The U.S. Surgeon General on Tuesday declared electronic cigarette use among America’s youth “an epidemic” and called for new restrictions on the products.
The action comes a day after release of a Monitoring the Future report, which confirmed that teen vaping nearly doubled in 2018, with one in five high school seniors reporting current use of e-cigarettes. More than 3.6 million teens in the U.S. reported that they regularly used the vaping products.
Recommendations in an advisory by Surgeon General Jerome Adams, MD, include banning vaping from establishments now covered by indoor smoke-free air policies, further restricting youth access to e-cigarettes in retail establishments, implementing new price policies, and banning marketing to youth.
“The recent surge in e-cigarette use among youth, which has been fueled by new types of e-cigarettes that have recently entered the market, is cause for great concern,” he said. “We must take action now to protect the health of our nation’s young people.”
In a Tuesday morning press conference, Adams cited a Surgeon General’s report issued 2 years ago on e-cigarette use among youth and young adults. He was joined by U.S. Health and Human Services Secretary Alex Azar and FDA Commissioner Scott Gottlieb, MD.
“We know that nicotine exposure during adolescence can uniquely harm the developing adolescent brain, impacting learning, memory, and attention,” Adams said. “We know that exposure during this critical period can lead to further addiction. And we know that the notion that e-cigarette aerosol is harmless water vapor — something even my 14-year-old son thought was true — is a myth.”
“Studies show youth, like my son, have no clue what’s in these products most of the time,” Adams continued. “And shockingly to me as a parent, a third of youth who have ever used e-cigarettes have used marijuana in them. Yet, 2 years after [the Surgeon General’s report] sounded the alarm bells, youth e-cigarette use has skyrocketed. So much so, that I am officially declaring e-cigarette use among youth an epidemic in the United States.”
Azar noted that the Monitoring the Future survey (sponsored by the National Institute on Drug Abuse) confirmed that the rise in youth e-cigarette use during 2017 and 2018 was the largest-ever single-year increase in use of a single substance ever recorded in the 43 years of the survey.
“We have never seen the use of any substance by America’s young people rise this rapidly. This is an unprecedented challenge,” Azar said. “We are at risk of a huge share of a whole generation developing an addiction to nicotine, and that is not a future that anyone wants for our country.”
Azar reaffirmed HHS’s commitment to exploring the potential of e-cigarettes as smoking-cessation products to help traditional cigarette smokers kick the habit.
“We want to ensure that e-cigarettes can be used as an off-ramp for adults who want to quit combustible cigarettes,” he said. “Traditional combustible cigarettes remain the leading cause of preventable death in the United States, and providing an effective off-ramp from them is a public health priority. But at the same time we can not allow e-cigarettes to become an on-ramp to nicotine addiction for younger Americans.”
Earlier this month, it was announced that the FDA will restrict the sale of certain flavored e-cigarettes in a move to address the epidemic increase in use among teens. At that time, Gottlieb warned that the agency may go much further if the flavor ban did not lead to reductions in youth tobacco use.
In his advisory, the Surgeon General singled out the new generation of e-cigarettes that have e-liquid contained in a cartridge, such as the brand Juul, as posing a particular risk to youth.
Sales of Juul increased by 600% in 2017 alone, making it the best-selling e-cigarette on the market.
The e-cigarettes, which resemble USB flash drives, have high levels of nicotine — as much in a single cartridge as a pack of 20 regular cigarettes. The products also employ nicotine salts which allow nicotine to be inhaled more easily with less irritation compared with other types of e-cigarettes.
“This is of particular concern for young people, because it could make it easier for them to initiate use of nicotine through these products and also could make it easier to progress to regular e-cigarette use and nicotine dependence,” Adams noted.
He added that despite these risks, approximately two-thirds of Juul users between the ages of 15 and 24 in one survey did not know that Juul always contains nicotine.
At Tuesday morning’s press conference, high school senior Sarah Ryan, of Holbrook, Massachusetts, discussed the dramatic increase in Juul use at her high school.
“This year it really spread like wildfire,” she said. “At one point the school had to shut down one of the bathrooms because vaping had become so commonplace. And it didn’t help much, because kids were still trading pods and even vaping during class.”
“My eyes were really opened to how big of an issue this had become when a 6th grader at my school came up to me and told me that it was easier to get someone to lend him a Juul than a pencil,” she said.