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High school e-cigarette use is exploding and reversing prevention gains

Monthly e-cigarette usage among high schoolers nearly doubled between 2017 and 2018, a new CDC report finds

Signs in the window of the Smoke Depot advertise electronic cigarettes and pods by Juul, the nation's largest maker of e-cigarette products, on Sept. 13, 2018 in Chicago, Illinois. (Scott Olson/Getty Images)
Signs in the window of the Smoke Depot advertise electronic cigarettes and pods by Juul, the nation's largest maker of e-cigarette products, on Sept. 13, 2018 in Chicago, Illinois. (Scott Olson/Getty Images)

The number of young people using tobacco products has reached its highest level in years, as e-cigarette popularity is reversing recent progress on other products that contain nicotine, the Centers for Disease Control and Prevention reported Monday.

In recent years, the overall proportion of high school students using any tobacco products fell, mainly due to fewer students smoking cigarettes and cigars, the CDC said. But from 2017 to 2018, the number of high school students reporting e-cigarette use within the past month nearly doubled from 11.7 percent to 20.8 percent. That pushed their overall tobacco use rate from 19.6 percent to 27.1 percent in 2018.

While changes to survey methodology and the existence of new products like e-cigarettes make today’s overall tobacco use numbers difficult to compare to years before 2011, the current high-school tobacco use rate resembles cigarette smoking levels not seen since 2001.

Additionally, recent decreases in the number of students smoking cigarettes and cigars are stagnating, the CDC said. The number of high school students reporting cigarette smoking in the past 30 days has dropped from 15.8 percent in 2011, but has been hovering around 8 percent since 2016. Cigar use experienced a similar trend, with current usage also around 8 percent of students.

For adult smokers, e-cigarettes are supposed to be a safer alternative, but only if a smoker switches completely. However, many adults who use the liquid nicotine products continue to use regular cigarettes, and the new CDC data show the number of dual users appears to be on the rise among young people.

Among tobacco users in high school, around 40 percent use two or more products. The most frequent combination of products was cigarettes and e-cigarettes, CDC official Brian A. King said on a call with reporters Monday.

The new report builds on evidence that youth e-cigarette use raises the risk of graduating to combustible cigarettes, he said.

“E-cigarettes could be playing a role in the patterns of use we’re seeing among kids in terms of cigarette smoking,” he said, adding, “It is possible that we are reinforcing and perpetuating dependency.”

FDA’s concerns

While the Trump administration says that e-cigarettes could be an effective tool for helping adults quit smoking traditional cigarettes, Monday’s report suggested that the opposite is true for younger people, said Food and Drug Administration Commissioner Scott Gottlieb.

“The kids using e-cigarettes are children who rejected conventional cigarettes, but don’t see the same stigma associated with the use of e-cigarettes,” Gottlieb said in a statement. “But now, having become exposed to nicotine through e-cigs, they will be more likely to smoke.”

The report also showed that those who use e-cigarettes are using them more frequently. The number of high school students who used e-cigarettes 20 or more days a month increased from 20 percent in 2017 to 27.7 percent in 2018.

Gottlieb said these trends could force the FDA “to make some tough decisions about the regulatory status of e-cigarettes.” While e-cigarettes are allowed to be on sale without undergoing an FDA review until 2022, the FDA is providing that flexibility so that it doesn’t limit options for adult smokers. In the past, Gottlieb has said that he would consider halting sales of e-cigarettes while companies go through the FDA review.

The new report comes as the FDA has tried to rein in the growing e-cigarette market and prevent young people from using popular products like the vaping device made by JUUL Labs, Inc.

The CDC report singles out the company’s sleek device, which is fueled by liquid nicotine “pods,” as a reason that the rate of youth e-cigarette use has climbed so high.

Last year, the Food and Drug Administration ordered JUUL and other e-cigarette companies to stop selling many of their most popular flavors in convenience stores, gas stations and other stores that aren’t age-restricted. But the companies are still allowed to sell products flavored like tobacco, mint and menthol, and early signs of cooperation appear to be fading.

Last week, FDA Commissioner Scott Gottlieb wrote a letter to JUUL chief executive Kevin Burns requesting a meeting. A 35 percent stake in the company was recently purchased by tobacco giant Altria Group, Inc. Since then, Gottlieb said that JUUL appears to be backtracking from previous statements about reducing youth use.

After the transaction, the companies suggested that JUUL would be able to take advantage of Altria’s considerable marketing and retail footprint, and that JUUL would be more prominently placed in stores and advertised through direct mail to adults.

Previously, JUUL had promised FDA that it would limit its marketing, including by ending social media accounts that could be appealing to youth. But the FDA appears concerned that the merger would have the opposite effect.

“Many of JUUL’s public statements seem inconsistent with its previous representations to the FDA,” Gottlieb wrote in the letter.

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