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Use of all tobacco products, including conventional and electronic cigarettes, declined among U.S. teens last year, according to the latest national survey data from the CDC.

Cigarette smoking among middle school and high school students continued a two-decade decline, falling to the lowest level ever recorded in the CDC's 2015-2016 National Youth Tobacco Survey (NYTS). appear in this week's Morbidity and Mortality Weekly Report, published online June 15.

Just 8% of high school students (6.9% female, 9.1% male) reported smoking cigarettes in the 2016 NYTS, compared to surveyed in 1997.

And after dramatic increases in e-cigarette use among youth in recent years, use among middle school and high school students fell in 2016 for the first time since the products were first included in the NYTS in 2011.

"The good news is we've seen a decline in youth tobacco use during the past year, which was primarily driven by a decline in e-cigarette use," said Brian King, PhD, of the CDC Office of Smoking and Health. "The bad news is that we still have 3.9 million youth in this country who are using tobacco products, and about half of them are using two or more products."

In the 2015-2016 survey, among high school students, decreases were reported in current use of any tobacco product, any combustible product, use of two or more tobacco products, e-cigarettes, and hookahs.

Among middle school students, 4.3% reported e-cigarette use, while roughly 2% reported smoking traditional cigarettes or cigars or using smokeless tobacco.

In 2016, one in five high school students and one in 14 middle school students reported current use of a tobacco product on one or more days in the past 30 days.

E-cigarettes remained the most commonly used tobacco product among high school (11.3%) and middle school (4.3%) students. Between 2011 and 2015, use of e-cigarettes among high school students responding to the NYTS Use of the products among high school students fell to 11.3% in the 2016 survey, but King told 麻豆传媒 that it is too soon to say if the decline in youth e-cigarette use represents a trend.

"I think it's clear that these products are not a fad, given the exponential increase in their use up until 2015," he said. "They are the most commonly used tobacco products among youth in the U.S., with more than 2.2 million youths using them."

While e-cigarettes are generally considered to be safer than cigarette smoking and are considered potential smoking cessation devices by some, King said they should not be considered safe for use by teens and younger children.

"Irrespective of any potential benefit that e-cigarettes might have for adult smokers who wish to use them to quit, youth should not be using any form of tobacco product," he said. "We know that e-cigarettes typically contain nicotine, which is highly addictive and can also harm the developing adolescent brain. And the U.S. Surgeon General has also concluded that e-cigarette aerosol is not harmless and may contain other harmful ingredients including heavy metals, ultrafine particulates, and volatile organic compounds."

A separate report published in the latest MMWR adds to the evidence that e-cigarette use is associated with greater uptake of cigarette smoking among teens.

In the 2015 Oregon Healthy Teens survey of 8th and 11th graders, e-cigarette use was commonly reported as the first tobacco product used among responding teens who currently smoked cigarettes or used any tobacco product.

Alexander Prokhorov, MD, PhD, who directs the University of Texas MD Anderson Cancer Center Tobacco Outreach Education Program, said while the 2016 NYTS data show welcome declines in youth e-cigarette and hookah use, as well as conventional cigarette smoking, use of these emerging tobacco products among teens should be closely monitored.

"We seen similar declines in the past and the tobacco industry always finds a way to hook youth with new products," he told 麻豆传媒. "The use of flavorings and other gimmicks are all done to get them interested."

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