E-cigarettes Threaten the "Tobacco Endgame"

The tobacco endgame – ending tobacco use and nicotine addiction in the U.S. – is within sight. About 14 percent of people in America smoke. The goal is to drive that rate down below five percent to save millions of lives. 

But e-cigarettes and other tobacco products (like cigarillos, hookah and smokeless tobacco) pose a significant threat to this goal. A new generation of tobacco products is addicting a new generation of users to tobacco and nicotine. More kids and young adults are using these products, and they’re using them more often. 

The kids are not all right.

The 2018 National Youth Tobacco Survey showed an alarming surge in e-cigarette use. Vaping is now the most popular way for adolescents to use tobacco. From 2017 to 2018, usage rose by 78 percent for high school students and 48 percent for middle school students.

Many kids falsely believe e-cigarettes and other tobacco products are safe. Some don’t even realize they contain nicotine. But these products can deliver much higher concentrations of this addictive drug than traditional cigarettes. For example, a JUUL prefilled liquid pod contains as much nicotine as a whole pack of cigarettes.

According to the U.S. surgeon general, exposure to nicotine during adolescence can cause addiction and harm the developing brain. But there’s no safety helmet to protect kids from this growing danger.

Here are the top reasons young people give for using e-cigs:

• Use by a friend or family member
• Appealing flavors like mint, candy, fruit or chocolate
• Belief that they are less harmful than other forms of tobacco

The youth tobacco epidemic is a serious public health threat. We know nearly 90 percent of smokers first try a tobacco product by age 18. But if people don’t start using tobacco by age 26, they are likely to never start. Our focus must be on prevention at this critical stage of life.

What about adults?

Tobacco companies promote e-cigarettes as a way to help smokers quit. But much more evidence is needed to show their effectiveness for quitting cigarettes and other forms of tobacco. 

These products may help some smokers quit or move to a less harmful product, but they can also lead to “dual use” – continuing to smoke traditional cigarettes and also vaping. So even if e-cigarettes are less harmful than traditional cigarettes, those benefits are erased when both products are used. And dual use makes it even harder to quit because of the increased nicotine exposure. 

Studies have also shown an association between vaping and other substances: alcohol, illegal or recreational drugs, and misuse of over-the-counter and prescription medications (such as opioids).

The truth is, there is no “safe” tobacco product. We don’t yet know the long-term health effects, especially of these newer products.

Most people don’t fully understand nicotine addiction and its health threats. Health care professionals need to be able to talk with patients about tobacco use, including e-cigarettes and these newer products. Thorough training and education can help make these conversations more meaningful and informed.

Seeing through the smoke screen.

And yet, tobacco companies have grown bolder in their efforts to keep people addicted and misinformed:

• They fund lawsuits to prevent or weaken tobacco-control policies.
• They spend millions lobbying lawmakers to oppose such policies.
• They target products and promotions to youth and other at-risk populations, including women, ethnic groups, LGBTQ people, rural residents, people with lower income and less education, and people with mental health conditions.
• They support watered-down and less effective tobacco-control measures as a public relations ploy.
• They fund organizations and groups that claim to address the tobacco epidemic but instead divert attention from proven measures.

How do we get to the tobacco endgame?

Reaching the tobacco endgame and preventing use by kids and young adults will require strong government oversight. We need stronger regulation of the design, manufacturing, sales and marketing of all tobacco products. For example:

• Restrict marketing efforts like celebrity endorsements, movie placements, price promotions, event sponsorships and merchandise branding.
• Ban characterizing flavors and sweeteners to reduce appeal to kids.
• Put graphic warning labels and nicotine concentration information on all products and work toward reducing nicotine levels in cigarettes and cigars.
• Strengthen enforcement efforts to prevent illegal sales of tobacco products.
• Verify the effectiveness of products marketed to help people stop smoking.

Support what’s already working.

We must also continue to support proven strategies and public policy, such as:

• Public education campaigns
• Youth prevention programs
• Advertising restrictions
• Clean indoor air laws
• Access to and coverage of evidence-based methods to quit tobacco use and nicotine addiction
• Tobacco excise taxes
• Ending the sale of tobacco in pharmacies and health-related businesses
• Raising the tobacco sales age to 21 (Tobacco 21 laws)

How you can help.

• Stay tobacco-free. If you smoke or use tobacco, make a plan to quit now.
• Talk with young people in your life about the dangers of vaping and any tobacco use.
• Share our infographic with your social networks.
• Advocate for strong, comprehensive tobacco policies and regulation.
• Join local efforts in your community and state at yourethecure.org.

Types of tobacco products.

Several types of products are now attracting new users through appealing flavors, aggressive marketing and social media engagement. Here are a few you should know about.

Cigarillos – Small cigars that resemble traditional cigarettes but are often exempt from regulation that applies to cigarettes. They tend to be low cost and come in flavors. They are the tobacco product most used by black adolescents.

E-cigarettes – Electronic devices containing a nicotine-based liquid that is vaporized and inhaled to mimic the experience of smoking cigarettes.

JUUL – One of the most popular types of e-cigarette that became available in the U.S. in 2015. Because of its small size, appealing flavors, less harsh inhale sensation and minimal vapor clouds exhaled, usage by kids in schools has become a nationwide epidemic. There are now several similar products under different brand names.

Heat-not-burn products – These devices generate an inhalable aerosol by heating tobacco at approximately 500°F rather than burning.

Hookah – A tobacco pipe with a long, flexible tube that draws the smoke through water. Often used to smoke flavored tobacco in a social group setting or “hookah bar.”

Smokeless tobacco – Products such as chewing and dipping tobacco, dissolvable tobacco lozenges, snus, and snuff. 

Sources:

American Heart Association Presidential Advisory, New and Emerging Tobacco Products and the Nicotine Endgame: The Role of Robust Regulation and Comprehensive Tobacco Control and Prevention, 2019
U.S. Food & Drug Administration, Youth Tobacco Use: Results from the National Youth Tobacco Survey, 2019(link opens in new window)