In recent years the numbers on teen smoking and the use of e-cigarettes by youths looked encouraging, showing a continuing decline in use of the addictive products.
In Washington state, the state Healthy Youth Survey for 2016 found that 3 percent of eight-graders, 6 percent of 10th-graders and 11 percent of 12th-graders had reported smoking cigarettes in the month previous, continuing a steady decline that started in 2002. Even the use of e-cigarettes and other “vape” devices had dropped from 18 percent among tenth-graders in 2014 to 13 percent in 2016.
But state youths were asked about their smoking and vaping habits shortly after the Juul e-cigarette and similar nicotine vaping devices were introduced in 2015.
Since then, the devices have exploded in popularity, particularly among teens, who have eagerly adopted the easily concealable devices, which look like an elongated flash drive and heat flavored nicotine salts rather than a liquid, producing far less of the tell-tale plume of vapor that is exhaled when using other e-cigarette devices.
The devices also deliver a particularly potent dose of nicotine with each breath inhaled. The devices can contain as much nicotine — the addictive agent in tobacco products — as a pack of traditional cigarettes.
That jump in popularity hasn’t escaped the notice of the federal Food and Drug Administration, which takes with deathly seriousness its mission to get smokers to quit and keep youths from starting.
A reminder of why:
Cigarette smoking causes an estimated 480,000 deaths each year in the United States, more than opioid and other illegal drug use, alcohol, homicide, suicide, AIDS and auto accidents — combined. And it costs the nation some $300 billion a year in health care spending and lost productivity.
The concern is that e-cigarettes, while they can help smokers quit, are providing teens a gateway to smoking. Recent surveys show this transition.
A study by the the University of Illinois Pediatrics Department late last year, that followed teens from 2013 to 2015, found that teens who used e-cigarettes in 2013 had 7 times greater odds of smoking tobacco a year later, according to a Forbes report.
A similar study by the National Institutes of Health’s Institute on Drug Abuse found that nearly 31 percent of teen e-cigarette users were smoking tobacco cigarettes within six months, compared to 8 percent of non-users who started smoking.
As recently as April, the FDA announced it was investigating marketing by the makers of Juul and other e-cigarettes to determine if the companies were deliberately targeting youths. That investigation is ongoing, but the numbers are already glaring. The FDA says that more than 2 million middle and high school students nationwide are using the e-cigarettes, the sale of which is prohibited to minors.
The state’s next Healthy Youth Survey is being readied now, but a reversal of the decline in e-cigarette use among teens should surprise no one.
Citing those “epidemic proportions,” the FDA accelerated its enforcement plan and announced Wednesday it was giving Juul Labs and four other makers of similar devices 60 days to prove they can keep them away from minors, The New York Times reported. The agency also sent out warning letters to 1,100 retailers, specifically national convenience store chains, and has issued 131 citations for selling e-cigarettes to minors.
If the FDA isn’t satisfied with the response, it could bring civil or criminal charges and may also consider curtailing the marketing and sale of flavored products. Part of the appeal of Juul to younger users can be attributed to the flavors sold, including mango, mint, creme, cucumber and menthol.
A year ago, the FDA had pursued a more measured response that recognized the value of e-cigarettes to those attempting to quit traditional tobacco products. While concerns remain about the health effects of the chemicals inhaled from e-cigarettes, they are recognized as less harmful than “combustible” tobacco.
The FDA had considered e-cigarettes as a tool in its plan to reduce the nicotine content of cigarettes, hoping smokers would make the switch to e-cigarettes, thus saving millions of lives. Reducing the nicotine in cigarettes could scale back smoking by adults from 15.5 percent in 2016 to as low as 1.4 percent by the end of the century and save an estimated 8 million lives, the FDA reported.
But that was before the Juul.
“We didn’t predict what I now believe is an epidemic of e-cigarette use among teenagers,” Dr. Scott Gottlieb, the FDA’s commissioner, said in a release.
And closing off e-cigarette’s availability to minors may require limiting some access to adults, Gottlieb admitted.
For its part, Juul Labs told The New York Times that it has stepped up its oversight with retailers and social media, asking Instagram, Facebook Marketplace and Google to remove posts that encouraged use of the product among youths.
But Gottlieb seems less than impressed with the response by makers, marketers and retailers.
“I’ve been warning the e-cigarette industry for more than a year that they needed to do much more to stem the youth trends,” he said in the release.
Gottlieb and the FDA are right to want to preserve e-cigarettes as a less-harmful alternative for smokers, but that can’t come at the risk of hooking millions of youths on nicotine and creating new generations of cancer, emphysema and heart disease victims.