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Outrage of the Month: Addicting Children to Nicotine With E-cigarettes

November 2013

Michael Carome, M.D.

On Sept. 6, 2013, the Centers for Disease Control and Prevention (CDC) published a report documenting a disturbing rise in the number of teenagers in the U.S. who are using electronic cigarettes, also known as e-cigarettes.

E-cigarettes are battery-powered devices that deliver nicotine, a highly addictive drug, in the form of an aerosol or vapor. Replaceable cartridges containing nicotine, combined with other additives and flavorings (such as fruit, mint or chocolate) that may be particularly appealing to children, are inserted into the devices. Currently, e-cigarettes are not regulated by the Food and Drug Administration (FDA), and many states lack restrictions on the sale of these products to minors. Moreover, unlike conventional cigarettes, e-cigarettes may be promoted on television.

The CDC report presented data regarding e-cigarette use from the 2011 and 2012 National Youth Tobacco Survey, conducted annually in a nationally representative sample of students in grades 6 to 12 from all 50 states and D.C. to monitor tobacco product use in children. Between 2011 and 2012, the number of middle school students (grades 6-8) who reported ever using e-cigarettes increased from 1.4 percent to 2.7 percent, and those reporting current use at the time of the survey increased from 0.6 percent to 1.1 percent. Among high school students (grades 9-12), the results were more dramatic: ever users of e-cigarettes increased from 4.7 percent in 2011 to 10 percent in 2012, and current users increased from 1.5 percent to 2.8 percent. For both groups of students, more than three-quarters of those reporting current e-cigarette use also reported current use of conventional cigarettes.

Though sometimes thought safer than conventional cigarettes because they don’t emit many of the carcinogens present in cigarette smoke, e-cigarettes use by children raises a number of serious public health concerns. For example, nicotine may adversely affect brain development. Most troubling is the likelihood that e-cigarette use will serve as a gateway to use of conventional cigarettes and other harmful tobacco products. Indeed, CDC director Tom Frieden noted that “Many teens who start with e-cigarettes may be condemned to struggling with lifelong addiction to nicotine and conventional cigarettes.”

In the absence of commonsense regulation, use of e-cigarettes by young people will grow as makers of these products expand their advertising campaigns, which often feature celebrity endorsements by prominent athletes and actors, as well as themes that appeal to young people. (The tobacco industry used similar strategies for years.)

As Matthew Myers, the president of the Washington-based Campaign for Tobacco-Free Kids, which for decades fought against cigarette ads targeting minors, said, “It is beyond troubling that [makers of] e-cigarettes are using the exact same marketing tactics we saw the tobacco industry use in the ‘50s, ‘60s and ‘70s, which made it so effective for tobacco products to reach youth.”

Allowing children easy access to such a dangerous and addictive product is unacceptable. It is therefore imperative that the FDA take prompt action to regulate the sale and advertising of e-cigarettes. As a recent editorial in The New York Times appropriately urged, “New rules ought to ban sales or marketing of electronic cigarettes to those under 18 and outlaw flavoring clearly designed to entice children.”

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