Hawaii Department of Health’s Youth Tobacco Survey Shows Significant Increase in E-Cigarette Use among Public School Teens

News Release from Hawaii DoH December 10, 2014

HONOLULU – Hawaii ranked first as the healthiest state in the nation for the second consecutive year, according to the 2014 America’s Health Rankings, with a 13.3 percent decrease in adult smoking in the last three years. However, the latest findings from the Hawaii Youth Tobacco Survey (YTS) are not so positive.

While tobacco use among Hawaii’s public middle and high school students has declined over the past decade, increased use of non-traditional tobacco products -- such as electronic cigarettes, water pipes or hookah and roll-your-own cigarettes -- could reverse this positive trend.

“Tobacco use is the leading preventable cause of death in our Islands. As a state we have made great progress to reduce tobacco use among youth, but we are seeing alarming trends in the use of non-traditional tobacco products that we need to monitor vigilantly,” said Lila Johnson, manager of the DOH Tobacco Prevention and Education Program.

The survey results show that while the use of traditional tobacco products -- such as cigarettes, cigars, smokeless tobacco and pipes and exposure to secondhand smoke -- have decreased, experimentation with and current use of new tobacco products --including e-cigarettes, tobacco in water pipes or hookah, and rollyour-own cigarettes -- are increasing. In particular, lifetime e-cigarette use among high school students tripled from 5.1 percent in 2011 to 17.6 percent in 2013, and quadrupled among middle school students, from 1.8 percent to 7.9 percent, during the same time period.

“Evidence suggests that e-cigarettes are being used by students who are not cigarette smokers,” said Tonya Lowery St. John, Epidemiologist for DOH’s Chronic Disease Prevention and Health Promotion. “More than a third of middle school students and almost a third of high school students who currently smoke e-cigarettes have never even tried a traditional cigarette.”

Among high school current e-cigarette users, 31.7 percent have never smoked a traditional cigarette, 31.6 percent have tried them but have not smoked one in the past 30 days, and 36.7 percent have smoked both ecigarettes and traditional cigarettes in the past 30 days. Among middle school current e-cigarette users, 33.2 percent have never smoked a traditional cigarette, 38.4 percent have tried traditional cigarettes but not in the past 30 days, and 28.4 percent have smoked both e-cigarettes and traditional cigarettes in the past 30 days.

Compared with national YTS results, Hawaii’s youth are using e-cigarettes more than their peers on the Mainland. In 2013, 1.1 percent of middle school students and 4.5 percent of high school students in the U.S. were current e-cigarette users, compared with 5.5 percent of middle school students and 10 percent of high school students in Hawaii. Lifetime e-cigarette use for U.S. middle school students was 3 percent and 11 percent for U.S. high school students, compared to 7.9 percent of middle school students and 17.9 percent of high school students in Hawaii.

Results also indicate that middle and high school students are seeing and hearing fewer messages about the dangers of cigarettes on TV, the Internet and radio, and are seeing fewer people smoking on TV and in movies. However, data also show that a significant proportion of students are receiving ads and coupons directly from tobacco companies, with 12.7 percent of middle school students and 8.8 percent of high school students reporting that they received ads directly from a tobacco company in the past 30 days through the mail, e-mail, the Internet, Facebook, Myspace or a text message. In addition, 7.9 percent of middle school students and 6.6 percent of high school students reported receiving coupons from a tobacco company through one of these vehicles in the past 30 days.

The Hawaii Departments of Health (DOH) and Education (DOE) jointly administer the YTS, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). The YTS is a module of the Hawaii School Health Survey which is conducted biennially or on odd-numbered years among Hawaii public middle school students (grades 6-8) and high school students (grades 9-12).

Participation in the survey is voluntary. In 2013 a representative sample of 1,980 middle school students and 1,455 high school students participated in the survey. The overall participation rate among selected schools and students was 67.2 percent for middle schools and 60.4 percent for high schools.

Based on these findings, DOH staff has added new questions to 2015 YTS which will begin data collection early next year. These questions will further explore student use of and attitudes towards e-cigarettes and other non-traditional tobacco products.

The YTS results are weighted by CDC to represent all public school students in Hawaii. Detailed data tables by state, sex, grade and race/ethnicity can be found on the Hawaii Health Data Warehouse website at www.hhdw.org .

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