We’ve known for some time that smoking causes cancer. In 1964, the Surgeon General started requiring tobacco companies to include warnings on their products about the risk. Since then, we’ve seen the number of smokers decline.
But in recent years, we’ve seen a new — and disturbing — trend: an increase in young people turning to nicotine.And they’re doing it with the help of e-cigarettes and a habit popularly known as “vaping.”
An e-cigarette is a battery-powered device that provides inhaled doses of nicotine through a vaporized solution. E-cigs might look like regular cigarettes, but they don't contain tobacco. Instead, there's a mechanism that heats up liquid nicotine, which turns into a vapor that smokers inhale and exhale.
That’s the reason for concern. Nicotine is a highly addictive drug, and it could create future health issues now that an estimated 3 million young people in the U.S. are using the e-devices. In 2016, the U.S. Food and Drug Administration (FDA) assumed authority over e-cigarettes, hookahs, and other tobacco products as “part of its goal to improve public health and protect future generations from the risks of tobacco use.”
Dangerous trends
According to data published by the Centers for Disease Control and Prevention (CDC) and the FDA’s Center for Tobacco Products, e-cig use among middle and high school students continues to climb – in fact, use among these students tripled from 2013 to 2014. In 2014, 2.46 million middle and high school students used e-cigarettes. In 2015, that number was 3 million — meaning more than half a million new students started using e-cigarettes in just one year’s time.
From 2011 to 2015, e-cigarette use among high school students rose from 1.5 percent to 16 percent. Of the 25.3 percent of high school students who reported using tobacco products in 2015, e-cigarettes were by far the most popular choice. More middle schoolers are using e-cigarettes as well — up from 0.6 percent in 2011 to 5.3 percent in 2015.
Complicating our efforts to end smoking is the popularity of hookah smoking. Hookahs are water pipes used to smoke specially made, usually flavored, tobacco and deliver nicotine to the user — the same highly addictive drug found in other tobacco products. After huge increases in hookah use among middle and high school students in recent years, hookah use declined among high schoolers and stayed the same among middle schoolers from 2014 to 2015.
If the trends continue, the U.S. Department of Health and Human Services projects more than 5 million American children and teens will die prematurely from smoking-related diseases. That’s something we all have to work together to prevent.
The arc of addiction
People start smoking when they’re young. That’s why we have to stop the trend of tobacco use among today’s generation of young people. We could do a lot better if we could get new generations never to start smoking – e-cigs or anything else. Studies show people are less likely to start using nicotine products later in life if they don’t try it when they’re younger.
As health professionals, we all had some hope that because smoking cigarettes had become less “cool,” tobacco use would dwindle. But whether it’s cool or not, there was no change in the use of cigarettes among middle or high school students from 2014 to 2015. And with one in four high schoolers and one in 13 middle schoolers reportedly using any tobacco product in 2015 — primarily e-cigs — that’s 4.7 million students who could be heading down the road to addiction.
Missing measurements
Of potentially greater concern is the lack of data surrounding these trends, particularly e-cigs. We really don’t have any good measurements to determine the future health effects. There’s little short-term data on the effects of e-cigs — and no long-term data.
Many students try e-cigs because they believe them to be a safe alternative to cigarettes. Dallas TV station WFAA reported on this trend in March 2016. Unfortunately, with the lack of long-term data on the subject, our young people may be using e-cigs under false assumptions. In fact, research suggests that using nicotine in any form may increase the risk of becoming addicted to other substances.
As experts complete more research, we’re finding that e-cigs may just be a gateway to traditional smoking instead of an alternative. One 2014 article in the medical journal JAMA Pediatrics noted, “Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. adolescents.”
Clearly, we need more information. We need to know if e-cigs help traditional smokers quit. We need to know if e-cigs are harmful to users’ health and if they lead to more young people getting hooked on nicotine.
But here are some things we do know:
- Formaldehyde, a known cancer-causing chemical, is one of the ingredients in the liquid additives used in e-cigs.
- Though the Texas Legislature passed a law in 2015 banning the sale of e-cigarettes to students under age 18, it’s still possible for young people to buy them online.
- There are alternatives to traditional smoking besides taking up e-cigs. Exercising regularly, avoiding the triggers that make you want nicotine, and making other changes in your lifestyle can help you quit successfully rather than potentially trade one addiction for another.
As noted by CDC Director Tom Frieden, M.D., M.P.H., “No form of youth tobacco use is safe.” We need to do all we can to change the dangerous trend of increased tobacco and nicotine use among our young people — so all of our kids grow up to be healthy and safe.
To learn more about the long-term complications of tobacco use, check out our Smoking Cessation Guide.
