefers a flavour called Courtroom, endorsed by the rapper Lil Ugly Mane, which is described on websites where it is sold as “a medley of things you might want while waiting for the jury to convict.”
As for whether he still craved cigarettes, “the only thing that’s really missing is feeling like your entire mouth is coated in dirt,” he said. “I’ve seen a lot of people who don’t smoke pick them up because it looks cool. But for every person I’ve met like that, I’ve met another using it like it’s a medicine against cigarettes.”
James, a senior in Virginia, said he and his friends started using e-cigarettes when he was 13, after his father abandoned the devices in a failed effort to quit smoking.
“It was something for us to do that was edgy and exciting,” said James, who asked that his last name not be used because he did not want his smoking habits to be on public display. He liked the smoke tricks that his friends had become good at, like blowing out the vapour so that it spun like a tornado. His favourite flavour is called Hawk Sauce, which he described as “a berry menthol kind of thing”.
He has never smoked cigarettes and said he could not imagine ever starting. “There’s a harshness to cigarettes,” he said. “Girls think they’re gross.”
E-cigarette use had grown exponentially in previous years, but from such a low base that the numbers had been relatively small. But last year’s rise, which was captured in the Centers for Disease Control and Prevention’s annual youth tobacco survey of about 20,000 schoolchildren, lifted e-cigarette use above that of traditional cigarettes, prompting an outcry from anti-tobacco advocates. They warned that e-cigarettes were undoing years of progress among the country’s most vulnerable citizens by making the act of puffing on a tobacco product normal again, and by introducing nicotine, an addictive substance, to a broad population of teenagers.
“This is a really bad thing,” said Dr Thomas R. Frieden, the director of the CDC, who noted that research had found that nicotine harms the developing brain. “This is another generation being hooked by the tobacco industry. It makes me angry.”
But the numbers had a bright side. The decline in cigarette use among teenagers accelerated substantially from 2013 to 2014, dropping by 25%, the fastest pace in years.
The pattern seemed to go against the dire predictions of anti-tobacco advocates that e-cigarettes would become a gateway to cigarettes among youths, and suggested they might actually be helping, not hurting. The pattern resembled those in Sweden and Norway, where a rise in the use of snus, a smokeless tobacco product, was followed by a sharp decline in cigarette use.
“They’re not a gateway in, and they might be accelerating the gateway out,” said David B. Abrams, executive director of the Schroeder Institute for Tobacco Research and Policy Studies, an anti-tobacco group.