E-cigarettes are now the most commonly used form of tobacco among young people in the United States, having surpassed conventional cigarettes in 2014. During the past five years, the number of middle school and high school students who report having used e-cigarettes has tripled. Among young adults ages 18 to 24, the number has doubled.
Public health officials say that the sharp rise is troubling, in part, because of how much researchers still don't know about the long-term effects of “vaping.”
For example, while e-cigarettes are widely believed to contain fewer toxic substances than traditional cigarettes, scientists have shown that the vapor from e-cigarettes isn't entirely harmless. In addition, while Tuesday's report stops short of saying e-cigarettes are a gateway to smoking, it found that vaping “is strongly associated with the use of other tobacco products among youth and young adults, particularly the use of combustible tobacco products.”
“A report of the surgeon general is the gold standard,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids. “This doesn’t answer all the questions people have about e-cigarettes, but it provides a scientific base to guide policy decisions and future discussions. This report makes clear the importance of doing everything we can to decrease the use of e-cigarettes by young people and the need for regulation to accomplish that goal.”
Tobacco-control advocates and public health leaders have insisted that the rise in the popularity of e-cigarettes stems in part from aggressive marketing campaigns that borrow from the tobacco industry playbook of earlier generations. Thursday's report echoes those concerns and calls for strict regulation of marketing aimed at young people.
E-cigarette firms have supported minimum age requirements for their products, and industry groups such as the Smoke-Free Alternatives Trade Association insists its members “have not and do not market to minors.” But public health officials say that not all manufacturers live up to that standard and have enticed young people with slick advertisements and an assortment of flavors, from bubble gum to piña colada.
“Companies are promoting their products through television and radio advertisements that use celebrities, sexual content, and claims of independence to glamorize these addictive products,” Tom Frieden, director of the Centers for Disease Control and Prevention, wrote in a forward to Thursday's report.
Others suggest those concerns may be misguided. Michael Siegel, a tobacco-control researcher at Boston University’s School of Public Health, said that despite fears about e-cigarettes being a gateway to smoking, existing scientific evidence doesn't support that conclusion.
“Although electronic cigarette uptake has skyrocketed among youth, cigarette smoking has fallen at historic rates. This would be nearly impossible to explain if electronic cigarettes were causing a substantial number of youths to start smoking,” Siegel, who had not yet seen Thursday's report, said in an email. “While the surgeon general is rightfully concerned about the emergence of a vaping culture among young people, the truth is that this vaping culture is helping to displace a smoking culture. All in all, this is a good thing.”
Siegel said he agreed with the goal of keeping young people off e-cigarettes, as well as traditional cigarettes. “But it is important that people understand the actual public health implications of the emergence of vaping,” he said, “and it is nothing close to what the surgeon general has suggested.”
Thursday's report focuses exclusively on youth use of e-cigarettes and steers clear of the broader, public health questions surrounding what has become a $3.5 billion industry: Will vaping prove to be a healthier alternative that helps adults quite cigarette smoking and reduce overall tobacco-related deaths? Are e-cigarettes unequivocally less harmful than tar-laden, chemical-filled cigarettes, as a growing body of research seems to suggest? Should they be regulated exactly the same way as traditional tobacco products?
Such questions have raged for years, with no resolution in sight.
Murthy said Thursday's report didn't aim to address those larger questions. Its primary purpose, he said, was to detail the clear risks of e-cigarettes to youth and to give parents, teachers and other adults guidance on how to prevent young people from using them.
“In order to address tobacco in America, we need a multipronged approach,” he said. “What’s at stake here is really protecting the next generation from nicotine addiction and tobacco-related disease.”
This spring, the federal government for the first time began regulating the booming e-cigarette market two years after it first said it intended to do so. The regulations include a ban on the sale of e-cigarettes to anyone under age 18. They also require manufacturers to disclose their ingredients and submit their products to the government for approval.