While public health efforts have successfully decreased cigarette use in the U.S., alternative tobacco products remain popular with adolescents and young adults. In a recent study led by Dr. Tracey Barnett, an assistant professor in the department of behavioral science and community health, researchers found that 12 percent of Florida high school students reported trying e-cigarettes, up from 8 percent the previous year.

In addition, teens who used e-cigarettes were more likely to use other tobacco products, including traditional cigarettes and hookah. The findings are troubling because they indicate that e-cigarettes may be serving as an introduction to smoking for a group who may have never started, Dr. Barnett said.

“We had been making good strides in preventing tobacco use in adolescents,” she said. “The concern is we don’t want a whole new generation of users.”

The study findings were recently published online ahead of print in the American Journal of Preventive Medicine. While other studies have shown a connection between e-cigarette and cigarette use in young people, the UF study, which was conducted in collaboration with the Florida Department of Health, is the first to show that e-cigarette smoking is strongly associated with hookah use.

“This is important because both e-cigarettes and hookah are appealing to adolescents and have fewer policy restrictions in place regarding flavors and public smoking, which could lead to re-normalizing smoking for youth,” Dr. Barnett said.

The UF study findings are based on data from the 2013 Florida Youth Tobacco Survey, an anonymous, annual survey administered by the Florida Department of Health to a random sample of public middle and high schools. The 2013 survey was completed by 12,600 students.

In addition to e-cigarettes, the survey asked about use of other tobacco products. More than one-fourth of high school students (grades 9 through 12) said they had tried traditional cigarettes and 35 percent of those respondents also reported e-cigarette use. Among high school respondents, 17 percent said they had tried hookah. Of hookah users, 43 percent had also used e-cigarettes.

A 2014 Florida state law bans the sale of nicotine dispensing devices, including e-cigarettes, to minors. UF researchers will continue to monitor rates of adolescent e-cigarette smoking to assess the law’s effect on e-cigarette use.