Are e-cigarettes sending progress on tobacco control up in smoke?

Tobacco control has been viewed as a public health victory. Since the U.S. Surgeon General’s report on smoking and health more than 50 years ago, smoking rates in the U.S. are falling. However, with the introduction of e-cigarettes in 2007, public health experts may have a new hurdle to overcome.


E-cigarettes have been promoted as a low-nicotine option that provides smokers a substitute for cigarettes to help them quit. However, tobacco-control advocates, scientists and public health leaders debate the effects of using e-cigarettes on the user’s health and some argue that vaping, a term for smoking flavored e-cigarettes, has become the gateway to smoking for people who did not previously smoke. With flavors like raspberry, bubble gum, and vanilla mocha frappe, is it any wonder that kids are attracted to vaping? A study from England found that kids who were exposed to ads for candy-flavored e-cigarettes increased their interest in vaping. And indeed, while e-cigarettes may be helping some individuals quit, for youth, the rate of nicotine use has skyrocketed, according to a study published this month.


E-cigarette use by adolescents has increased rapidly in recent years. The CDC found that in one year, between 2013 and 2014, e-cigarette use tripled among middle and high school students. Similar smoking rates among 12th graders haven’t been seen since 1995. Using data from the Children’s Health Study, a longitudinal study of 12th grade cohorts, researchers found that while smoking rates of southern California adolescents has declined, adolescents who use e-cigarettes are not merely substituting for cigarettes. Instead, the data indicates that e-cigarette use is occurring in adolescents who would not otherwise have used tobacco products. Among 12th-grade students, the combined adjusted prevalence of current cigarette or e-cigarette use in 2014 was 13.7%. This was substantially greater than the 9.0% adjusted prevalence of current cigarette use in 2004, before e-cigarettes were available.


A pack of cigarettes typically contains anywhere from 8 mg to 20 mg of nicotine (along with many other chemicals) and your body absorbs about 1mg of that. In comparison, e-cigarettes can be purchased without nicotine or with as much as 48 mg/ml of nicotine. However, preliminary tests by the FDA found nicotine in all but one of the non-nicotine e-cigarettes that were tested. Also, the differences in devices and the rate at which you ‘vape’ lead to big differences in the amount of nicotine you absorb. Research suggests that experience also makes a difference. Current e-cigarette smokers achieved systemic nicotine and/or cotinine concentrations similar to those produced from traditional cigarettes, compared to inexperienced e-cigarette users who inhaled modest nicotine concentrations. However, exposure to any amount of nicotine at a young age is harmful to healthy brain development.


In a 2015 survey, 61% of males and females aged 19 years or older felt e-cigarettes should not be used in front of children. The FDA recently passed regulations to restrict the sale of e-cigarettes to minors and include warning labels on products. Hopefully the impact of the FDA’s regulation will help to halt the growing popularity of these products among youth. If not, further regulation may be required. Additional public health interventions also need to be designed that specifically target minors and discourage any use of e-cigarettes.

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