North Carolina teens are smoking fewer cigarettes but are consuming more electronic cigarettes and hookahs, according to the latest N.C. Youth Tobacco Survey released Friday.
Researchers found that while the rate of teen cigarette smoking is lower than ever before, overall tobacco use among high school students jumped from 25.8 percent to 29.7 percent from 2011 to 2013.
Cigarette smoking dropped 13 percent among high school students during that time and 40 percent among middle school students. Now, 2.5 percent of North Carolina middle school students and 13.5 percent of high school students smoke cigarettes.
But other tobacco products are increasingly popular, including hookah – water pipes that use flavored tobacco – and electronic cigarettes. The survey found that electronic cigarette use among North Carolina high school students increased 352 percent, from 1.7 percent of students in 2011 to 7.7 percent in 2013.
Hookah use more than doubled among high school students, to 6.1 percent.
Almost one-fifth of all teen tobacco consumers say they use two or more forms of tobacco. Ten percent of high school students said they are considering using electronic cigarettes – also known as “vaping” – in the next year, and nearly 11 percent said they might try hookah.
“We celebrate the decline in cigarette smoking,” said Dr. Ruth Petersen, chief of the Chronic Disease and Injury Section in the N.C. Division of Public Health. “However, this trend toward other tobacco use and dual use of tobacco products is a real cause for concern.”
In North Carolina, it is illegal for anyone under the age of 18 to buy tobacco products, tobacco-derived products or vapor products, which include e-cigarettes and hookah.
The tobacco use survey is released by the state Department of Health and Human Services and has been conducted every two years since 1999. In 2013, more than 8,000 middle and high school students responded to the survey.
The survey has found a long-term decline in smoking among teens. The percentage of high school students who said they smoke cigarettes has dropped from 31.6 percent in 1999 to 13.5 percent last year.
Statewide numbers reflect a national trend. Nationwide, cigarette smoking among teens decreased dramatically in last decade, to 5.6 percent in 2013, down from 13 percent in 2002, according to the Substance Abuse and Mental Health Services Administration’s 2013 National Survey on Drug Use and Health. The national survey did not account for electronic cigarettes or hookah.
Despite the decline of cigarette use, anti-smoking advocates are concerned. Electronic cigarettes, which contain liquid nicotine, and hookah are both highly addictive.
Using nicotine during adolescence could harm brain development, Petersen said, and hookah and electronic cigarettes are new ways to deliver it. Hookah pens are e-cigarettes that look like writing pens, and are increasingly popular with younger teens.
“It is clear that young people do not understand the addictive nature or the potential harms of these products.” Petersen said. “I keep hearing of young people around the state describing e-cigarettes as nothing but flavored water vapor, when that is far from the truth.”