Well-intentioned ideas can also have unplanned, serious repercussions. This is the case with the creation of electronic cigarettes. While the original e-cigarette was invented by Hon Lik, a 52-year-old Beijing pharmacist, in 2003 with the intention of minimizing smoking combustible cigarettes, the handling of this device has now taken a drastic turn (LaMotte, 2018). The use of e-cigarettes by middle school and high school aged youth is now being called an epidemic (LaMotte, 2018). This post will describe e-cigarettes as a public health issue, examine the pros and cons of the original intention and present reality, and consider how the situation reached this point to uncover potential resolutions.
As mentioned earlier, electronic cigarettes were first created in 2003; however, they were not introduced to the United States as a method to stop smoking tobacco until 2007 (LaMotte, 2018). E-cigarettes are devices that heat a liquid into an aerosol for the user to inhale (Douglas, 2018). E-cigarettes can take on the appearance of cigarettes, cigars, pipes, pens, or USB flash drives (Douglas, 2018). When a puff of the e-cigarette is taken, a filament is triggered to heat up liquid nicotine. The devices are used by millions of people now- sometimes along with combustible tobacco cigarettes. Conventional cigarettes are extremely addictive due to their high concentrations of nicotine and other chemical compounds. However, the e-cigarettes have shown to be less hazardous compared to cigarettes (Douglas, 2018). Therefore, by creating a device where not everything is being burned, e-cigarettes help wean people off cigarettes and into a less dangerous habit. The ultimate goal is to eventually cut tobacco use completely.
While benefits exist, using e-cigarettes to quit smoking has many negative externalities. There is a lack of evidence that e-cigarettes act as anti-smoking aids, and there are concerns over their possible long-term health effects (LaMotte, 2018). This is not new information. In 2008, the World Health Organization released a statement that marketers should not be claiming that e-cigarettes are a "safe and effective smoking cessation aid" because there is "no scientific evidence to confirm the product's safety and efficacy" (LaMotte, 2018). Additionally, a cross-sectional study performed by Lucy Popova and Pamela Ling in 2012 showed that, of 1836 current or recently former tobacco smokers who use alternative tobacco products, no successful attempts to quit smoking were associated with e-cigarette use (Popova & Ling, 2012).
Another disturbing aspect of the rise of e-cigarettes is the dramatic escalation in middle-school and high-school users. Although cigarette smoking is beginning to decline among youth, use of electronic cigarettes is continuing to rise. In 2017, in a poll of high school students, 11.7% reported using an electronic cigarette in the past 30 days, compared to 1.5% in 2011 (“Smoking & Tobacco Use,” 2018). This is an issue for many reasons. For instance, vaping can serve as a gateway to more extreme tobacco use. A study found that adolescents who vape are three times more likely to start smoking cigarettes by the following year compared to those who have never smoked (LaMotte, 2018). A recent study found that daily e-cigarette use can double the risk for a heart attack. Another concern is that many health issues associated with e-cigarette use are still unknown because e-cigarettes have not been around long enough for their long-term effects to unfold (LaMotte, 2018).
This rise of e-cigarette use by youth can be linked to marketing. In 2009, the FDA first raised concerns that youth will be attracted to the flavors which e-cigarettes offer, including chocolate, bubble gum, and mint (LaMotte, 2018). By using appealing advertisements, youth are more likely to try the product at least once. Additionally, a cross-sectional survey conducted in 2014 examined perceptions of e-cigarettes and noncigarette tobacco products among American youth, grades six through twelve. The results demonstrated that most perceive e-cigarettes to be less harmful and addictive than cigarettes (Amrock, Lee, & Weittzman, 2016). Additionally, the FDA accredits the success of Juul to its ability to market: streamlined packaging for the products and a “cool and hip” social media campaign (“FDA Chief,” 2018). This is alarming because adolescents who try e-cigarettes are at an increased risk for later conventional cigarette smoking. This study also found that use of e-cigarettes by adolescents does not divert the population from smoking—it might encourage progression to cigarette use (Chaffee, Watkins & Glantz, 2018).
The FDA is making an effort to stop adolescent use of e-cigarettes. Scott Gottlieb, the commissioner of the FDA, is currently leading a major action against retailers. The FDA is threatening to ban flavored e-cigarette liquids for manufacturers if retailers do not stop selling to minors. They also demanded a plan to control sales to minors from Juul and four other major manufacturers within sixty days of their request. Gottlieb is working to reverse the trend of youth using e-cigarettes due to a fear of the effects of nicotine on the developing brains of teenagers and other potential detrimental health conditions. The plan is to reduce the nicotine levels in cigarettes to non-addictive levels (“FDA Chief,” 2018). This action has the potential to help smokers quit and to prevent kids from becoming addicted. However, the FDA should reduce the nicotine level in all combustible products, not just in cigarettes, and they should establish a set date by which this will be accomplished.
It is imperative to balance the potential benefits of e-cigarettes and their costs. E-cigarettes are significantly less dangerous than conventional cigarettes and could help cigarette smokers quit. However, if advertised as health promoting, a younger audience will be drawn to the facade of “coolness,” while also believing the habit is perfectly safe. The population of adolescents using e-cigarettes is continuing to grow. The efforts of the FDA to stop this growth are praiseworthy; however, the epidemic will need support from the government, manufacturers, retailers, and individuals to finally put an end to the public health issue of tobacco use in the United States.
Carlye Goldenberg is a sophomore studying at the University of Michigan.
Amrock, S. M., Lee, L., & Weitzman, M. (2016, November 01). Perceptions of e-Cigarettes and Noncigarette Tobacco Products Among US Youth. Retrieved from http://pediatrics.aappublications.org/content/138/5/e20154306
Chaffee, B. W., Watkins, S. L., & Glantz, S. A. (2018, April 01). Electronic Cigarette Use and Progression From Experimentation to Established Smoking. Retrieved from http://pediatrics.aappublications.org/content/141/4/e20173594
FDA Chief Calls Youth E-cigarettes an 'Epidemic'. (2018, September 12). Retrieved from https://www.washingtonpost.com/national/health-science/fda-chief-calls-youth-use-of-juul-other-e-cigarettes-an-epidemic/2018/09/12/ddaa6612-b5c8-11e8-a7b5-adaaa5b2a57f_story.html?noredirect=on&utm_term=.53d4fc5e6ffc
LaMotte, S. (2018, October 02). 5 cancer-causing toxins found in e-cigarette vapor. Retrieved October 18, 2018, from https://www.cnn.com/2015/12/31/health/where-we-stand-now-e-cigarettes/index.html
Office of the Commissioner. (n.d.). Press Announcements - Statement from FDA Commissioner Scott Gottlieb, M.D., on new enforcement actions and a Youth Tobacco Prevention Plan to stop youth use of, and access to, JUUL and other e-cigarettes. Retrieved from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm605432.htm
Popova, L., & Ling, P. M. (2012, September 9). Alternative Tobacco Product Use and Smoking Cessation: A National Study. Retrieved October 18, 2018, from https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301070
Smoking & Tobacco Use. (2018, June 25). Retrieved October 19, 2018, from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm