Electronic cigarettes are attracting three times as many teens in Hawaii as the rest of the United States, and it may be because of taxes, perceived safety, and rampant advertising to younger populations. Researchers from University of Hawaii Cancer Centers found electronic cigarette smoking rates that they believe to be alarming in a study published in the journal Pediatrics.

"You have to think carefully about the risks and benefits of using either tobacco or nicotine, which is known to be an addictive substance," said Dr. Thomas Wills, the interim director of the UH Cancer Center's Prevention and Control Program, in a press release. "A lot of teens think it is easy to quit smoking but it isn't true. It's hard for anybody to quit."

Researchers studied more than 1,900 teens in Hawaii and found almost 30 percent of them had tried an electronic cigarette more commonly called an “e-cig.” In the States, only 4.7 percent of teens had tried them between 2011 and 2012. The popularity of the e-cigarette has increased considerably since then, but nearly three times as many teens in Hawaii have tried the cigarettes, and 12 percent of them were using both the electronic and regular cigarettes.

"The marketing is very aggressive here," Wills said. Manufacturers frequently target teen hangout spots such as movie theatres and choose fruity flavored liquids to attract their young taste buds — with mango, pineapple, bubblegum, and cherry being among their most popular flavors. Unfortunately 67 percent of teens believe e-cigarettes are healthier or safer than regular cigarettes, when the truth is the U.S. Food and Drug Administration (FDA) is not done testing the health consequences or possible benefits of chronic long-term use.

Wills also said the high tax rate on cigarettes in Hawaii could have encouraged more teens, who generally have less money on hand, to turn to the cheaper electronic version. The teens surveyed were as young as 14 and 15 years old, and attended a mix of public and private schools. They were also asked to report their alcohol and marijuana use; the researchers found there was a link between e-cigarette use and substance abuse. Those who said they used e-cigarettes were immediately at a higher risk for using other drugs or alcohol compared to those teens who only tried regular cigarettes.

The health benefits remain a debate until the FDA announces otherwise, but many experts and parents worry about how attractive the electronic version is to teens. It could be creating a larger population of nicotine addicts despite what type of cigarette they choose. No matter what, a teen who doesn’t smoke any kind of cigarette is healthier than the one who chooses an electronic version The lure of a possibly safer alternative may encourage teens who wouldn’t have otherwise tried smoking to try it.

Source: Wills T, et al. Pediatrics. 2014.