Commentary

Rising E-Cig Use By Teens Lights Up Debate

The number of teenagers using e-cigarettes tripled between 2013 and 2014 as the use of as cigarettes among them declined, according to data published yesterday by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration’s Center for Tobacco Products (CTP). Hookah smoking roughly doubled for middle and high school students.

CDC director Tom Frieden called the increase in vaping by students “alarming” and “shocking,” according to Brady Dennis in the Washington Post, and argued that the rise in consumption is at least partially due to “aggressive, largely unregulated marketing campaigns that [he] said are ‘straight out of the playbook’ of cigarette ads that targeted young people in earlier generations.”

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But defenders of e-cigarettes read the new figures entirely differently.

“The CDC should really be jumping for joy at the fact that smoking rates are declining. This is a huge success,” Michael Siegel, a professor at Boston University’s School of Public Health, tells Dennis. “Instead, they are using this as another opportunity to demonize e-cigarettes.”

E-cigarette use (on at least one day in the past 30) among high schoolers increased from about 660,000 to 2 million students — a jump from 4.5% of the cohort to 13.4%. Among middle school students, use more than tripled from 1.1% to 3.9% over the same period — an increase from approximately 120,000 to 450,000 students.

The report concluded that “further reducing youth tobacco use and initiation is achievable through regulation of the manufacturing, distribution, and marketing of tobacco products coupled with proven strategies,” according to a news release.

“Some teenagers described vaping as an entirely different culture from cigarette smoking, and scoffed at the idea that it could be a way into cigarettes,” writes Sabrina Tavernise in the New York Times after interviewing a number of them across the country. 

“It’s the healthy alternative taking over my school,” Tom, a 15-year-old sophomore at a school in Westchester County, N.Y., told Tavernise, who reports that he started vaping to kick his smoking habit. 

Tobacco use kills more than 5 million people per year globally, according to the World Health Organization.

“We want parents to know that nicotine is dangerous for kids at any age, whether it’s an e-cigarette, hookah, cigarette or cigar,” said Frieden, a medical doctor with a masters degree in public health. “Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use.”

The study found that there was “no decline in overall tobacco use by students” between 2011 and 2014 but that the percentage of students reporting current use of cigarettes declined from 15.8% to 9.2%.

“This dramatic fall in teen smoking should be part of the discussion,” Gregory Conley, president of the American Vaping Association, emailed Rob Stein for NPR’s Shots health blog, “but the CDC deemed this finding to not be worthy of a single line in their press release. That is not surprising, as it would interfere with the CDC's evidence-free attempts to paint e-cigarettes as a potential gateway to traditional cigarettes."

Whether e-cigs actually have a positive influence on most people trying to quit cigarettes — a claim that proponents of vaping make — also needs to be part of the discussion, it appears. A study published online yesterday by the American Journal of Public Health “found that smokers who used e-cigarettes were less likely to quit regular cigarettes than those who hadn't tried the devices,” Robert Preidt reports on WebMD.

“Smokers who said they had ever used e-cigarettes were about half as likely to cut down on their smoking and 59% less likely to quit, compared to those who never used e-cigarettes,” Preidt writes.  

“Asking smokers about their ‘ever use’ of a product, and then somehow attributing that ‘ever use’ to their subsequent success or failure to quit smoking months or years down the line, is dishonest and unethical,” the American Vaping Association’s Conley responded.

A new study published in Tobacco Control this week, meanwhile, found that chronic ingestion of some of the chemicals used to add flavor to e-cigarettes “could spur respiratory irritation,” Alexandra Sifferlin reports in Time, and “may be more dangerous when inhaled than when they are ingested in food.”

The researchers, led by study author James F. Pankow, a professor of chemistry and civil & environmental engineering at Portland (Ore.) State University, “point out several concerns about flavoring, including the fear that flavored e-cigarettes might attract young people and the fact that flavored e-cigarettes don’t usually list the levels of specific chemicals that are present in the liquids.”

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