Time for a Great American Vape Out?

November 21, 2019|1:03 p.m.| Michael Fraser, PhD, MS

Today is the Great American Smokeout, an event that has been hosted by the American Cancer Society for over 40 years on the third Thursday of November. The event began in the 1970s, when smoking and secondhand smoke were common. It has helped dramatically change Americans’ attitudes about tobacco. Today we should celebrate that high school cigarette use is at an all-time low of 5.8 percent, dropping from 8.1percent between 2018 and 2019. That is great news.

And while this year’s event is an opportunity to reflect on a major public health success story, there is also much to be concerned about. The Food and Drug Administration’s recent release of the 2019 Youth Tobacco Survey tells a troubling story: e-cigarette use among high school students continued to increase from 20.8 percent in 2018 to a new high of 27.5 percent in 2019. Over 5 million youths now use e-cigarettes, making these devices the most widely used nicotine product among young people by a wide margin. Middle school students are picking up e-cigarettes, too: 10.5 percent reported using e-cigarettes in 2019, up from 4.9 percent in 2018. As we see this dramatic rise in youth use of e-cigarettes, is it time for a Great American Smoke and Vape Out?

It is becoming increasingly clear that the use of electronic cigarettes is a major threat to the health of our country’s youth. The combination of appealing candy-like flavors in a compelling, high tech gadget is hard to resist, but can also result in a life-long addiction to nicotine, impaired brain development and a gateway to other combustible cigarettes and other addictive drugs. All signs point to the variety of flavored offerings on the market as a major factor driving this surge in use. Among youth who use e-cigarettes, flavored blends are extremely popular. Sixty-eight percent of youth who use e-cigarettes report using flavored cartridges, and appealing flavors—like mint, candy, fruit, and chocolate—were cited by teenagers as one of the top three reasons they tried an e-cigarette for the first time.

The recent outbreak of vaping-related pulmonary injury brings additional concerns of long-term lung damage and even death for any e-cigarette user. Recent news coverage has focused heavily on Vitamin E acetate and the dangers of black-market vaporizer cartridges, but mainstream e-cigarettes, like the brand Juul, are far from proven safe either. Research published earlier this year in the American Journal of Preventive Medicine identified numerous compounds in Juul pods that inflame airways, and the long-term effects of inhaling these chemicals are still entirely unknown. Let’s be clear: there is a big difference between safe and effective, and unknown.

Contrary to public belief, e-cigarettes are not regulated. They are also not an approved cessation tool, they are simply replacing combustible tobacco smoke with nicotine vapor. Depending on the brand and flavor, nicotine levels in e-cigarettes can actually be higher than combustible cigarettes, making it even harder to quit. In the United Kingdom, e-cigarettes are available for use to help individuals stop smoking but that is overseen by a health professional and the device and cartridges are carefully regulated.

The FDA has the authority but has delayed implementation of industry reporting, so little is known about ingredients and there are no limits on how e-cigarettes are packaged, sold or marketed. Indeed, use of fruit-like and candy flavors is an obvious enough attraction for youth that they have now been banned by the FDA in combustible cigarettes, yet e-cigarette manufacturers are still free to use these and other additives. Further regulation by the FDA does not appear to be forthcoming so it is time for others to take action.

This is precisely why state governments across the nation have launched efforts to ban flavored e-cigarettes from the market. Loose regulations and flavored offerings are driving e-cigarette use, and e-cigarettes are far from a harmless alternative to traditional cigarettes—especially when it comes to youth use.

In addition to flavor bans there are a number of other policy and regulatory actions state public health leaders can take. These include taxes to increase e-cigarette product price; incorporating e-cigarettes in comprehensive clean indoor air acts; raising the age of sale for e-cigarette products to 21; placing point of sale restrictions on advertising; and restricting the sale of products above a set nicotine concentration level.

State and federal legislators are poised to introduce new tobacco control legislation in 2020. Legislative proposals include prohibiting the sale of all flavored e-cigarettes within the state, certain flavors of e-cigarettes, or flavored tobacco products more broadly and restricting the locations where flavored e-cigarettes or tobacco products can be sold. But there is more that can be done, and that’s why public health leaders recently asked ASTHO to provide an analysis and recommendations of steps states can take to adopt a comprehensive, evidence-based approach to reducing youth use of e-cigarettes.  

This analysis will be released to ASTHO membership later this month. In the meantime, ASTHO has compiled resources that include talking points and FAQs drawn from recent congressional testimony of 6 state health officials, a summary of FDA testimony, and the status of legal actions against states that have issued executive orders banning e-cigarette flavors.

This year’s Great American Smokeout is timely, as national attention to the health effects of tobacco use is the greatest it has been in decades. America cannot afford to let a new generation of kids become addicted to nicotine, and states are once again taking the lead, using effective, science-based approaches to protect the public’s health. It is indeed time for a Great American Smoke and Vape Out.