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THURSDAY, March 15, 2018 (HealthDay News) -- Teenagers who use tobacco products other than cigarettes often see their habit as harmless, a new U.S. government survey finds.
The report, from researchers at the U.S. Centers for Disease Control and Prevention, asked teenagers whether they considered themselves tobacco users. It turned out that kids who favored products like electronic cigarettes, hookahs (water pipes) and smokeless tobacco often failed to see themselves as tobacco users.
Even among teens who agreed that "all tobacco products" are harmful, there were many who thought their product of choice wasn't. That included three-quarters of kids who used e-cigarettes, and 56 percent of those who used hookahs.
"Teenagers might not realize the products they use contain nicotine and are addictive," said Erika Sward, assistant vice president of national advocacy for the American Lung Association.
That means education efforts have to do a better job of tackling the products that are popular with kids these days, Sward added.
"We can't just be talking about cigarettes anymore," she said.
However, the U.S. Food and Drug Administration announced on Thursday that it plans to try to lower the amount of nicotine in cigarettes to make them less addictive.
The CDC report comes from a survey of over 20,000 U.S. middle school and high school students.
Overall, 558 kids said they'd used e-cigarettes in the past month. But 60 percent did not consider themselves a "tobacco user." The same was true of over 80 percent of kids who used "roll your own" or pipe tobacco.
Similar patterns were seen among students who'd smoked only cigars or hookahs.
Meanwhile, there was a disconnect between what kids thought of tobacco products as a whole, and how they saw their product of choice.
Of kids who used e-cigarettes, most (80 percent) agreed that "all tobacco products" were harmful. Yet only 22 percent thought e-cigarettes were risky. There was a similar disconnect among kids who used hookahs or smokeless tobacco.
A hookah is a large water pipe that uses charcoal to heat tobacco, which may be sweetened or flavored.
Hookah "lounges" are popular, and Sward said many young people may see hookah smoking as a social activity, rather than tobacco use.
As for e-cigarettes, she said, kids may not consider them tobacco products because they are smoke-free.
But e-cigarettes do contain nicotine -- which, Sward said, can affect the developing adolescent brain and cause addiction.
"Kids who use e-cigarettes are more likely to go on to smoke combustible cigarettes," she noted.
On top of that, the U.S. Surgeon General has warned that e-cigarettes may contain other harmful substances -- including heavy metals and ultrafine particles that can be inhaled deeply into the lungs.
According to study co-author Dr. Israel Agaku, a researcher with the CDC's Office on Smoking and Health, "Youth use of tobacco products in any form, including e-cigarettes and hookahs, is unsafe."
The CDC report was published online March 15 in the journal Pediatrics.
It's important for adults to set a good example by being tobacco-free, Agaku said. And it's up to everyone -- parents, teachers, doctors -- to talk to kids about the risks of all tobacco products, he explained.
Sward added, "We've had this problem for years with smokeless tobacco," referring to kids' misperceptions that it's "safe."
Now, she said, there are additional products, including e-cigarettes and hookahs, drawing kids in.
"Parents need to be aware that these products have a vice grip on kids today, the way cigarettes had on [their generation]," Sward said.
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SOURCES: Israel Agaku, D.M.D., Ph.D., M.P.H., senior service fellow, Office on Smoking and Health, U.S. Centers for Disease Control and Prevention; Erika Sward, M.A., assistant vice president, national advocacy, American Lung Association; March 15, 2018, Pediatrics, online