CREDIT: Shutterstock Despite a small decline in the number of American youth smoking cigarettes, an increasing number of middle and high-school students are turning to tobacco alternatives such as hookahs, electronic cigarettes, and cigar products like flavored “little cigars,” according to the Centers for Disease Control (CDC). Youth smoking rates declined about one percent in 2012 compared to the previous year — but middle school and high school students self-reported using e-cigarettes at almost double the rate that they did in 2011.