No Time to Waste in Battle to Regulate E-cigarettes

Apr 28, 2015, 8:53 AM, Posted by Joe Marx

The CDC just released alarming data on the new rise of electronic cigarette use among U.S. teens. Unless the FDA acts now, it may get worse with each passing day which is a gamble we can't take.

If the health debate coalescing around e-cigarettes feels familiar, there’s good reason. The uncertainty and questions about this relatively new—and unregulated—product harken back to an age when it was chic for Hollywood stars to blow smoke at the screen, and cigarette brands were plastered all over race cars.  

The tobacco industry knew just what to do to entice young people, and this formula hooked millions upon millions of them and locked in a lifetime of smoking—tragically shortening lives in countless cases.

Even today, just over 50 years since the Surgeon General’s first landmark report on Smoking and Health, tobacco addiction causes a host of cancers and other illnesses. Smoking is still the leading preventable cause of death in the U.S., killing 480,000 people annually and costing over $325 billion in medical expenditures and lost productivity.

It’s in this sobering context that we should consider the report issued on April 16 by the Centers for Disease Control and Prevention on student smoking in the United States. The latest survey found that the use of electronic cigarettes among middle and high school students tripled in just one year and surpassed youth use of traditional cigarettes. In 2014, 13.4% of high school students used an e-cigarette at least once a month, up from 4.5% in 2013; 3.9% of middle school students used them, up from 1.1% in 2013.

To be sure, much is unknown about these products, and they are evolving rapidly. Even within the health community, there is debate on the value of e-cigarettes in helping people quit smoking traditional cigarettes.

But here’s what we do know, summed up powerfully and succinctly by CDC Director Tom Frieden:

Nicotine is dangerous for kids at any age, whether it’s an e-cigarette, hookah, cigarette or cigar. Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use.

It’s that last phrase—sustained tobacco use—that stands to haunt this country and millions of families ravaged by the effects of these products, if the FDA does not quickly act within its authority under the Tobacco Control Act to halt this rising tide of e-cigarette use among young people.

The FDA must regulate this product. As the Robert Wood Johnson Foundation noted in comments to the agency nearly a year ago, regulation of the sale, production and marketing of e-cigarettes will be the first critical step. No one younger than 18 should be allowed to purchase these products, and the blatant push to attract young people to e-cigarettes must end.

Today, at least 40 states prohibit the sale of e-cigarettes to minors. In the remaining 10 states and the District of Columbia, e-cigarettes can be legally sold to children. Once young people take the bait, we know how this plays out: the 2012 Surgeon General’s Report found that 90% of all adult smokers first tried cigarettes as adolescents. Three of every four teen smokers continue into adulthood. We know, too, as Dr. Frieden noted, that the adolescent brain is still developing into the mid-20s, so harm done early on will have a lifetime of repercussions.

It’s no wonder, then, that tobacco companies are employing the effective marketing tactics of yesteryear—celebrity endorsements, slick ads and event sponsorships—to capture this next generation.

The flavors of e-cigarettes, too, sound like something ordered off an ice cream truck: cotton candy, banana split and chocolate, to mention just a few. We’ve seen sites, for example, asking (presumably with a straight face), “Love biting into a fresh watermelon or peach? How about vaping flavors that taste like your favorite fruit?”

As someone who has helped wage this battle against tobacco for nearly 30 years—first with the American Heart Association and now with RWJF—this feels like a Sisyphean moment. Just as millions of Americans had left tobacco behind and teen smoking rates had reached their lowest point ever, addictive e-cigarettes are now gaining traction.

At the Robert Wood Johnson Foundation, we firmly believe that we must all work together toward a Culture of Health. That shared responsibility, and a whole generation of Americans, will suffer an astounding setback without swift FDA action on e-cigarettes. Millions of teens could be ensnared in Big Tobacco’s net, and the fight to save their lives will begin anew.

Health experts, not the tobacco industry, should determine how these products are marketed and sold and what health claims are made about them. To say that the industry has a credibility problem on such issues is putting it kindly.

We’ve seen how e-cigarette use among the young can skyrocket in just 12 months. And unless the FDA acts now, it may get worse with each passing day. That’s a gamble we just can’t take—for our kids, our families, and our nation’s future.