Electronic cigarette use is exploding among adolescents, and the latest evidence indicates this is not good. A study published last week in JAMA Pediatrics found youth e-cigarette users had higher odds of being tobacco smokers, progressing from experimentation to established smoking; were more likely to be heavier smokers; and were less likely to have quit smoking than smokers who did not also use e-cigarettes.
“What is particularly concerning,” study co-author Lauren Dutra said in an interview, “is that 20 percent of middle school students who tried an e-cigarette had never tried a real cigarette. E-cigarette ads reach teenagers at an age when the brain is really vulnerable to nicotine.’’
Dutra and co-author Stanton Glantz from the University of California, San Francisco said more studies need to be done, and critics were quick to leap on the results as inconclusive. E-cigarette manufacturers and public health advocates who hope the devices offer a safer alternative to tobacco say the study did not prove e-cigs directly cause more tobacco smoking.
E-cigarettes are battery-powered heating devices that deliver nicotine vapor to users. Big Tobacco hopes to sell them as a revolution in health. Murray Kessler, CEO of Lorillard, maker of the popular Blu, boasted last month that the e-cigarette will be “one of the greatest harm-reduction opportunities ever presented to a smoker.”
But that is not happening. According to the Centers for Disease Control and Prevention, the percentage of youths in grades six to 12 who tried e-cigarettes more than doubled from 3.3 percent to 6.8 percent between 2011 to 2012. Dual use among youths was extremely high, with 76 percent of e-cigarette users also smoking tobacco cigarettes.
Tim McAfee, the CDC’s director of Smoking and Health, said, “We must keep our youth from experimenting or using any tobacco product. These dramatic increases suggest that developing strategies to prevent marketing, sales, and use of e-cigarettes among youth is critical.”
Everyone agrees e-cigarettes are less harmful than traditional carcinogenic cigarettes. But the chemicals in e-cigarettes have never been conclusively tested for their own risk. That has allowed e-cig companies to flood the market with devices that come in a variety of fruit, spice, candy, and dessert flavorings that the FDA banned in tobacco cigarettes because they were clearly targeted at adolescents. They are also getting away with racy ads no longer allowed for tobacco. Anti-smoking advocates cite an ad for Blu in Sports Illustrated’s current swimsuit edition. It shows the lower torso of a woman with the product’s logo on the middle of her bikini bottom, with text saying, “Slim, Charged, Ready to Go.”
The marketing is so slick that The New York Times reported last week that the number of teenagers using e-cigarettes may be vastly underestimated. Many adolescents who say they never have smoked an e-cigarette actually have, under other names such as “hookah” and “vape” pens.
Many cities are trying to treat e-cigarettes like tobacco. Boston was one of the first in 2011 to ban sales to minors and prohibit vaping in workplaces, and 100 municipalities have some level of restrictions. Last week, Los Angeles followed suit.
But without federal regulation, the hip marketing of e-cigarettes will overwhelm public health efforts. Boston is part of a coalition of cities that is about to ask the FDA to finally regulate e-cigarettes. Barbara Ferrer, Boston’s public health commissioner, said, “I don’t think they’re safe. No one should be talking about these products as a tool for smoking cessation until they are tested and regulated. We’re seeing much more usage out there, but when kids don’t even know the name of what they are using, they’re being sold a bill of goods.”
When the kids do not know what they’re smoking, that is a public health emergency. The FDA must regulate these products before a new generation vapes itself into a nicotine haze.