e-Cigs a 'Public Health Crisis' for Youth, Surgeon General Says

Alicia Ault

December 08, 2016

WASHINGTON, DC — Exploding use of e-cigarettes and other electronic nicotine delivery devices among adolescents and children is a public health crisis in the making, according to the first-ever Surgeon General's report on the products.

"e-Cigarettes went from being rare in 2010 to the most common tobacco product used by our nation's youth," said Surgeon General Vivek Murthy, MD, at a briefing here on "E-Cigarette Use Among Youth and Young Adults."

The Centers for Disease Control and Prevention's National Youth Tobacco Survey found that the percentage of high school students who had ever used e-cigarettes had risen from about 5% in 2011 to 38% in 2015. Six percent of high school students said they'd used e-cigarettes in the past 30 days, compared with 0.1% in 2011. Use among middle school students was also on the rise, with 10% having ever used and 4% using within the past month.

"This represents a staggering development in a relatively short period of time," said Dr Murthy. He said the growth was due to lack of information about the risks and advertising tactics targeting children that borrowed from the tobacco industry, including celebrity endorsements, use of flavors, and sponsored sports and music events.

After compiling the available evidence on e-cigarettes, vaporizers, vape pens, hookah pens, and e-pipes, 150 experts concluded in the Surgeon General's report that "nicotine-containing products in any form, including e-cigarettes, are not safe for youth," said Dr Murthy.

In a joint statement supporting the Surgeon General's report, The American Academy of Pediatrics (AAP), the American Academy of Family Physicians, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, and the American Medical Association note that not only are developing brains vulnerable to nicotine but that nicotine's effects are also dangerous to pregnant women and their developing fetuses.

"e-Cigarettes have the potential to addict the next generation of children, and it's a major public health crisis as far as we're concerned," said AAP President Benard Dreyer, MD, who spoke at the briefing.

The rising number of users over the last few years "implies to me that they're hooked," Dr Dreyer told Medscape Medical News in an interview. "That's really scary because once you're hooked on nicotine, it's hard to get off," he said.

Not everyone agreed with the report's findings. Edward Anselm, MD, a senior fellow at the nonpartisan think tank the R Street Institute, said in a statement that the report "focuses on youth experimentation and completely omits the opportunities for harm reduction these devices offer for adult smokers."

Dr Anselm, also an assistant clinical professor of medicine at the Icahn School of Medicine at Mount Sinai, New York, said it represented "a continuation of the recent demonization of nicotine by some in the public health community, to the detriment of 40 million adult smokers who could be helped to reduce their risk to tobacco-related disease substantially."

Kids Confused About Vaping Safety

While e-cigs and other such devices grow in popularity, the confusion about them is "widespread," Dr Murthy said. It's not clear what's in the liquids used to fuel the electronic devices or whether they are a safe alternative to smoking, he said.

"Some say the use of e-cigarettes may protect young people from becoming cigarette smokers," Dr Murthy said. "But there is actually no evidence to support this claim," he said. "Instead, there is evidence of more children being exposed to nicotine through e-cigarettes." The CDC found that 7.5% of 18- to 24-year-olds used both cigarettes and e-cigarettes in 2014. The evidence suggests that e-cigarette use is associated with use of other tobacco products and with alcohol and other substance use, according to the Surgeon General's report.

"Most kids use e-cigarettes not to stop smoking — they're using it as a gateway because they think it's safe and it tastes good," Dr Dreyer told Medscape Medical News. "They don't really understand that nicotine is addictive."

Dr Anselm said that while it appeared to be true that "young people who try e-cigarettes are more likely to experiment with other adult behaviors, including smoking," he added, "If there were no e-cigarettes, they would go straight to smoking."

The joint statement from the medical associations urged physicians to counsel parents and caregivers about the risks of e-cigarette use and secondhand smoke; to advise children and adolescents on the dangers of tobacco use; and to discuss the potential risk of poisoning with liquid nicotine, which is highly potent and extremely toxic, they said.

FDA Restrictions on the Way

One of the biggest obstacles to communicating risk about electronic nicotine products is the lack of accurate information. "Right now, you don't even know what is in most of those e-cigarettes — how much nicotine, or what else is there," Dr Dreyer said.

The US Food and Drug Administration (FDA) aims to find out. New regulations went into effect in August, giving the FDA the power to regulate the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of the electronic devices. The regulations also ban the sale of e-cigarettes to anyone under age 18.

But it will take years for answers — manufacturers who had products on the market before the new law took effect can sell those products for up to 2 years while they seek FDA approval, along with another year of sales while the FDA reviews the application.

Starting in 2018, all electronic nicotine delivery products must state: "WARNING: This product contains nicotine. Nicotine is an addictive chemical."

The FDA did not, however, ban flavored products, as had been desired by many adolescent health, antitobacco, and medical organizations.

"That's what we're going to be working on now," Dr Dreyer told Medscape Medical News, noting that the lack of action on flavors was a big disappointment for the AAP.

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