Notes from the field: electronic cigarette use among middle and high school students — united states, 2011-2012

Electronic cigarettes, or e cigarettes, are battery powered devices that provide doses of nicotine and other additives to the user in an aerosol. Depending on the brand, e cigarette cartridges typically contain nicotine, a component to produce the aerosol (e.g., propylene glycol or glycerol), and flavorings (e.g., fruit, mint, or chocolate) (1). Potentially harmful constituents also have been documented in some e cigarette cartridges, including irritants, genotoxins, and animal carcinogens (1). E cigarettes that are not marketed for therapeutic purposes are currently unregulated by the Food and Drug Administration, and in most states there are no restrictions on the sale of e cigarettes to minors. Use of e cigarettes has increased among U.S. adult current and former smokers in recent years (2) however, the extent of use among youths is uncertain.

Data from the 2011 and 2012 National Youth Tobacco Survey (NYTS), a school based, pencil and paper questionnaire given to U.S. middle school (grades 6 8) and high school (grades 9 12) students, were used to estimate the prevalence of ever and current ( 1 day in the past 30 days) use of e cigarettes, ever and current ( 1 day in the past 30 days) use of conventional cigarettes, and use of both. NYTS consists of a cross sectional, nationally representative sample of students in grades 6 12 from all 50 states and the District of Columbia (3).

During 2011 2012, among all students in grades 6 12, ever e cigarette use increased from 3.3&#37 to 6.8&#37 (p<0.05) (Figure) current e cigarette use increased from 1.1&#37 to 2.1&#37 (p<0.05), and current use of both e cigarettes and conventional cigarettes increased from 0.8&#37 to 1.6&#37 (p<0.05). In 2012, among ever e cigarette users, 9.3&#37 reported never smoking conventional cigarettes among current e cigarette users, 76.3&#37 reported current conventional cigarette smoking.

Among middle school students, ever e cigarette use increased from 1.4&#37 to 2.7&#37 during 2011 2012 (p<0.05) (Figure) current e cigarette use increased from 0.6&#37 to 1.1&#37 (p<0.05), and current use of both e cigarettes and conventional cigarettes increased from 0.3&#37 to 0.7&#37 (p<0.05). In 2012, among middle school ever e cigarette users, 20.3&#37 reported never smoking conventional cigarettes among middle school current e cigarette users, 61.1&#37 reported current conventional cigarette smoking.

Among high school students, ever e cigarette use increased from 4.7&#37 to 10.0&#37 during 2011 2012 (p<0.05) (Figure) current e cigarette use increased from 1.5&#37 to 2.8&#37 (p<0.05), and current use of both e cigarettes and conventional cigarettes increased from 1.2&#37 to 2.2&#37 (p<0.05). In 2012, among high school ever e cigarette users, 7.2&#37 reported never smoking conventional cigarettes among high school current e cigarette users, 80.5&#37 reported current conventional cigarette smoking.

E cigarette experimentation and recent use doubled among U.S. middle and high school students during 2011 2012, resulting in an estimated 1.78 million students having ever used e cigarettes as of 2012. Moreover, in 2012, an estimated 160,000 students who reported ever using e cigarettes had never used conventional cigarettes. This is a serious concern because the overall impact of e cigarette use on public health remains uncertain. In youths, concerns include the potential negative impact of nicotine on adolescent brain development (4), as well as the risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products.

CDC and the Food and Drug Administration will continue to explore ways to increase surveillance and research on e cigarettes. Given the rapid increase in use and youths’ susceptibility to social and environmental influences to use tobacco, developing strategies to prevent marketing, sales, and use of e cigarettes among youths is critical.

Reported by

Catherine Corey, MSPH, Baoguang Wang, MD, Sarah E. Johnson, PhD, Benjamin Apelberg, PhD, Corinne Husten, MD, Center for Tobacco Products, Food and Drug Administration. Brian A. King, PhD, Tim A. McAfee, MD, Rebecca Bunnell, PhD, Ren A. Arrazola, MPH, Shanta R. Dube, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor Brian A. King, baking , 770 488 5107.


