Cigarette smoking, a public health epidemic that has been an aggressive foe for the last 50 years, is finally showing signs of weakness. But another health hazard is taking its place: e-cigarettes. And they are detrimental to our youngest citizens. As Commissioner of Health of Rockland County, it is my responsibility to sound an alarm on issues of public health and safety. This is one of those issues.
New federal regulations for electronic cigarettes went into effect on Monday, August 8, 2016. Among other requirements by the Food and Drug Administration, people under 18 won’t be able to buy e-cigarettes. This is insufficient. Tobacco use is the single largest preventable cause of disease and death in the United States. The use of electronic nicotine delivery systems by our nation’s youth continues to rise rapidly. More than 3 million middle and high school students were current users of e-cigarettes in 2015, up from 2 million in 2014.
E-cigarettes were the most commonly used tobacco product among middle and high school students last year. Vaporizing (or vaping) has been linked to increased teen nicotine rates. A recent study in Pediatrics found that many teenagers who had never smoked are now vaping with flavored e-cigarettes, which is leading to a new generation using nicotine at rates not seen since the 1990s.
E-cigarettes have also become a “gateway” to traditional tobacco cigarettes. Young people who smoke e-cigarettes are more likely to smoke tobacco cigarettes within a year than their peers. Adolescents have used e-cigarette devices to vaporize marijuana and other substances.
The vaping liquid, which is available in bubble gum, marshmallow, chocolate, cotton candy and other flavors, targets children. This is a highly addictive liquid “candy” and is marketed directly to pre-teens and teens, luring impressionable youth into the dangerous world of nicotine addiction. As stated in the National Institute on Drug Abuse report from 2015, “over 60 percent of middle and high school students reported vaporizing as ‘just flavoring.’” In reality, some products labeled nicotine-free may actually contain nicotine, a highly addictive substance. This early exposure and addiction to nicotine in malleable brains can negatively impact cognitive development. Adolescents demonstrate symptoms of nicotine dependence earlier and at lower doses than adults. Their addiction to nicotine is also more severe and difficult to beat. Some youths experience tobacco dependence within a day of first inhaling. According to a 2010 report prepared for the European Union by a group of distinguished scientists, tobacco has a substantially higher risk of causing addiction than heroin, cocaine, alcohol, or cannabis.
Long-term effects in adolescents, due to the disruption of circuits in the brain, are reported to affect attention, working memory, academic problems, depression, panic disorder, and addiction to other substances. Early introduction of e-cigarettes causes a combination of early dependence and addiction, which promotes a grim future for the health of our teens.
E-cigarettes layer on additional dangers, including cancer, due to chemicals and toxins they contain. FDA-conducted studies found that, compared with traditional cigarettes, e-cigarettes have higher levels of certain carcinogens, such as tin, copper, nickel and silver, as well as silicate beads and nanoparticles, and diethylene glycol (a chemical found in antifreeze).
When the manufacturers of these electronic nicotine devices offer anecdotal claims of safety of their products, to date, there is no peer-reviewed, verifiable research available to support these benign claims. In addition, there are no scientific, peer-reviewed studies to support that these products are an effective way to wean off cigarettes. According to University of Southern California researchers, “e-cigarettes do not appear to have made a dent in regular cigarette use.” The rate of teenagers using nicotine, at 23.5 percent, either through tobacco cigarettes or e-cigarettes is on the rise. This rate represents the highest number since 1995.
Raising the sale to age 21, rather than 18, is science-based with the aim to protect our youth. According to the National Survey on Drug Use and Health, nearly 80 percent of all adult smokers began smoking by age 18, and 90 percent do so before leaving their teens. Because of the addictive power of nicotine, 47 percent of adult smokers had transitioned to daily smoking before age 18 and 80 percent transitioned to daily smoking before age 21. Overall, three of every four teenage smokers continue to smoke in adulthood.
If smoking initiation was delayed by three years to age 21, there would be a substantial decrease in young people who ever start smoking. This would lead to an overall decline in adult smokers, which would also serve to reduce the health burden on society. We must prevent a worse crisis than the one that e-cigarettes were created to improve. The decades-long uphill battle for tobacco control measures and public health gains are at serious risk if e-cigarettes are not deglamorized and de-normalized. The time is now to restrict the sale of e-cigarettes to those 21 and over, before more young people enter the world of nicotine addiction.
http://www.cdc.gov/tobacco/data_statistics/surveys/nyts/ The National Youth Tobacco Survey, 2015.
http://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6514.pdf MMWR Morbidity and Mortality Weekly Report 2016 Apr15;65(14):361-7.
https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Adolescents-Who-Vape-Six-Times-More-Likely-to-to-Smoke-in-Early-Adulthood.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token Pediatrics 16 Jun 2016.
https://www.drugabuse.gov/related-topics/trends-statistics National Institute on Drug Abuse (2015).
http://perspectivesinmedicine.cshlp.org/content/2/12/a012120.full Cold Spring Harbor Perspectives in Medicine (2012).
http://www.familypracticenews.com/?id=2633&tx_ttnews[tt_news]=510001&cHash=3a913a6f16aa44a82e843d16dac422ce Family Practice News 25 May 2016.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859972/ Front Public Health.2013; 1:56.2013 Nov 18.9
http://keck.usc.edu/news/teens-who-use-e-cigarettes-may-be-transitioning-to-tobacco-products-research-shows/ University of California. USC. 2015 Aug18.
https://nsduhweb.rti.org/respweb/homepage.cfm National Survey on Drug Use and Health.
http://www.tobaccofreekids.org/ Tobacco Free Kids 2016 Jun 23.
https://www.cdc.gov/tobacco Smoking and Tobacco Use.