Rise in Teen Hookah and E-Cigarette Use


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E-liquids which are used in e-cigarettes. Some studies have identified carcinogens in at least some e-cigarettes.

These are e-liquids which go in e-cigarettes. Some studies have identified carcinogens in at least some e-cigarettes. Image by Lauri Rantala.

According to recent reports from the Centers for Disease Control (CDC), smoking rates for teens are down. Instead, teens are getting their fixes from hookahs and electronic cigarettes, or e-cigarettes. The National Youth Tobacco Survey completed in 2012 indicates a decline of about one percentage point for both middle and high school students smoking rates-about 3.5% and 14%, respectively.  The report also indicates that 6.7% of middle schoolers and 23.3% of high schoolers identify themselves as tobacco users.

E-Cigarettes vs. Tobacco Smoke: Regular Cig Use Declining over the Years

There had been a steady decline of cigarette use among teens since the late nineties, most likely due to the Master Tobacco Settlement (MTA) of 1998. The MTA prohibited tobacco companies from targeting youth with ads, reduced cigarette use in Hollywood films and shows, and allowed states to fund tobacco prevention and cessation programs, some of which targeted youth. In the early 2000s, funding  slowly began dwindling for those prevention and cessation programs, occurring simultaneously with the introduction of new products by tobacco companies.

Alternatives to Traditional Cigarettes

Data indicates a rise from 4.1% of hookah use among teens in 2011 to 5.4% in 2012, according to the CDC. Furthermore, cigar use among African American teens has also increased dramatically from 2011 to 2012, rising from 11.7% to 16.7%. Among middle schoolers, 1.3% admitted to using a hookah with 1.1% self-identifying as e-cigarette users.

High school rates were noticeably higher, with 5.4% using hookahs and 2.8% using e-cigarettes.

Electronic Cigarettes: What are They?

According to information from the American Cancer Society, e-cigarettes are rechargeable, battery-operated heating devices which most often contain nicotine and other chemicals that use heat to convert the contents of the cartridge to a vapor, which the user then inhales. This is not identified by the U.S. Food and Drug Administration (FDA) as a tobacco product and is not regulated by the FDA at this time. It is likely that e-cigarettes will fall under FDA regulation in the near future, but without these policies in place now, youth have easier access to them than other tobacco products such as cigarettes.

Also gaining popularity, but using a different vehicle for nicotine, are hookahs. According to the American Cancer Society, hookahs, also known as water-pipes, are bowl-shaped devices with a tubular pipe. Charcoal-heated air passes through a tobacco mixture, through a chamber filled with water, than ultimately through the pipe and inhaled by the user. Hookah bars typically offer a wide variety of flavors, making those spots an appealing option for teens who want to socialize with friends.

E-Cigarette Risks and Health Effects

While some argue that e-cigarettes and hookahs aren’t as harmful as cigarettes, some evidence shows that this is not the case. Long-term studies have not been complete yet to show what effects e-cigarettes have, but initial lab test results by the FDA have shown detectable levels of carcinogens, which are cancer-causing agents, in the electronic cigarettes.  Hookahs may actually have more risks associated with them than cigarettes due to exposure to a greater volume of smoke, as most hookah sessions average about sixty minutes in length.

Tobacco and Youth: The Bottom Line

There is no known amount of tobacco use that is considered to be risk-free. Tobacco companies are targeting youth with newer options and more flavorings, making the use of nicotine products appealing. Tobacco use remains a significant problem and is the leading cause of death, disability and disease in the United States, according to the CDC.


American Cancer Society. E-Cigarettes, Hookahs Gain Popularity Among US Youth. Accessed November 17, 2013. 

American Cancer Society. Restrict the Sale of Electronic Cigarettes. Accessed November 17, 2013.

American Cancer Society. E-Cigarettes. Accessed November 17, 2013.

American Cancer Society. Hookahs are trendy, but are they safe? Accessed November 17, 2013.

American Lung Association. Children and Teens. Accessed November 17, 2013.

Mayo Clinic. Is hookah smoking safer than smoking cigarettes? Accessed November 17, 2013.

Kaplan, Karen. Cigars, e-cigarettes and hookahs increasingly popular among youth: study. thespec.com. Accessed November 17, 2013.

Sifferlin, Alexandra.  Teens and Tobacco Use: Why Declines in Youth Have StalledTime Magazine. Accessed November 17, 2013.

Koch, Wendy. Fewer teens smoke but more use e-cigarettes, hookahs. USA Today. Accessed November 17, 2013.

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