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An increasing number of students in middle school and high school are smoking e-cigarettes, hookahs and cigars, a new government report concludes.

The Centers for Disease Control and Prevention (CDC) found overall youth smoking rates have not declined. “We need effective action to protect our kids from addiction to nicotine,” Dr. Tom Frieden, Director of the CDC, said in a news release.

The findings come from the 2012 National Youth Tobacco Survey, which includes 25,000 students in grades 6 through 12. Among high school students, e-cigarette use increased to 2.8 percent in 2012, from 1.5 percent in 2011. Among middle school students, e-cigarette use increased to 1.1 percent, from 0.6 percent the previous year.

Hookah smoking rose from 4.1 percent of high school students in 2011, to 5.4 percent in 2012, CBS News reports.

The report found cigar use among black high school students jumped from 11.7 percent in 2011, to 16.7 percent in 2012. The survey included flavored little cigars, or cigarillos, which contain candy or fruit flavorings and look similar to cigarettes.

According to the CDC, the rise in the use of e-cigarettes and hookahs may be due to an increase in marketing, availability and visibility of these products, and the perception they may be safer than regular cigarettes. E-cigarettes, hookahs and cigars are not subject to regulation by the Food and Drug Administration. The agency is expected to issue rules to tighten regulation of e-cigarettes and other non-cigarette nicotine products.

The CDC researchers recommend additional measures, such as increasing the products’ price, using media campaigns to discourage smoking, increasing access to services to help people quit, and enforcing restrictions on promotion and advertising.

“This report raises a red flag about newer tobacco products,” Dr. Frieden said. “Cigars and hookah tobacco are smoked tobacco – addictive and deadly. We need effective action to protect our kids from addiction to nicotine.”

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