U.S. Surgeon General Jerome Adams, M.D., spoke at The University of Texas MD Anderson Cancer Center on Wednesday about the meteoric rise of the use of e-cigarettes among adolescents and the negative health risks associated with nicotine.
“It’s important that everyone understands that young people are using these devices in record numbers, but it’s important that folks also understand that these devices and nicotine are uniquely harmful to the young, developing brain,” Adams said.
The conversation came on the heels of the Surgeon General’s Advisory on E-Cigarette Use Among Youth, released Tuesday, in which Adams declared e-cigarette use among young people an epidemic. Only the fourth Surgeon General’s Advisory in the past 13 years, it also warned parents, teachers and health professionals about the latest e-cigarette products fueling the nation’s addiction to tobacco.
“It’s a great pleasure to welcome the Surgeon General to our campus today to reinforce through the advisory the importance of e-cigarettes and their impact on the population, particularly among the youth,” said Ernest Hawk, M.D., vice president and division head for Cancer Prevention and Population Sciences at MD Anderson. “His messages align exactly with the core values of this institution and its strong commitment to cancer prevention, practiced both in the clinical and individualized sense, but also in the population sense.”
Adams joined Carin A. Hagberg, M.D., head of the division of anesthesiology, critical care and pain medicine at MD Anderson, and Welela Tereffe, M.D., chief medical officer at MD Anderson, before an audience of faculty members to discuss federal efforts to combat the escalating popularity of e-cigarettes and the harmful effects of tobacco.
“Over the past 50 years, we’ve had great success in driving down youth use of all tobacco products. It reached a historic low last year. Unfortunately, we’re seeing that progress we’ve made start to be erased. We’re starting to see an uptick in youth tobacco overall,” Adams said. “We’ve been surveying young people for 44 years, and never in 44 years have we seen the type of increase that we’ve seen in the past year in the use of a substance—that substance being e-cigarettes.”
Adams’ discussion drew from new data on national adolescent drug trends in 2018—part of the National Institutes of Health’s annual survey, Monitoring the Future—released earlier this week. While the report showed a decrease in opioid and alcohol use among adolescents, e-cigarette use surged to staggering proportions. The percentage of American high school seniors who said they vaped in the past year jumped from 27.8 percent in 2017 to 37.3 percent in 2018. The percentage of high school seniors who vaped nicotine within the 30 days before the survey nearly doubled in one year, soaring from 11 percent in 2017 to 20.9 percent in 2018.
E-cigarettes were initially introduced to the market to help adult smokers ease out of their tobacco addiction, but Adam’s stance on young people smoking e-cigarettes was clear and simple: “These products are not safe in the hands of the youth,” he said.
“I’m not against preserving e-cigarettes and vaping as an option for adults who want to quit smoking,” he added, “but I absolutely want people to understand that for young people, this presents a very unique danger. … Nicotine is uniquely harmful to the young, developing brain. We know that the brain continues to develop up to the age of 25. For the developing brain, [nicotine] can cause learning, attention and memory problems and it can prime the brain for future addiction.”
Adams criticized tobacco companies for misleading kids into thinking e-cigarettes are safe, luring them with whimsical flavors (such as crème brûlée, cotton candy and fruit punch) and playing up the “coolness” factor, just as tobacco companies had done with ordinary combustible cigarettes.
“It took us a long time to deal with advertising and marketing to help turn the tide so youth no longer thought they were cool. We’re now to a point where, if you talk to most kids, they’ll tell you it’s not cool to smoke,” Adams said. “Unfortunately, with e-cigarettes, kids—like my own son who thought that these just contain flavored water—think they’re safe and cool. They’re being marketed to them through YouTube, video games, music videos that kids watch. It shows that some of these companies are, in fact, directing their marketing toward children. If we can disrupt that coolness factor and share the facts about e-cigarettes with our young people, then they’ll make the right choice, just as they have been doing with tobacco, just as they’ve done with opioid and as we’re starting to see them do with binge drinking.”
In November, FDA Commissioner Scott Gottlieb, M.D., announced new regulations to limit the sale of most flavored e-cigarettes to in-person age-restricted locations and to require more stringent age-verification processes for online purchases.
The FDA’s latest effort to curb the growing e-cigarette trend is considered by many health experts to be a step in the right direction, but more work needs to be done.
One initiative to introduce new policy to address the e-cigarette trend is Tobacco 21, a national campaign focused on raising the minimum legal age for tobacco and nicotine sales in the country to 21. Currently, six states—California, New Jersey, Massachusetts, Oregon, Hawaii and Maine—have passed Tobacco 21 laws.
“We want the science to be an important part of that policy discussion. I think the science is clear that raising the age of which youth can purchase these tobacco products to 21 has clear public health benefits. There’s no doubt about that,” Adams said. “The science part of this policy equation is clear: Tobacco 21 works.”
While Adams admits that “policy is always difficult” and that “it truly is a crazy time in D.C.,” he remains steadfast in his mission to promote healthier lifestyles for youth.
“Quite frankly, when you have difficulties that come before you, the opportunities to change things are often much greater,” Adams said. “Through trial and tribulation comes opportunity.”
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