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National data have shown teen use of e-cigarettes is increasing steadily each year. A new survey of high school students in Hawaii found 29 percent have used e-cigarettes, which is substantially higher than previous estimates.

The study, “Risk Factors for Exclusive E-Cigarette Use and Dual E-Cigare​tte Use and Tobacco Use in Adolescents​,” in the January 2015 Pediatrics, surveyed 1,941 high school students in Hawaii in 2013.​

Students reported their use of e-cigarettes, tobacco cigarettes, alcohol and marijuana, as well as psychosocial factors related to substance use, such as parental support, academic involvement, peer smoking and sensation-seeking behaviors.

Researchers found 17 percent of students reported using e-cigarettes only, 12 percent used both e-cigarettes and cigarettes, and 3 percent used cigarettes only. Students who only used e-cigarettes had fewer psychosocial risk factors than students who used both cigarettes and e-cigarettes.

According to the study authors, this raises the possibility that e-cigarettes are recruiting medium-risk adolescents to cigarette smoking who otherwise would be less susceptible to tobacco use.