Vaping is a gateway to a smoking habit for teenagers
NEW YORK» Traditional cigarette smoking in America has dropped to historic lows, and it looks like electronic cigarettes could be helping. As “vaping” grows in popularity, studies have shown that the habit encourages adult smokers to quit the older, nastier version.
But there’s a big problem — teenagers. And they’re making the entire e-cigarette phenomenon a regulatory nightmare. While traditional smoking among young people is also headed down, emerging evidence indicates that e-cigs are serving as a gateway for those youths who don’t already smoke cigarettes. Dartmouth College researchers showed that some cigarette-smoking adults in the U.S. were able to quit with the help of the devices, but it also revealed that 81 times as many adolescents and young adults who used e-cigs eventually moved on to a regular smoking habit.
Samir Soneji, an associate professor of health policy at Dartmouth’s Geisel School of Medicine and the paper’s lead author, warned that the high level of nicotine in e-cigs (the device vaporizes a flavored liquid containing the addictive substance), combined with the expense of the modern habit, sets teens up to become real smokers.
“Kids may think they’re vaping flavor-only e-cigarettes, but
the actual nicotine content of e-juice may be considerably higher than what is written on the packaging. Even some e-juice claiming to be nicotine-free actually contain nicotine,” said Soneji. Plus, the cost of a rechargeable device ranges from $25 to $145, and a nicotine pod, which can have anywhere from 200 to 400 puffs, costs $43 a month. The average cost of a regular pack of cigarettes in the U.S. is $7.62.
“A cigarette can be a cheap and quick alternative for an adolescent who has recently become addicted to nicotine through the use of e-cigarettes,” he said.
But there’s a further connection between e-cig smoking and real smoking among young people, Soneji added: The more they smoke, the more their perception of traditional cigarettes changes. Youths start to think smoking is “less harmful and less dangerous,” making it easier to pick up the habit.
The wide variety of flavors has been cited as a top reason youths start using ecigs.
With e-cig use skyrocketing among youths age 12 to 25 (despite it being illegal to sell e-cigs to minors), the U.S. Food and Drug Administration has been under pressure to crack down. On March 27, the Campaign for Tobacco-Free Kids sued the agency over its July 2017 decision to delay reviewing the product for four years, pointing out the need for an assessment of how e-cig flavors lure young adopters. By not studying the matter, “the FDA is not getting the information it needs to know,” said Matthew Myers, president of the Campaign.
The FDA should be studying the use of flavors and determining whether any of them help people quit — or if they instead cause people to start smoking cigarettes, some members of Congress argued. “If companies want to use flavors, they should be required to demonstrate to the FDA that use of flavors will benefit public health,” 11 Democratic U.S. senators, including Minority Leader Chuck Schumer of New York, Dick Durbin of Illinois, Elizabeth Warren of Massachusetts and Tim Kaine of Virginia, wrote in a letter April 18.
Flavor is at the center of the debate. Choices range from the predictable, such as classic tobacco and menthol, to the bizarre, including “Galactic Milk” and “Not-Cho Cheese Fauxritos.” The wide variety of flavors and the occasionally tongue-in-cheek branding have been cited as a top reason youths start using ecigs. The first study to look into flavored e-cigarette use across different age groups found that a large majority of young adults nationwide preferred flavors, such as fruit or candy, over the taste of traditional tobacco. While the data would suggest that restricting the range of flavors could help reduce early adopters, it turns out that adult users seem to prefer non-tobacco flavors, too.
For regulators, all of this presents a conundrum. At first, the FDA laid out its plan for device review, saying it extended the timeline to “explore clear and meaningful measures to make tobacco products less toxic, appealing and addictive” without jeopardizing “innovations” that could help both age groups. But March 20, it issued a call for information about the role flavors play in tobacco products, a potential prelude to restrictions on the sale and distribution of tobacco products with flavors.
“No child should use any tobacco products, including e-cigarettes,” FDA Commissioner Scott Gottlieb said last month. “At the same time, we’re aware that certain flavors may help currently addicted adult smokers switch to potentially less-harmful forms of nicotine-containing tobacco products.”
The industry has been pushing back on the concept of restricting flavors, emphasizing the role they play in helping adults quit regular smoking. For now, with regulation of e-cigarettes still in its early stages, manufacturers have free rein to advertise as they see fit.