Tobacco use has been on the decline with kids; it's about half what it was in the mid-1990s. But the latest CDC study shows a growing number of middle and high school students have tried e-cigarettes.
One in 10 high school students surveyed said they had tried e-cigarettes last year. That's double the number from 2011. One high school in Connecticut banned them after the principal said administrators dealt with at least one incident involving e-cigarettes every day.
CDC director Tom Frieden characterized this trend as "deeply troubling."
But as far as risky behavior goes, it's still a tiny fraction of students. The survey showed about 3 percent of these kids said they had used one in the last 30 days. By contrast, 39 percent of students said they drank some amount of alcohol in the past 30 days, 22 percent binge drank and 24 percent rode with a driver who had been drinking.
The real problem is that 88 percent of adult smokers who smoke daily said they started when they were kids, according to the CDC. Kids who start down the path to using e-cigarettes may stick with them for life.
"So much is unknown about them and what the long-term complications could be with their use," said the American Lung Association's Erika Sward. "Bottom line, we don't know what the consequences of using them are, and we are very troubled that kids would find them attractive."
E-cigarettes are unregulated in the United States; no laws make manufacturers tell you what you are actually inhaling. The unknown is one of the many qualities of e-cigarettes that the American Lung Association doesn't like.
It's "a complete unregulated Wild West," Sward said. She wants the FDA to move quickly with regulatory oversight, which she says would make manufacturers disclose what the actual ingredients are in each of the 250 or so brands available.
In 2009, a FDA test on a small number of e-cigarette samples found "detectable levels of known carcinogens and toxic chemicals to which users could potentially be exposed." They found diethylene glycol in one cartridge at a 1 percent level; this is an ingredient used in antifreeze and can be toxic to humans in large quantities. Diethylene glycol is also found in some dental products and in some pharmaceuticals.
After that study, the FDA banned the sale of e-cigarettes. They warned e-cigarette smokers that they were inhaling "toxic" and "harmful" chemicals. However, in 2010, a court ruled that "the FDA had cited no evidence to show that electronic cigarettes harmed anyone," and stores could go on selling them.
The early e-adopters
On the other side of the debate are the passionate supporters of e-cigarettes. Many who use them say it is the first thing that has helped them stop using cigarettes -- something more than 90 percent of smokers fail to do with any of the existing FDA-approved methods. There are blogs and message boards dedicated to them. And there are countless impassioned testimonials from the people who use them.
Florida resident Craig Lashley says they've changed his life.
"I got tired of being like that little kid in 'Peanuts' who had the cloud of smoke following him all the time," Lashley said. "I didn't like the way I smelled when I smoked, and I didn't like what smoking said about me, especially to kids."
He discovered the e-cigarette about a year ago and hasn't smoked a regular cigarette since.
He says he smells better, feels better and spends a lot less -- about $10 a week on e-cigarettes. He used to spend about $45 a week on regular cigarettes.
"I like the feel of blowing smoke," Lashley said. "It seems to me like (e-cigarettes are) a healthier alternative."
A growing number of respected physicians and scientists agree, and they say these products could end a major health problem.
"Electronic cigarettes and other nicotine-containing devices offer massive potential to improve public health, by providing smokers with a much safer alternative to tobacco," the Royal College of Physicians says. "They need to be widely available and affordable to smokers."
The latest study, published in the British journal the Lancet, examined whether people who used them as an alternative to smoking would abstain from using regular cigarettes.