News Archives

Vaping isn’t working at cessation; it is working at hooking our teens

By  and  | Guest Commentary
PUBLISHED:  | UPDATED: 
When electronic cigarettes first came on the market, we hoped they might help reduce the tremendous harm caused by tobacco cigarettes. If smokers inhaled a vapor containing nicotine, flavorings and other additives rather than the multitude of cancer-causing chemicals in tobacco smoke, there might be some benefit.

While some adults have used e-cigarettes to wean themselves from tobacco, research indicates that e-cigarettes are really just another nicotine delivery device with its own unique hazards that addict users to nicotine. This is especially concerning for teens and young adults who are using e-cigarettes with alarming frequency.

One recent study did suggest that e-cigarettes helped adults stop smoking. However, those who quit tobacco continued to consume e-cigarettes and nicotine a year later. More common appears to be the experience of smokers studied by Dr. Russell Bowler, a professor of medicine at National Jewish Health. He found that most of the tobacco smokers who started using e-cigarettes in hopes of quitting tobacco continued to smoke tobacco at similar or higher levels five years later. Former smokers who began using e-cigarettes were more than 16 times as likely to resume tobacco smoking.

Additional research at National Jewish Health has shown that, while less harmful than tobacco smoke, e-cigarette vapor itself is harmful. It injures cells lining the airways and blood vessels in the lungs, and increases susceptibility to respiratory viruses.

E-cigarette use, or vaping, by teens and young adults is especially worrisome. After decades of decline, the consumption of tobacco products has taken a U-turn and begun a precipitous climb. Vaping among middle and high school students increased 900 percent from 2011 to 2015 and nearly doubled in just the last year.

Today, one in 20 middle schoolers and one in five high school students use e-cigarettes. College students and young adults vape at similar or even greater rates.

Research has shown that youth who try an e-cigarette are more likely to begin smoking tobacco. The Surgeon General and the Food and Drug Administration have both called e-cigarette use by teens and young adults a serious public health threat.

Nicotine in e-cigarettes poses unique threats to young users’ health. Adolescence is an important period of brain development when learning capacity, decision making, working memory, reward processing and emotional regulation all grow and mature. Nicotine use during adolescence profoundly alters this process, priming the brain for future addictions and increasing the risk of mood disorders, intellectual problems and impulsiveness.

E-cigarettes have become immensely popular, fueled by flavors and marketing targeted at young people. Peer pressure to vape is bearing down on those who don’t. Many don’t even realize they are vaping nicotine and mistakenly believe they are inhaling simple water vapor. Teenage brains are especially susceptible to nicotine’s addictive and rewarding effects, yet many fail to recognize the threat e-cigarettes pose to long-term mental and physical health.

After decades of fighting to reduce harm from tobacco, it is astounding that a new generation faces a renewed threat from tobacco. We must help young people avoid nicotine and quit e-cigarettes. Teens can call the Colorado QuitLine (1-800-QUIT-NOW), which recently lowered the age of eligibility for services to 12.

As the operator of the Colorado and many other state quitlines for 17 years, National Jewish Health has extensive experience treating nicotine addiction with personalized plans to avoid nicotine, navigate peer pressure and manage nicotine withdrawal. At the same time, the FDA must tighten regulation of e-cigarettes and follow through on promises to close down manufacturers who don’t meaningfully limit youth access to e-cigarettes.

JUUL, the dominant company in the market, must follow through on its action plan to cease marketing to youth and limit their access to its products.

We urge Colorado legislators to pass the recently introduced bill to raise the age for legal purchase of e-cigarettes.

Together, we can protect our youth from the dangers of e-cigarettes and vaping.

Dr. Michael Salem is president and CEO of National Jewish Health. Thomas Ylioja, PhD, is an assistant professor of medicine and clinical director of health initiatives at National Jewish Health.

Lehi becomes first Utah city to raise legal tobacco age to 21. It may not be the last.

The Salt Lake Tribune:

Lehi • The City Council here approved raising the legal age for tobacco to 21 in what is a first in Utah, where state law allows 19-year-olds to purchase and possess tobacco products.

The new ordinance, approved unanimously Tuesday night, also applies to e-cigarettes. It will take effect 20 days after it is signed and posted.

Ryan Bartlett, spokesman for the state Health Department’s Tobacco Prevention and Control Program, said he would love to see other Utah cities follow suit. “I know there are a few looking at it right now.”

Bartlett said there are 425 cities and counties in 23 states that have adopted 21 as the minimum age for tobacco.

In neighboring Colorado, the towns of Aspen, Basalt and Avon passed their own Tobacco 21 policies, one after another, starting in 2017.

Bartlett said he has noticed that when a city passes a Tobacco 21 policy, other grass-roots movements tend to pop up in other localities and municipalities soon after.

Tobacco 21 laws can legally trump Utah law because there is no pre-emptive language blocking political subdivisions from passing more restrictive rules, Bartlett said. Cities, however, can’t set the legal age below 19.

