E-Cigarette Use Doubles Among Young People

Laura McMullen

"Alarming and disturbing." This is how Tim McAfee, director of the Centers for Disease Control and Prevention's Office on Smoking and Health, describes the new findings on electronic cigarette use among young people. Experimentation with e-cigarettes more than doubled among U.S. middle school and high school students from 2011 to 2012, to the point that 10 percent of high school students have given them a try, according to data released Thursday by the CDC.

Need a primer on e-cigarettes to understand the significance of the new findings? They're battery-powered devices that typically dispense nicotine and other additives in an aerosol. While users don't light e-cigarettes, they otherwise use it in the same way as the conventional varieties. Many brands even look like the conventional cigarettes, while others appear more futuristic. McAfee describes them as simply "nicotine delivery devices."

The fact that more and more youth are trying e-cigarettes was enough for the CDC to do something rare: The agency published the e-cigarette findings in an article Thursday called "Notes From the Field," which McAfee points out, "is usually reserved for very urgent matters - the type of thing that would be done for something like a food-borne epidemic for which we'd need to get the word out quickly."

U.S. News talked with McAfee about the significance of the report and about e-cigarettes. His responses have been edited.

Why are these new findings so concerning to you?

For one, e-cigarettes - their manufacturing, marketing, distribution and sales - are unregulated. Although they have fewer toxins in them than conventional cigarettes, they're not safe, and they have levels of toxins that we don't know about because they're unregulated. Even if one brand tests very low levels at one point, the next month, many more e-cigarettes are coming off assembly lines in China, so we don't know what's actually in them.

The other concern is that if a 13-year-old is experimenting with an e-cigarette, we have reason to be very concerned that this could increase his or her chances of eventually experimenting with conventional cigarettes. They're going to get used to the idea that it's cool to bring a white cylinder up to their mouth and suck on it. They're going to see ads that look sexy; they're going to see older role models using these. And as long as cigarettes continue to be ubiquitous in our society, we are very, very concerned that this could ultimately end up with more people smoking cigarettes than less. And this is particularly worrisome with youth. The last issue is nicotine. These are nicotine delivery devices. There's increasing evidence that exposure to nicotine in adolescence has negative effects on brain development.

Any thoughts on why more young people are smoking e-cigarettes?

All the efforts that both society and, to some extent, the tobacco manufacturers themselves have undertaken in the last 20 years to decrease youth initiation of cigarettes do not apply to e-cigarettes, because they're unregulated. What we're seeing is the return of the marketing of a tobacco product to television, the use of actors and actresses to glorify e-cigarette use, as well as uncertainty and ambiguity about their use in public places by most governmental entities - all of which is being taken advantage of in both the formal marketing of products, as well as the informal, web-based social media marketing of the products. Plus, the majority of states do not have limits on their sale to minors.

Could you provide a few specific examples of the marketing of e-cigarettes that's may be contributing to more youths smoking them?

Go to YouTube and simply enter e-cigarettes, and you will rapidly see both what is being done informally as well as what's being done formally by some of the companies. For example, there was just recently a Jenny McCarthy ad that was released. Many of these ads are extremely well done and make e-cigarette use look sexy and glamorous, and as if they improve social relations. This is all classic material that the tobacco industry used for cigarettes back when they were [advertised] on television. Once again, the e-cigarette marketing often associates its use with types of aspirations, similar to the kind of marketing the tobacco industry used to double women's smoking back in the 1960s and 70s. Back then, the association for Virginia Slims was, "You've come a long way, baby." Now we're now seeing ads for e-cigarettes that are associated with freedom and independence that are both sophisticated and blatant.

It seems like the health risks of e-cigarettes are still unclear, or at least hotly debated. Do you think this ambiguity helps sell e-cigarettes - as in, "We're not positive how these affect your health, so don't worry about it?"

I'll say this: Starting in the 1950s, one of the main ways the tobacco industry was able to successfully sustain the tobacco epidemic for so long was by sewing uncertainty. What they would say is, "Well we're not certain that smoking causes cancer. Sure, some scientists say it does, but other scientists say it doesn't." So I think this is a very important thing for us to realize over the next two to five years, because we're uncertain of how e-cigarettes are going to play out among adults.

Is it confirmed if e-cigarettes are better, worse or comparable to conventional cigarettes?

We're not saying that e-cigarettes are worse than real cigarettes - far from it. But, we don't know what's going to happen with e-cigarettes in terms of adults and smokers. We don't know how much they're going to end up actually helping smokers permanently and completely transition off conventional cigarettes, which are the No. 1 cause of death and disease in our country. That would be a good thing, but we don't know if that's going to happen. There's no evidence. The companies have not gone to the [Food and Drug Administration] and asked for approval to be used as a formal method to help quit smoking.

So, if anything, there's potential for e-cigarettes to help smokers ween off traditional cigarettes?

We do acknowledge that, if used as a compete substitution for cigarettes by adults who are already regular, frequent, daily smokers - in the circumstance that those people would actually do a complete substitution - we would expect that they would be significantly lowering their risk for disease. But in order for that to be done as an actual marketing claim, or certainly to make the claim that e-cigarettes would help people to quit, there's a process that drug manufactures have to go through to make that kind of claim.

The important thing to realize is that, for the most part, that's not what's happening in adults. What's mostly happening is that adults are doing dual use - they're smoking e-cigarettes in certain circumstances, and in other circumstances, they're continuing to smoke cigarettes. We need to learn a lot more about how this is happening. Unless it's leading them to completely quit cigarettes, we do not think people are materially benefitting themselves by substituting a few e-cigarettes.

Smoking is killing half a million Americans [per year]. If you're a smoker and you want to improve your health, the thing you need to do is completely quit smoking cigarettes. The good news is that we have a bunch of things that we know work in that respect. There are seven FDA-approved medications; there are multiple forms of counseling, delivered by physicians, over the telephone and via the Internet that all work. It's not like we have no other options for quitting.