Tobacco use among kids is down, according to a new CDC report. But the percentage of young adults lighting up, especially with e-cigarettes, should still give parents concern.

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Smoking is still too often thought of as a sign of being "cool," even though tobacco use is the number one preventable cause of disease and death in the US, according to the Centers for Disease Control and Prevention. And unfortunately, tweens and teens haven't totally gotten the message of tobacco's danger, says a new report from that organization.

One in five teens uses tobacco

First, the good news: Tobacco use has gone down overall among youth in the past seven years. The CDC analyzed data from the recent National Youth Tobacco Survey and found that 3.6 million middle and high school students in 2017 said they'd used some kind of tobacco in the past 30 days, down from 4.5 million in 2011. "In this study, there were about one million fewer youth tobacco product users between 2011 and 2017, which is a good thing," Teresa Wang, Ph.D., epidemiologist and lead author of this week's CDC Morbidity and Mortality Weekly Report, tells

But that number still means nearly one in five high schoolers, and one in 18 middle schoolers, is using tobacco—way too many. Nearly all tobacco use, which often leads to major health problems later, starts in young adulthood. A recent CDC statistic notes that one out of every 13 children under 17 alive today will die of a smoking-related illness.

So why do kids still use tobacco? "We know what works to prevent tobacco product use among youth—proven strategies include tobacco product price increases, smoke-free policies in all indoor public areas, media campaigns warning about the risks of youth tobacco product use, and youth access restrictions such as increasing the minimum age of sale for tobacco products to age 21," Dr. Wang says. But these strategies have not been universally adopted in many states and communities across the country, she says, so not all youth can benefit from them.

E-cigarettes hold appeal for kids

In addition, it's not just cigarettes that are the problem. "The tobacco product landscape continues to rapidly evolve to include multiple types of products, including e-cigarettes," Dr. Wang says. Using electronic cigarettes ("vaping," "juuling") has been the most popular way to use tobacco among youth since 2014.

Although they might seem "cleaner" because they don't produce the same stinky smoke as regular cigarettes, they still present a major health risk. "Many youths aren't aware of the dangers of these products, including the negative impacts of nicotine exposure on the developing adolescent brain," Wang says. E-cigarettes contain nicotine derived from tobacco, and can also be a gateway to other forms of tobacco use.

Even so, e-cigarettes are particularly appealing to teens. "A major factor driving youth e-cigarette use is the prominent advertising of these products through media commonly used by youth," Dr. Wang says. "We know many e-cigarette advertisements use the same themes and tactics that have previously been shown to prompt the initiation of conventional cigarette smoking among youth."

Young people also like their kid-friendly flavors like fruit and candy. "About 85 percent of youth e-cigarette users report using flavored varieties of these products," Wang says. "Research shows that the availability of flavors is a primary reason US youth report using these products."

E-cigarettes are also a new and enticing technology, which appeals to young people's sheer curiosity. In addition, "product design, in particular the sleek and discreet design of some newer e-cigarette products, including those shaped like USB flash drives, allows them to be used unnoticed, including in school classrooms," Dr. Wang says.

What can parents do?

The CDC says they're going to re-double their efforts to make sure e-cigarettes aren't being marketed or sold to kids, as well as implementing more evidence-based anti-tobacco strategies in general. In the meantime, parents should educate their children about the dangers of e-cigarettes, along with other tobacco products. You can use the US Surgeon General's fact sheets and tips on how to talk to kids about e-cigarettes as a starting point.

In addition, keep track of what media your children are using to make sure they're not being exposed to inappropriate messaging on tobacco use. Watch programs together to use any tobacco imagery as a teachable moment to discuss the risks, Dr. Wang says. And perhaps one of the greatest influences may be what you model for your kids. "Parents can set a positive example by being tobacco-free, and ensuring their kids aren't exposed to the secondhand emissions from any tobacco products," Dr. Wang says.



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