Hawaii is one of six states that have implemented Tobacco 21 policies and was the first to do so in 2016. Bartlett said Oregon, California, Massachusetts, New Jersey and Maine adopted similar statutes in subsequent years.

Just last week, Richard Creagan, a Hawaii representative, introduced a bill proposing to raise the minimum age for tobacco in his state to 100 by 2024.

Utah’s law has set the minimum age at 19 since 1963. But for a half-century before that, tobacco buyers had to be 21 or older, according to Bartlett. Before 1911, the legal age was 18.

Localities and states that pass Tobacco 21 measures do ultimately restrict young people’s access to cigarettes and other tobacco products — an important feat, Bartlett said, as research shows the younger someone starts tobacco use, the more likely he or she is to become hooked.

. . .

Summit County Sees Signs of a Teen Vaping Epidemic

“E-cigarettes are branded as alternatives to cigarettes that can help people stop smoking. But teenagers are using these devices to start smoking. Schools across Summit County have seen an increase in vaping, and local health officials are working to combat the issue that’s now considered a national epidemic.

 

. . .

Vaping as a gateway
“Research is showing youth that start this, it’s a one way street to not only long term vaping addiction, but also traditional tobacco use,” said Cory Kendrick, director of population health at the Summit County health department. He said principals and superintendents across the county have identified this as a problem in their schools.

“It’s almost like a cool thing to do to show hey, I’m vaping in class,” he said. “There’s techniques on how to do this in class like blowing the vapor in your shirt and those sorts of things.”

Eighteen-year-old Ashlee Barnett told me she tried vaping once when she was in the car with her friends.

“I was just like, ‘Eh, like I don’t know.’ They were like ‘it’s not a big deal, it doesn’t have nicotine in it, like, it’s fine. You can just do it once and you don’t have to do it ever again,” she said. “I was just like, ‘okay.’”

 

. . .

 

Barnett said the vape was green apple flavored.

Lack of regulation cause for concern
While some vapor fluids are nicotine-free,  Kendrick from Summit County Public Health says there is little government regulation on the devices, especially ones that are purchased online coming from overseas.

The fluid, or “juice,” comes in many different flavors, which Kendrick suspects is one of the reasons vaping has become so popular among kids. According to a report from the U.S. Surgeon General, that juice contains cancer-causing substances.

North High School resource officer Evans said kids might not be informed of the health risks of these flavored e-cigarettes.

“If you’ve ever been around someone who’s vaping or e-cigarettes, you get that sweet smell, and I’m not sure kids understand the harmful effects of it,” he said.

A suburban problem
While vaping is a problem for Officer Evans, he says there are bigger concerns in the district, particularly with illegal drugs. According to Kendrick’s research at the county health department, vaping seems to be more prevalent in the suburbs.

“The schools that have a higher socioeconomic status, students can afford more,” he said. “Juuls aren’t cheap…whereas you can get a two pack of black and mild cigarellos for a dollar.”

At Green High School just south of Akron, Principal Cindy Brown has seen an increase in students vaping over the past three years. She said principals at similar schools are seeing the uptick as well.

. . .

Limiting access
One way officials nationwide are trying to combat the teen vaping epidemic is through Tobacco 21, an initiative focused on raising the legal age to purchase tobacco from 18 to 21. In Summit County, six of the 33 municipalities have already passed this ordinance, including Akron and Green.

But Green principal Cindy Brown said kids can still find ways to vape. Some have told her adults have bought the devices for them. She’s also seen other ways.

“I think a lot of people get around that doing it through some online purchases and buying loadable credit cards, you know, like a visa gift card or something like that, and then kids can use that to purchase them online.”

Brown said the health classes at Green teach a whole unit on vaping in order to inform students of the health risks. Districts across the county have adopted stricter punishments for vaping in their codes of conduct. Kendrick says the county needs to take steps to inform both parents and kids about the dangers of vaping.

“It’s something we’re going to have to look at as a community – how do we solve this issue, especially for those who are already addicted,” he said.

The Tobacco 21 ordinance was recently introduced to Stow City Council. If passed, Stow would become the seventh municipality to raise the tobacco buying age to 21 in Summit County.

FDA pursues order barring specific retailers from selling tobacco products as part of its continuing efforts to target youth tobacco use: Agency escalates enforcement action against local Walgreens, Circle K retail locations for repeatedly selling tobacco products to minors

The U.S. Food and Drug Administration today initiated enforcement action against certain retail locations of Walgreen Co. and Circle K, Inc. for repeated violations of restrictions on the sale and distribution of tobacco products, including sales of cigars and menthol cigarettes to minors. The agency filed complaints seeking No-Tobacco-Sale Orders (NTSO), which seek to bar the two specific retail locations from selling tobacco products for 30 days. The two retail outlets that are the subject of these NTSO actions are a Walgreens store in Miami, Florida, and a Circle K store in Charleston, South Carolina. Notably, Walgreens is currently the top violator among pharmacies that sell tobacco products, with 22 percent of the stores inspected having illegally sold tobacco products to minors.

