Two distinct stories emerge from CDC survey on youth tobacco use

The annual National Youth Tobacco Survey (NYTS), released April 16 by the Centers for Disease Control and Prevention (CDC), shows significant drops in cigarette use and suggests dramatic progress in the battle against the traditional cigarette and, at the same time, indicates dramatic increases in uses of e-cigarettes and hookah.

"The data on cigarette use is a success story for the tobacco control community, and for public education campaigns like truth®," said Robin Koval, CEO and president of Truth Initiative, which runs the award-winning youth tobacco-education campaign truth. "Our campaigns, as well as those run by the Food and Drug Administration (FDA) and CDC, have targeted cigarettes and traditional combustible product use, and we see impressive declines in this data. It is a big deal that cigarette use is down among high schoolers and middle schoolers. When you compare this year’s numbers to those of last year, cigarette use at the high school level is 9.2 percent - that’s down 3.5 percentage points; a drop of more than 25 percent from last year’s NYTS survey and almost 42 percent since the 2011 survey."

"What that says to me," Koval says, "is that we can make this the generation that ends the tobacco epidemic. If we focus, this is a problem we can fix."

The NYTS data also showed a drop in cigar use. This was somewhat surprising given the Monitoring the Future data released last December by the National Institutes of Health, and what researchers at [Truth Initiative] see in terms of marketing and use of those unregulated products. "We remain concerned about unregulated little flavored cigars that we know appeal to young people – particularly urban and ethnic youth – and about menthol flavoring in any combustible form," said David B. Abrams, PhD, executive director of the Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative.

Dr. Abrams noted that flavors are also prominently associated with e-cigarettes and hookah. "We all have reason to be concerned about the jump in e-cigarette and hookah use shown in this survey,” Abrams said. “Both are nicotine products. In the case of hookah, the product is the lethal smoke and carbon monoxide form of combustible tobacco – no matter how it smells or that you smoke it via a water pipe. We need to be aggressive about protecting youth from exposure to all nicotine and tobacco in any form."

The FDA has taken its first steps to regulate e-cigarettes, hookah and cigars with draft regulations introduced a year ago. "If the steep increase in e-cigarette and hookah use by youth does anything, it should reinforce how important it is that the FDA finalize those regulations and move swiftly to get them into practice," Koval added.

There are limitations to the conclusions one can draw from NYTS data. "We need to carefully watch patterns of e-cigarette use," Abrams said. "Longitudinal studies like the National Institute of Health’s Population Assessment of Tobacco and Health and [Truth Initiative’s] Teen Longitudinal Cohort will be coming out in the next few years. Those studies will deepen our understanding of e-cigarette use and help us answer what are still open questions today as to whether e-cigarette use is a gateway to smoking combustible products or to lifelong nicotine addiction. While those questions remain, we want to be clear that we absolutely know that any nicotine use by youth is unacceptable."