A recent federal report indicates that the use of electronic cigarettes among American teens tripled over the course of a year, and local health officials are concerned that could have an impact on the health of local youth.

“From a public health perspective, e-cigarettes present a gateway to potentially using other tobacco products,” said Claire Oakley, director of Population Health Services at RiverStone Health, Yellowstone County’s public health agency. “And that’s a concern.”

The report, released in mid-April by the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration’s Center for Tobacco Products, states that 13.6 percent of American high school students reported in 2014 using e-cigarettes at least once a month, up from 4.5 percent in 2013, increasing from an estimated 660,000 to 2 million students.

For middle school students, that number went from 1.1 percent in 2013 to 3.9 last year.

“This is the first time since the survey started collecting data on e-cigarettes in 2011 that current e-cigarette use has surpassed current use of every other tobacco product overall, including conventional cigarettes,” the CDC said in a news release.

While the report goes on to say that cigarette use declined among high school students and remained unchanged among middle school students, Oakley worries that e-cigarettes could open the door to teens picking up cigarettes or chewing tobacco.

“If they wait until they’re 18, there’s much less chance that a child will start smoking,” she said. “More and more kids are trying e-cigarettes and I think people have to recognize that e-cigarettes depend upon a tobacco product. Nicotine is still involved.”

Jeff Uhren, assistant principal at Senior High School, said that local high school officials began noticing a significant spike in students using e-cigarettes, vaping or using related products in the last year or so.

The rise has been seen in a wide range of students across Billings.

“We’ve absolutely seen an increase,” Uhren said. “It’s not just your tobacco users. It’s non-tobacco users, too. Some of the perception is that the vapor and flavor are healthier. We also have reports of them vaping things more than nicotine and flavors, other substances or synthetic drugs.”

Some of the products appeal to younger buyers because of the flavoring, easy use, ready access, the ability to make their own fluid at home, said Tammy Perkins, a Rimrock Foundation addiction counselor contracted out by School District 2.

Like Oakley, she expressed concern that e-cigarette use could lead youth to smoking cigarettes or using other tobacco products. She also said it’s not always used as a smoking-cessation tool.

“They’re not using it to taper down from cigarette use,” she said. “They’re using it to use it.”

School District 2 considers e-cigarettes and related products part of its tobacco and paraphernalia policies, meaning they and their use are banned from school property. While not all such products actually contain nicotine or tobacco — they can be made with just flavoring, oils and other ingredients — they all fall under the district’s policy.

The sale of tobacco products to minors in Montana is illegal, and the Legislature this spring approved a ban of e-cigarette sales and possession for the same age group.

Gov. Steve Bullock signed Senate Bill 66, proposed by Attorney General Tim Fox and sponsored by Sen. Diane Sands, D-Missoula, into law in late April.

The law goes into effect on Jan. 1 and adds e-cigarettes to Montana’s laws that prohibit youth access to tobacco products. It also requires sellers of the devices to purchase an annual $5 license and the Gazette recently reported than an estimated two-thirds of the 1,700 Montana vendors who sell tobacco also e-cigarettes.

“Montana has joined the vast majority of states in prohibiting the sale of electronic cigarettes and ‘vaping’ equipment to minors,” Fox wrote in a guest editorial to the Gazette. “We worked together to address the significant risk to our children’s health posed by the use of e-cigarettes.”

Oakley said that the law is an important step in youth tobacco use prevention efforts.

“The important part is that SB66 won’t allow selling to children under the age of 18,” she said. “I’d like to see the use of e-cigarettes automatically included in the Clean Indoor Act next. That would be ideal.”

The CDC report notes that 42 other states already have similar laws banning children buying or possessing e-cigarettes.

Oakley said that existing prevention and awareness programs in area middle schools will play a key role in future efforts.

RiverStone’s reACT: Against Corporate Tobacco program forms crews of students in all of Yellowstone County middle schools to hold events that focus on health, education and prevention through peer-to-peer activities.

As of mid-May, the program included 92 students in five area middle schools and much of their effort can be tailored to include e-cigarettes.

“The whole point is to reach kids earlier, at the middle school age, about the highly addictive nature of nicotine,” Oakley said.

Uhren said that efforts continue at the high-school level through education in health and physical education classes, staff awareness and the help of professionals such as Perkins.

“We’ve just seen so much more of it in the last year, year and a half,” he said. “Prior to that, it was sparse.”

Perkins said that counselors in schools across Billings can also provide educational information, speak with students and often put up posters and other literature around schools.

In addition, smoking cessation classes that were originally designed for youth who received minor in possession citations for cigarettes have been expanded to include other products.

“Those kiddos need the information for e-cigarettes, they need it for chew and snuff and anything that’s in the tobacco family,” she said.