“I will be writing the corporate management of Walgreens and requesting a meeting with them to discuss whether there is a corporate-wide issue related to their stores’ non-compliance and put them on notice that the FDA is considering additional enforcement avenues to address their record of violative tobacco sales to youth. We all share the important responsibility of keeping harmful and addictive tobacco products out of the hands of kids. Retailers in particular – especially those who position themselves as health-and-wellness-minded businesses – are on the frontlines of these efforts and must take that legal obligation seriously. I’m also deeply disturbed that a single pharmacy chain racked up almost 1,800 violations for selling tobacco products to minors across the country. I have particular concerns about whether the pharmacy setting is influencing consumer and retailer perceptions around tobacco products in a way that’s contributing to these troubling findings,” said FDA Commissioner Scott Gottlieb, M.D. “The FDA will continue to hold retailers accountable by vigorously enforcing the law. We are also evaluating our data on other large, national retail chains to identify other entities that also have high rates of repeat violations and are considering what additional measures we should pursue. While many of our recent enforcement actions focused on the illegal sales and marketing of e-cigarettes, today’s announcement is a reminder that youth access to all tobacco products remains a public health problem. No child should be using any tobacco or nicotine-containing product. And no retailer should be illegally selling these products to minors. As part of our Youth Tobacco Prevention Plan, we’ll continue to employ all the tools at our disposal to monitor, penalize and prevent sales of all tobacco products, including e-cigarettes, to minors at brick-and-mortar stores and Internet storefronts as we work to ensure these products are sold in ways that make them less accessible and appealing to kids.”

An estimated 4.9 million middle and high school students reported current (past 30 days) use of any tobacco product in 2018, according to preliminary results of the 2018 National Youth Tobacco Survey. An epidemic-level rise in e-cigarette use over the last year has led overall tobacco product use to increase by 38 percent among high school students (to 27.1 percent) and by 29 percent among middle school students (to 7.2 percent) in the last year, reversing the declines seen in the last few years.

Because tobacco use is almost always initiated and established during adolescence, early intervention ‒ including making sure tobacco products aren’t being sold to kids ‒ is critical. One of the ways the FDA combats youth tobacco use is through its compliance and enforcement efforts. In particular, the agency provides education and training opportunities to retailers to encourage compliance with restrictions on sales to minors, monitors compliance through surveillance, inspections and investigations, and then takes action when violations occur.

When violations are found, the agency generally issues warning letters and may take enforcement actions, including civil money penalties and NTSOs. Since its retailer enforcement program began in 2010, the FDA has issued more than 81,570 warning letters to retailers for violating the law, initiated more than 19,800 civil money penalty cases and issued 145 NTSOs, as of Dec. 31, 2018.

The NTSO action against this Walgreens outlet follows the issuance of more than 1,550 warning letters and 240 civil money penalty actions against Walgreens stores nationwide for unlawful tobacco product sales to minors. This is, however, the first NTSO action taken against a Walgreens store. While the NTSO action against Circle K is not its first, it marks the first time the agency has initiated an NTSO complaint for the sale of deemed products (cigars) to minors. Since 2010, the FDA has issued over 1,045 warning letters and 205 civil money penalty actions to retailers doing business as Circle K for sales to minors. To put Walgreens’ rate of violations into perspective, among other national, corporate-owned chains, 17.5 percent of Walmart Inc. stores inspected had violations for illegal sales of tobacco products to minors. Additionally, 14 percent of Dollar General Corp. stores inspected, and 9.6 percent of Rite Aid Corp. stores inspected had illegally sold tobacco products to minors.

Under the law, the FDA may pursue an NTSO against a retail outlet that has committed a total of five or more repeated violations of federal tobacco regulations within 36 months. After the FDA initiates an NTSO action by filing a complaint, a retailer has the opportunity to respond to the complaint, and must generally do so within 30 days. Retailers who receive an NTSO complaint from the FDA may enter into a settlement agreement or respond with an answer and contest the allegations before an administrative law judge. If an NTSO goes into effect, a retailer is responsible for ensuring that the establishment does not sell tobacco products during the specified period. Removing or covering up tobacco products are examples of steps that a retailer may choose to take to ensure compliance with an NTSO, but these specific actions are not required. It is up to the retailer to decide what measures to take to ensure no regulated tobacco products are sold at the store during the time period specified in the order. The FDA plans to conduct unannounced compliance check inspections during that period to check whether each establishment is complying with the terms of the order and will take further action if necessary. Consumers and other interested parties can report a potential tobacco-related violation of the Food Drug & Cosmetic Act, including sale of tobacco products to minors, by using the FDA’s Potential Tobacco Product Violation Reporting Form.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.