Youth Vaping an Epidemic, US Surgeon General Declares

Alicia Ault

December 18, 2018

The Office of the US Surgeon General has officially declared e-cigarette use in youth an epidemic, issuing an e-cigarette advisory and calling on the federal government, parents, teachers, government, and healthcare professionals to help stem the tide.

Jerome Adams, MD, MPH

"Today we must protect our nation's young people from a lifetime of nicotine addiction and associated problems by immediately addressing youth e-cigarette use," said US Surgeon General Jerome Adams, MD, MPH, at a press briefing in Washington, DC.

Adams specifically called on colleagues to help.

"As the nation's doctor, I call on my fellow health professionals to ask about e-cigarette use when screening patients for tobacco use and [to] educate patients and their parents about the risks of all forms of tobacco," said Adams, adding that as a parent of a 14, 13, and 9 year old, the issue hits home.

"I just took my kids in for their annual checkups," he said. "When you're doing an annual checkup for kids, are you asking those children, 'Are you using tobacco products, including e-cigarettes?' Do you even know what to ask them about?"

Adams said he doesn't use the word "epidemic" lightly.

Unprecedented Increase

"We're in the midst of a historic and unprecedented increase in youth use of any substance, with 12th grade e-cigarette use doubling, doubling in the past year," he said, referencing the just-released Monitoring the Future survey by the National Institute on Drug Abuse (NIDA) and the University of Michigan.

That survey showed that 21% of high school seniors said they had vaped in the previous 30 days, up from 11% in 2017. More than 1 in 10 eighth graders said they vaped nicotine in the past year.

The NIDA survey numbers are similar to those in the recent National Youth Tobacco urvey, which showed a 78% increase in the number of high school students who were vaping. That survey is funded by the Centers for Disease Control & Prevention and the Food and Drug Administration (FDA).

Both surveys concluded that 1.3 million to 1.5 million more high school students had taken up use of e-cigarettes in 2018.

"We have never seen use of any substance by America's young people rise this rapidly," said Health & Human Services Secretary Alex Azar at the briefing. "This is an unprecedented challenge."

Flavors a Major Problem

At the briefing, federal officials, a school substance abuse counsellor, and a teenage antitobacco advocate all agreed that young people generally believe — incorrectly — that e-cigarettes do not contain nicotine, and thus are not harmful.

"We've been successful in this country stigmatizing tobacco use among kids," said FDA Commissioner Scott Gottlieb, MD, at the briefing. "Kids recognize that using tobacco products is unhealthy and wrong, but we haven't had the same success when it comes to the e-cigarettes," he said.

E-cigarette manufacturers are trying to make their products seem cool and safe — taking a page from the playbook of tobacco companies, said Adams. "They're not safe, they're not cool, and they can cause long-term problems in terms of learning, attention, memory, and priming the brain towards addiction," said Adams.

E-cigarettes — which come in some 8000 different flavors — have a special lure for children, said those at the briefing.

"The flavors are such a huge factor," said Sarah Ryan, a high school senior, from Holbrooke, Massachusetts, who is also a national youth ambassador for the Campaign for Tobacco-Free Kids. She said flavors are the main reason for youth use and that "some of the products are so clearly marketed to youth because of the way that they taste, like Sour Patch Kids" or other candy.

The flavorings also hide the taste and smell of tobacco, which she said is a turnoff to most teens. "They also associate the smell and taste of traditional tobacco with a health risk," said Ryan. "The flavor almost gives a false sense of security."

Gottlieb said it's crucial to "limit the access and appeal that these products have to kids," adding, "That starts with the role of the flavors."

FDA to Take "Aggressive" Action

In November, the FDA said it would prohibit sales of fruit- and candy-flavored e-cigarettes to anyone under 18 at convenience stores and gas stations. Gottlieb said the agency would be increasing its enforcement activity around youth sales.

"You're going to see FDA taking some aggressive steps," said Gottlieb. "We're going to be in those stores, doing our own surveys, doing our own undercover purchases and holding people accountable when they sell these products to kids," he said.

The surgeon general said his office was launching a new public service campaign to warn of the dangers of e-cigarettes — following in the FDA's footsteps. The FDA issued its "The Real Cost" prevention campaign in October.

But, primarily, since the surgeon general cannot make policy or issue rules, Adams called on the public to help combat youth use of e-cigarettes.

Parents and teachers should educate themselves about the different sizes, shapes, and forms that e-cigarettes can take; adopt tobacco-free rules at home and in vehicles; and enforce tobacco-free zones and polices for schools.

States, communities, tribes, and territories should implement evidence-based policies known to prevent tobacco access and use and to reduce harms from the products, said Adams.

"We have evidence-based strategies to prevent tobacco use that can be applied to e-cigarettes," said Adams. "We must take action now to protect the health of our nation's young people."

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