More than two out of every five middle and high school students who smoke report using either flavored little cigars or flavored cigarettes, according to a report by the Centers for Disease Control and Prevention (CDC). The study, based on data from a 2011 National Youth Tobacco Survey, is CDC’s first attempt to measure usage of flavored little cigars and cigarettes by youth in the U.S. The findings were published online in the Journal of Adolescent Health on Oct. 22, 2013.

“Flavored or not, cigars cause cancer, heart disease, lung disease and many other health problems. Flavored little cigars appeal to youth and the use of these tobacco products may lead to disfigurement, disability and premature death,” CDC director Dr. Tom Frieden said in an agency news release. “We need to take comprehensive steps to reduce all tobacco use for all of our youth.”

One reason flavored cigarettes and little cigars appeal to young people is because the candy and fruit flavors mask the harsh taste of tobacco. The flavored little cigars are also more affordable. Unlike cigarettes, they are not taxed in most states and can be bought individually or in doubles, so teens do not have to buy a whole pack at a time.

Little cigars have become more popular in recent years. Sales have increased 240 percent from 1997 to 2007, with flavored brands making up almost 80 percent of the market share.

The CDC also reported that e-cigarette (electronic cigarette) use among young smokers has doubled, due in part to brands that come in flavors such as bubble gum, gummy bear, orange cream soda and cotton candy.

Health officials are concerned that flavored tobacco products obscure the health risks of smoking and entice young people into continued use of tobacco.