Tobacco Use Rising Among NC High School Students; E-Cigarettes Remain Popular

North Carolina teen tobacco use continues to climb, with youth use rising by 1.2 percent to 28.8 percent based on results of the 2017 N.C. Youth Tobacco Survey, released today by the North Carolina Department of Health and Human Services. Data also show that 16.9 percent of North Carolina teens report using e-cigarettes, compared to 11.7 percent in the National Youth Tobacco Survey, also released today.

The state survey showed e-cigarettes have been the tobacco product most frequently used by middle and high school students in North Carolina since 2015.

"The use of e-cigarettes by youth is very concerning," said State Health Director and DHHS Chief Medical Officer Betsey Tilson, M.D., MPH. "Nicotine exposure during adolescence and young adulthood can lead to nicotine addiction and it harms brain development."

Another indicator that e-cigarettes will continue to be popular among North Carolina youth is 23.3 percent of high school students said they were considering using the products in the coming year.

One brand of e-cigarettes holds more than 60 percent of the U.S. market and delivers more nicotine than most of its competitors. San Francisco-based JUUL brand’s popularity among youth may be related to the product’s resemblance to a USB flash drive, which makes it easy to conceal.

The allure of e-cigarettes is triggered by a friend or family member using them, surveyed North Carolina youth said. Nearly 25 percent of those surveyed also reported using e-cigarettes because they were available in flavors. The 2014 U.S. Surgeon General’s report, E-cigarette Use Among Youth and Young Adults, states that e-cigarette products are marketed in a variety of channels, including social media, that reach youth using themes and techniques found to be appealing to youth in conventional cigarette advertising and promotion. 

"The marketing and flavors draw youth in; but the nicotine, which is highly addictive, keeps them coming back," said Susan Kansagra, M.D., MBA, chief of the Chronic Disease and Injury Section of the Division of Public Health. “Another worrisome trend we are seeing is that youth are using multiple tobacco products."

Half of high schoolers who use tobacco and nearly half of middle schoolers who use tobacco report using more than one tobacco product, which is similar to national data. Use of cigars, flavored little cigars and cigarillos by high school students increased from 2015 to 2017.

"The use of multiple products creates concern about nicotine exposure," added Dr. Kansagra. "There is also data showing that youth who use e-cigarettes are more likely to become regular cigarette smokers than those who do not.”

The North Carolina survey is administered in the fall on odd-numbered years within randomly selected middle and high schools. More than 6,300 students representative of middle and high school peers across state participated in the 2017 survey.