Although Zika has been capturing much of the recent media attention, for those in public health there has been another issue gaining attention and inspiring debate—electronic cigarettes or e-cigarettes. In a nutshell, e-cigarette use has risen while traditional cigarette smoking rates have declined—according to the CDC 12.6% of adults have at least tried an e-cigarette once. Usage increases when you look at current and recent former smokers, which is critical as e-cigarettes have been marketing as both a smoking cessation tool and a healthier alternative to conventional cigarettes.
We’ve been keeping an eye on the impact the rise in e-cigarettes has and the implications for tobacco use initiation prevention and cessation, particularly for youth. Though the use of conventional cigarettes among youth has been on the decline, recent years have seen a dramatic surge in the use of e-cigs. A new report from the CDC shows that 16% of high school students have used e-cigarettes in 2015, compared to 1.5% in 2011. The trend was similar for middle school students who increased to 5.3% in 2015 from 0.6% in 2011. While the science is still out on the long-term health consequences of e-cigarette use, it should be noted that this does not necessarily indicate that e-cigarette use is safe. In fact, the main ingredient is nicotine which is addictive and may harm brain development. Further, data indicate that many e-cigarette users also smoke conventional cigarettes, which have known adverse health outcomes such as coronary heart disease, stroke, and lung cancer.
The numbers alone and implications for a new generation of tobacco users are troubling, however, the CDC has emphasized and a new study has confirmed the link between e-cigarette advertising exposure and an increased odds of e-cigarette usage among middle and high school students. We’ve had two recent opportunities to hear Dr. Brian King, the Deputy Director of Research Translation in the CDC’s Office on Smoking and Health speak about this meaningful association, including at the Reduce Tobacco Use Conference in Arlington, VA earlier this week. Since the 1998 Master Settlement Agreement, tobacco companies have been forbidden from indirectly or directly marketing to youth as well as some other restrictions such as the use of kid-friendly cartoons. However, such restrictions are not in place for e-cigarette advertising and the methods tobacco companies are using to market their products is reminiscent of methods outlined in the 2012 Surgeon General’s Report that tobacco companies employed for conventional cigarettes to encourage use, including fruit and candy-flavored products and advertising evoking rebellion, sex, glamour and utilizing celebrities.
On the bright side, there are efforts in place committed to tobacco use prevention among youth. There are several tobacco prevention and education advertising campaigns currently ongoing including the FDA’s The Real Cost campaign, CDC’s Tips from Former Smokers campaign, and Truth Initiative’s truth campaign—of which both The Real Cost and truth are specifically aimed at youth and young adults. CDC has begun incorporating e-cigarettes into their Tips messaging with highlighting the story of Kristy who attempted to use e-cigarettes as a cessation aid. Further, state governments are working on prevention and control efforts to reverse this e-cigarette use trend. We heard about several of these efforts at the Reduce Tobacco Use Conference and also at National Summit on Smokeless and Spit Tobacco in Albuquerque, NM, where we attended the launch of FDA’s The Real Cost smokeless prevention targeted campaign and presented research on segmenting the rural, at-risk smokeless tobacco youth market (despite the name, the interest in e-cigarette trends was a common topic for discussion).
We’ll continue to keep an ear out if these new findings prompt further discussion about the need for further tobacco regulation that extends to newer products such as e-cigarettes.