More than a quarter of a million youth who had never smoked a cigarette used electronic cigarettes in 2013, according to a Centers for Disease Control and Prevention (CDC) study published in the journal Nicotine and Tobacco Research. This number reflects a threefold increase, from about 79,000 in 2011, to more than 263,000 in 2013.

The data, which comes from the 2011, 2012, and 2013 National Youth Tobacco surveys of middle and high school students, show that youth who had never smoked conventional cigarettes but who used e-cigarettes were almost twice as likely to intend to smoke conventional cigarettes as those who had never used e-cigarettes. Among non-smoking youth who had ever used e-cigarettes, 43.9% said they intended to smoke conventional cigarettes within the next year, compared with 21.5% of those who had never used e-cigarettes.

“We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes, or other tobacco products. Not only is nicotine highly addictive, it can harm adolescent brain development,” says Tim McAfee, MD, MPH, director of the CDC’s Office on Smoking and Health.

There is evidence that nicotine’s adverse effects on adolescent brain development could result in lasting deficits in cognitive function. Nicotine is highly addictive. About three out of every four teen smokers become adult smokers, even if they intend to quit in a few years.

“The increasing number of young people who use e-cigarettes should be a concern for parents and the public health community, especially since youth e-cigarette users were nearly twice as likely to have intentions to smoke conventional cigarettes compared with youth who had never tried e-cigarettes,” says Rebecca Bunnell, ScD, MEd, the associate director for science in CDC’s Office on Smoking and Health and the lead author of the study.

The analysis also looked at the association between tobacco advertisements and smoking intentions among middle and high school students. Students were asked about whether they had seen tobacco ads on the Internet, in magazines and newspapers, in retail stores, and in television programs and movies. Consistent with previous studies, this study found that youth who reported exposure to tobacco ads had higher rates of intention to smoke than those who weren’t exposed to such ads.

The researchers also found the greater the number of advertising sources to which young people were exposed, the greater their rate of intention to smoke cigarettes. Thirteen percent of students who said they had no exposures to such ads had intentions to smoke, compared to 20.4% among those who reported exposures from one to two ad sources and 25.6% among those who reported exposures from three to four of the sources.

More than 50 years since the landmark Surgeon General’s Report linking cigarette smoking to lung cancer, smoking remains the leading cause of preventable death and disease in the United States. Smoking kills nearly half a million Americans every year. More than 16 million Americans live with a smoking-related disease. Each day, more than 3,200 American youth smoke their first cigarette. The Surgeon General has concluded that unless the smoking rate is rapidly reduced, 5.6 million American children alive today—about one in every 13—will die prematurely from a smoking-related disease.

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