Most of Pennsylvania’s high school and middle school students are tobacco-free, but the use of cigarettes, and their digital counterpart, e-cigarettes, is still a cause for concern, according to Penn State researchers.

The survey, which was given to students across the state in the 2014–15 school year, asked about which tobacco and nicotine products the participants had recently used. The most commonly used product by middle schoolers was e-cigarettes — the use of which is known as “vaping” — and the most commonly used product by high schoolers was cigarettes.

Sophia Allen, postdoctoral scholar in public health sciences, College of Medicine, said the survey helps gather data the state can use to create, implement and evaluate programs and interventions to help prevent the uptake of smoking and other tobacco use in young people.

“Nicotine is highly addictive, and tobacco products are not only harmful to your health, but can also affect adolescent brain development,” Allen said. “Ideally, the data gathered from these types of surveys can help spark discussions about how many youths are using these products and ways to stop it.”

The survey was administered to 2,668 students from 72 middle schools and 2,017 students from 63 high schools across Pennsylvania. Seventy-four-and-a-half percent of middle schoolers and 64.7 percent of high schoolers completed the survey.

The survey consisted of questions about whether participants had recently used such tobacco and nicotine products as cigarettes, cigars, e-cigarettes and smokeless tobacco, among others.

After analyzing the results, the researchers found that 4.3 percent of middle schoolers and 22.4 percent of high schoolers reported using some kind of tobacco product at least once during the previous 30 days. E-cigarettes were the most popular product with middle schoolers at 2.3 percent, and cigarettes were the most popular with high schoolers at 11 percent.

Jonathan Foulds, professor of public health sciences and psychiatry, College of Medicine, said that because the survey only asked about product use in the past 30 days, the results do not specify whether the students use the products regularly or if they just tried them once.

“The results can be interpreted as a warning sign about who’s at risk for prolonged use of these products,” Foulds said. “If someone’s under 18 and they’re already trying these products, past research has shown that’s quite predictive of who will continue to be a daily user and possibly become addicted. This gives us an idea of how many kids are using and how many are at high risk of becoming addicted to these products.”

This year was the first time questions about e-cigarettes — devices that allow vaporized liquid containing nicotine to be inhaled without the smoke — were included. E-cigarettes are not considered a tobacco product under the Youth Access to Tobacco Law in Pennsylvania, however, federal law prohibits the sale of tobacco products, including e-cigarettes, to people under age 18.

Foulds said that while there is evidence that e-cigarettes are not as harmful as inhaled products like cigarettes, they still come with their own risks.

“Less harmful doesn’t mean harmless,” Foulds said. “There’s a bit of evidence that kids who have never smoked, but who try e-cigs, are more likely to then go on and try cigarettes. So that’s a concern, along with the effects of nicotine on the brain and the risk of becoming addicted.”

Allen and Foulds both said the results suggest that more can be done in Pennsylvania to help prevent children and adolescents from using these products.

“It’s illegal to sell tobacco products to those under 18, but this survey shows very clearly that despite this, kids are able to get their hands on these products, even middle schoolers,” Foulds said. “We think it suggests that despite the laws we have on the books, we need to get tougher and to enforce the laws a bit more. There’s also plenty of room to increase the taxation on tobacco products in Pennsylvania so they’re less affordable to young people.”

The results of this research were published in the February online edition of Preventing Chronic Disease.

The National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the US Food and Drug Administration helped support this work, but the authors’ views do not necessarily represent those of the NIH, FDA or PA Department of Health.

Emily Wasserman, research data analyst; Susan Veldheer, research project manager; Shari Hrabovsky, advanced care practitioner; Jessica Yingst, human research technologist; and Guodong Liu, assistant professor of public health sciences, also participated in this research.