Action needed now to prevent a new generation of nicotine addiction

Patrice A. Harris, MD, MA , Former President

Flavored e-cigarettes and vaping products are quickly erasing decades of progress in decreasing youth tobacco use. And, unless the Trump administration takes swift action, these products will lead to severe but entirely preventable health consequences for a new generation of Americans addicted to nicotine.

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Although vaping technology is too new to gauge its long-term effects on health, the immediate impact is stark: More than one-quarter of U.S. high school students, and one in 10 middle school students, have used e-cigarettes in the past 30 days, according to the 2019 National Youth Tobacco Survey from the U.S. Centers for Disease Control (CDC).

This represents about 5.3 million teens and preteens who admit to experimenting with these unregulated and harmful vaping devices in the past month, signaling a monumental shift in tobacco product use among youth that peaked in the 1970s. For context, the same study reported that more than 27% of high school students said they used e-cigarettes in the previous month, while less than 6% of students admitted using traditional combustible cigarettes over the same period.

In September, the White House announced the Trump administration intended to ban flavored e-cigarettes, including mint and menthol, from the market. Shortly thereafter, President Trump made it clear that he was reconsidering such a move. With the stakes of this public health epidemic growing by the day, President Trump invited the American Medical Association (AMA) and other leading public health organizations, as well as representatives of the vaping industry, to the White House in November to discuss the issue.

During that meeting, the physician and public health organizations urged the President to immediately ban all flavored e-cigarettes from the marketplace – our best hope to reverse the devastating trend we’re seeing in our high schools and middle schools. We anticipate the President’s decision in the coming weeks.

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The urgent public health threat created by e-cigarettes and vaping is driven by several factors, including the sophisticated technology for nicotine delivery that lessens the social stigma tied to smoking. Also, the slick marketing campaigns by some of the biggest players in the vaping and tobacco industries – which now have significant cross-ownership – previously emphasized an array of flavored products such as fruit, candy and mint specifically designed to attract teens and young adults.

In fact, the CDC survey cited above shows that flavored e-cigarettes are the most commonly used flavored tobacco product; these products are selected by nearly 70% of e-cigarette users. More than 20% of middle and high school students who have tried using e-cigarettes indicated that the availability of flavors such as mint, candy, fruit or chocolate drove their decision.

America’s physicians, led by the AMA, have waged a public battle against tobacco use since the 1960s, when evidence in peer-reviewed journals directly linked cigarettes to lung cancer and heart disease. As the lethal health risks of smoking became clear, the tobacco industry fought back by sowing uncertainty in the face of scientific consensus. They maintained that a definitive link had not been proven and asserted that further research was needed. Today, manufacturers of e-cigarettes and vaping devices must defend their products against the surging rate of youth vaping.

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The long-term health effects of nicotine addiction are abundantly clear. People younger than 25 are at greater risk from nicotine due to its effects on the developing brain, particularly in the areas of impulse control, attention span and the ability to learn. The U.S. surgeon general also has determined that nicotine use during adolescence can prime the brain for further addiction to other drugs. And while we advocate for an immediate federal ban on all flavored e-cigarettes, the AMA also continues to support local, state and federal actions to prohibit the sale of flavored tobacco products. We applaud the eight states and dozens of municipalities that have enacted bans on flavored products, and strongly encourage other jurisdictions to follow suit.

We support legislation pending in the U.S. House of Representatives, the “Reversing the Youth Tobacco Epidemic Act of 2019,” (HR 2339), and urge Congress to take swift action to adopt legislation to ban e-cigarette product advertisements and prohibit online sales of tobacco products.  

And we strongly encourage further clinical and epidemiological research on e-cigarettes and greater awareness of the potential effects on public health.

We cannot waste years or even decades on this emerging public health threat while a new generation falls prey to nicotine addiction. The verdict on vaping is clear. The time for bold and decisive action is now.