  1. Cobb NK, Byron MJ, Abrams DB, Shields PG. Novel nicotine delivery systems and public health the rise of the «e cigarette.» Am J Public Health 2010 100 2340 2.
  2. King BA, Alam S, Promoff G, Arrazola R, Dube SR. Awareness and ever use of electronic cigarettes among U.S. adults, 2010 2011. Nicotine Tob Res 2013 15 1623 7.
  3. CDC. National Youth Tobacco Survey. Atlanta, GA US Department of Health and Human Services, CDC 2013. Available at
  4. Dwyer JB, McQuown SC, Leslie FM. The dynamic effects of nicotine on the developing brain. Pharmacol Ther 2009 122 125 39.

E-cigarettes: a reliable smoking alternative or vials of toxic poison? – consumerist

E Cigarettes contain liquid nicotine a powerful and possibly dangerous toxin.

For more than 50 years the Surgeon General has warned consumers of the risks associated with smoking cigarettes. Since that time, many products introduced as alternatives. One of the most recent, and popular options is the use of e cigarettes. But poison control officials say the reusable sticks contain enough nicotine to be bad for your health.

Manufacturers promote electronic cigarette as mimicking the sensation of smoking without exposing the user to the dangerous chemicals found in traditional cigarettes. But their main stimulant, liquid nicotine, could be just as dangerous to consumers, the New York Times reports.

Concerns about liquid nicotine go much farther than just affecting the person smoking. Poison control officials warn that even small amounts of the liquid pose a significant risk to the public if ingested or absorbed through the skin. Children, who may be drawn to refillable e liquid’s bright color packaging and flavors, are at a higher risk of death from coming into contact with the toxin.

Most liquid nicotine levels in e cigarettes range between 1.8% and 2.4% enough to cause sickness in children and adults. Higher concentrations, 7.2% or more, which can be found through online retailers, could be lethal for children and adults.

Since 2011, there has been one death in the United States associated with liquid nicotine, the Times reports. In that case, an adult committed suicide by injecting the liquid.

It s not a matter of if a child will be seriously poisoned or killed, says Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. It s a matter of when.

In 2013, the number of accidental poisonings linked to liquid nicotine rose 300% from the previous year to 1,315 cases, many of which involved children. Minnesota reported 74 e cigarette and nicotine poisoning cases last year, of those cases 29 involved children two and younger.

The number of accidental poisoning cases doesn’t look to be slowing down. In the first two months of this year, 23 of the 25 cases reported in Oklahoma involved children ages four and younger.

Officials say an increase in poisonings is a reflection of the more common use and the evolution of e cigarettes in the United States. Because newer models can be refilled with a liquid combination of nicotine, flavoring and solvents, consumers may be at more risk of coming into direct contact with the toxins.

In the past, Consumerist has reported on issues with e cigarettes, many of which have had more to do with the device itself than with liquid nicotine. The most common reports involved the products exploding while being used.

However, when an e cigarette breaks users face the risk of shock and toxin poisoning. The Times reports a woman in Kentucky was admitted to the hospital with cardiac problems after her skin absorbed e liquid when her e cigarette broke.

Currently, there are no federal regulations protecting consumers from the products. However, many cities across the country have banned the products from being used in public places like parks and the subway.

Last October, 40 State Attorneys General agreed that e cigarettes need to be regulated. The Food and Drug Administration plans to regulate the products but so far nothing has been announced. Additionally, it’s unknown how regulators would enforce rules with manufacturers outside the United States or operating online.

Some e cigarette advocates say they would welcome regulations such as childproof bottles, warning labels and manufacturing standards.

Dr. Neal L. Benowitz, a professor at University of Southern California, tells the Times that manufacturing standards would likely include mandating proper precautions like wearing gloves while mixing e liquids.

There s no risk to a barista no matter how much caffeine they spill on themselves, Benowitz, who specializes in nicotine research, says. Nicotine is different.

Selling a Poison by the Barrel Liquid Nicotine for E Cigarettes The New York Times