(HealthDay News) — More than a quarter-million middle and high school students who were non-smokers say they used an electronic cigarette last year – a three-fold increase from 2011, according to a new U.S. study published online Aug. 20 in the journal Nicotine & Tobacco Research.

The new study findings come from an analysis of data from the 2011, 2012, and 2013 National Youth Tobacco surveys of middle and high school students in the United States. Nearly 26% of teens who saw tobacco ads from three or four sources said they planned to start smoking, compared with about 20% among those who reported one to two ad sources, and 13% among those who saw no such ads.

The CDC report also found that non-smoking children who used e-cigarettes were nearly twice as likely to say they plan to start smoking tobacco cigarettes compared to those who never used e-cigarettes – about 44% vs. 21.5%.

“We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes, or other tobacco products. Not only is nicotine highly addictive, it can harm adolescent brain development,” Tim McAfee, MD, MPH, director of CDC’s Office on Smoking and Health, said in an agency news release.

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