Since the 1990s, the number of high school students who smoke cigarettes has dropped by about 50 percent.
“That’s a big change in the last 10 years,” says Dr. Maria Franco, a pediatric pulmonologist at the Miami Children’s Hospital.
But just as cigarette smoking is trending down, the use of e-cigarettes, hookahs and mini-cigars are on the rise.
According to the 2013 Florida Youth Tobacco Survey (FYTS), during the past six years, e-cigarette usage has increased by more than 43 percent among Florida middle school students and almost 102 percent among high school students.
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The number who have tried hookah has increased by almost 38 percent among middle school students and 24 percent among high school students. And more high school students smoke cigars than cigarettes.
“Children who would never think of lighting a cigarette are now being tempted by these alternative smoking products,” says Dr. Metee Comkornruecha, attending physician in the Division of Adolescent Medicine at Miami Children’s Hospital. “They’ve created a whole new audience for smoking,” he says adding that 10 percent of people who smoke e-cigs have never smoked a regular cigarette.
According to the CDC, if smoking persists at the current rate, one in every 13 Americans now aged 17 or younger will die prematurely from a smoking-related illness.
Whether it’s peer pressure, a need to show their independence or self-medicate, youngsters are still tempted to try smoking.
Electronic smoking devices were first marketed in 2004. Today these e-cigarettes resemble traditional cigarettes but actually use a battery-powered coil to vaporize liquid in a cartridge that is inhaled into the lungs.
In 2009, the U.S. Food and Drug Administration (FDA) analyzed samples of nicotine cartridges from two manufacturers. The amount of nicotine delivered did not always match the amount stated on the label. The study also revealed that some cartridges labeled “nicotine-free” did contain nicotine.
And cancer-causing compounds found in tobacco were also found in some e-cigarette cartridges, along with other toxins such as diethylene glycol, a toxic chemical used in antifreeze.
To make them appeal to the young, e-cigarettes often come with added flavorings — grape, cherry or cola — and colorful packages.
What’s more, they are marketed at sporting events, concerts and other places where youth gather, says Melissa Iglesias, an advanced registered nurse practitioner for the Family Medicine Center at West Kendall Baptist Hospital.
But no matter how attractive e-cigarettes may be, it’s hard to tell what you are lighting up. No government agency currently regulates them and they are not required to list their contents on their labels.
“We know what happens when you smoke cigarettes. But we don’t know what happens with e-cigs or hookah. Nobody has done studies on the long-term effects, starting with smoking in adolescence,” Comkornruecha says.
Hookahs, which aren’t regulated either, have been used to smoke tobacco for centuries in the Middle East. In these pipes, which many baby boomers will recognize as bongs, charcoal is used to heat the tobacco.
The smoke passes through the water before being drawn into the smoker’s mouth and lungs. Although the water may remove some particles from the smoke, it’s the chemicals in the smoke that are harmful and addictive, says Andrew Cuddihy, director of health promotions for the American Lung Association serving South and Southeast Florida.
And the water in the pipe does little to filter these chemicals, which include carbon monoxide, tar, formaldehyde, cyanide and ammonia.
Also, to pull the smoke through the water you need to inhale deeply. That means the smoke reaches deeper into the lungs where it can do more damage. And finally, because the smoke is cooled by the water and feels more pleasant in the mouth, you tend to smoke more.
“It’s a very intense exposure in a short period of time,” Cuddihy says. In fact, a one-hour hookah session is said to be equivalent to smoking a pack of cigarettes.
What’s more, smoking hookah like mini-cigars has many of the same risks as smoking cigarettes if not more, says Franco, also director of the Cystic Fibrosis Center at Miami Children’s Hospital.
That means you may put yourself at risk for addiction, strokes, cataracts, atherosclerosis, COPD, ulcers, periodontal disease, osteoporosis and, of course, many cancers.
And because you often share a hookah with other smokers, you also may be exposed to infectious diseases such as tuberculosis, meningitis and hepatitis.
Then there are mini-cigars, which are often flavored, that kids smoke like cigarettes. “The mini-cigar manufacturers are targeting youngsters because I doubt very much that a 35-year-old smoker is going to be interested in a grape-flavored cigar,” Cuddihy said.
And they can be sold individually for about 50 cents, which makes them easier for kids to purchase than cigarettes which, by law, must be sold in packs.
To address the health concerns, the FDA is trying to regulate alternative smoking devices. A rule proposed in June (79FR23141) would give the FDA the authority to regulate hookah tobacco, cigars and electronic cigarettes as well as prevent their sale to minors. The final comment period for this regulation ends Aug. 8.
States also are taking action. Last month Gov. Rick Scott signed a bill that makes it illegal in Florida to sell e-cigarettes to minors or for them to possess e-cigs.
And local communities such as Weston, Lighthouse Point and Sunrise have banned the sale of e-cigarettes to those who are younger than 18. Last month, the Miami-Dade County Commission banned the sale of e-cigarettes and other “nicotine-dispensing devices” to people under 18. The law also prohibits displaying or selling the products in vending machines.
Although these regulations as well as classroom programs and public service campaigns are helping educate children from the dangers of smoking, parents need to get involved.
If you smoke and you want to help your child avoid the habit, the first thing you need to do is quit. “That’s the single best thing I can tell you to do for your children,” Cuddihy says.
Parents also need to talk to their children openly about the dangers of smoking, starting the conversation when children are about 6 years of age. That’s before they are under the influence of their friends or looking for a way to show their independence, says Iglesias, who regularly talks to her 10-year-old daughter about the dangers of smoking.
She knows that today, like every day, 3,200 young people will try their first cigarette.
“I don’t think any parent believes their child will smoke. But it’s something you really have to consider because no form of nicotine or tobacco is safe,” she says.