Youth E-Cigarette Use Prompts Health Concerns, New Policies in Guam

October 28, 2014|12:19 p.m.| ASTHO Staff

Electronic cigarette use is rising throughout U.S. states, territories, and freely associated states, creating a new challenge for health officials as they grapple with how to treat the increasingly popular products. Researchers continue to study e-cigarette's health effects, but many health experts have expressed concerns about the growing trend.

One possible issue is that e-cigarettes, which contain nicotine, may act as a gateway to tobacco use, particularly for youth. CDC's National Youth Tobacco Survey found that high school students' use of e-cigarettes doubled from 2011 to 2012. In addition, 1.8 million middle and high school students said they tried e-cigarettes in 2012. In March 2014, the American Medical Association's journal JAMA Pediatrics published a study, "Electronic Cigarettes and Conventional Cigarette Use Among U.S. Adolescents," which found that adolescents who used e-cigarettes were more likely to smoke cigarettes than those who did not.

Although evidence suggests that e-cigarettes contain lower levels of some common tobacco-related toxicants than traditional cigarettes, an FDA analysis found that there are several impurities harmful to human health in e-cigarette cartridges. Additionally, the user's level of exposure to nicotine and toxins can vary widely among e-cigarette products. Some contain nicotine levels that approach fatal doses, and may be linked to nicotine poisoning. In April 2014, CDC reported that calls to poison control centers from states and territories regarding nicotine poisoning from e-cigarettes rose sharply between 2010 and 2014, and more than 50 percent of the calls involved children aged 5 or younger.

Because FDA is still reviewing comments to the proposed deeming rule that it released in April 2014, U.S. states, territories, and freely associated states are adopting their own approaches to the issue.

Guam Prohibits E-Cigarette Use in Health Department Vehicles, Sale to Minors

Despite the many unknowns surrounding the health effects of e-cigarettes, use was growing among Guam's middle and high school students, news reports showed. Guam's health official felt the trend merited attention.

"I thought we needed to do something to at least show leadership and try to start the public conversation on this matter," Guam Department of Public Health and Social Services Director James Gillan, MS, HAS said.

In February 2014, GDPHSS expanded its smoke-free policy to prohibit the use of e-cigarettes in all department facilities and vehicles. "The actual contents in the cartridges are unknown, which poses health and safety concerns. … Initial lab tests conducted by the FDA found detectable levels of carcinogens and toxic chemicals, including an ingredient used in antifreeze in two brands of e-cigarettes and numerous cartridges," said a press release from Guam's health department.

Following the updated smoke-free policy's implementation, Gillan discussed e-cigarettes with Sen. Dennis Rodriguez, chairman of the Guam Legislative Committee on Health. Within weeks, Rodriguez had drafted Bill 264, a measure that would prohibit the sale or distribution of electronic cigarettes to minors. Gillan expects that the bill will pass the legislature and the governor will sign it. "What we are seeing is the recruitment of a whole new generation of addicts, finding another way to get nicotine into people's systems, and touting it as a fairly harmless way to do so," Gillan said while discussing the bill's rationale at its legislative hearing.

To rally support for Bill 264, Guam's health department leveraged its strong relationships with partners. The Guam Cancer Coalition, the Pacific Region Cancer Coalition, the Guam Behavioral Health and Wellness Center's tobacco cessation program, the Guam chapter of the American Cancer Society, and several community leaders supported the bill at its hearing. Bill 264 was passed and signed in May 2014, becoming Guam Public Law 32-160.

Learn more about how the Guam Department of Public Health and Social Services addressed e-cigarette smoking among youth in this story from ASTHO's "Have You Shared" story collection. View ASTHO's complete collection of stories at