The New York Times
The Risks of Another Epidemic: Teenage
“We’re stepping backward from all the advances we’ve made in tobacco control,” oneinvestigator said.
By Jane E. Brody
Nov. 23, 2020
While most of us strive to avoid inhaling aerosols that could harbor a deadly virus,millions of teens and young adults are deliberately bathing their lungs in aerosols rich inchemicals with known or suspected health hazards.
I’m referring to vaping (or “juuling”): the use of e-cigarettes that is hooking youngpeople on a highly addictive drug — nicotine — and will be likely to keep them hookedfor decades. Meanwhile, e-cigarettes and other vaping devices are legally sold with fewrestrictions while producers and sellers reap the monetary rewards. Although manystates prohibit e-cigarette sales to persons younger than 18 or 21, youngsters have littletrouble accessing the products online or from friends and relatives.
In just one year, from 2017 to 2018, vaping by high school seniors increased more than“for any substance we’ve ever monitored in 45 years, and the next year it rose againalmost as much,” said Richard Miech, principal investigator for the national surveyMonitoring the Future.
By 2019, a quarter of 12th graders were vaping nicotine, nearly half of them daily. Dailyvaping rose in all three grades surveyed — eighth, 10th and 12th — “with accompanyingincreases in the proportions of youth who are physically addicted to nicotine,” Dr. Miechand colleagues reported in The New England Journal of Medicine last year.
Although self-reported use of e-cigarettes by high school and middle school studentsdecreased over the past year, Dr. Robert R. Redfield, director of the Centers for DiseaseControl and Prevention, cautioned, “Youth e-cigarette use remains an epidemic.”
“We’re stepping backward from all the advances we’ve made in tobacco control,” Dr.Miech, professor at the Institute for Social Research at the University of Michigan, saidin an interview. “I’m worried that we will eventually return to the tobacco situation ofyore. There’s evidence that kids who vape are four to five times more likely the next yearto experiment with cigarettes for the first time.”
As someone who witnessed the persuasive tactics the tobacco industry used to get nearlyhalf of American adults hooked on regular cigarettes in the 1950s, I see similar effortsbeing used today to promote these new delivery systems for nicotine: sex, glamour,endorsements by celebrities and doctors, and sponsorship of popular sports and musicalevents. Only now there are even more pervasive avenues of influence through websitesand social media.
In 2016, ads for e-cigarettes reached nearly four in five middle and high school studentsin the United States, Dr. Ellen S. Rome noted.
As in decades past, the nation’s regulatory agencies have been slow — some saynegligent — to recognize this fast-growing threat to the health and development ofyoung Americans. Dr. Rome, a pediatrician who heads the Center for AdolescentMedicine at the Cleveland Clinic, explained that nicotine forms addictive pathways inthe brain that can increase a youngster’s susceptibility to addiction throughout life. Theadolescent brain is still developing, she told me, and e-cigarette use is often a gateway tovaping of marijuana, which can affect the brain centers responsible for attention,memory, learning, cognition, self-control and decision-making.
In a review published last December in the Cleveland Clinic Journal of Medicine, Dr.Rome and her co-author, Perry Dinardo, challenged the public perception that vaping isharmless, or “at least less harmful than cigarette smoking.”
While it’s likely to be true that vaping may be less hazardous than tobacco cigarettes,since the vaped aerosols that reach the lungs are devoid of the thousands of tobacco-derived toxic and carcinogenic substances inhaled by cigarette smokers, vaping stillintroduces a fair share of potentially harmful chemicals. In addition to nicotine, some ofthe chemicals, like the carcinogen formaldehyde, are created when the nicotine-richliquid in some vaping devices is heated to high temperatures.
“E-cigarettes might have their own unique health effects we haven’t discovered yet,” saidTheodore L. Wagener, director of the Center for Tobacco Research at Ohio State
University. “Although compared to tobacco cigarettes, e-cigarettes without a doubtexpose users to much lower levels of harmful chemicals, we still don’t know how thebody handles them and what their long-term effects might be.”
Remember, it took many decades of smoking by tens of millions of people before thedeadly hazards of tobacco cigarettes were recognized.
The surge in the use of electronic cigarettes was tied to a game-changing product, Juul, acartridge device introduced in 2017 in a slew of enticing flavors. Flavors especiallyattractive to youngsters are now banned from use in closed-system devices like Juul,which now is sold only in tobacco and menthol flavors, but can still be used in the open-system products sold in vape shops. And now, taking advantage of a loophole inregulations, a disposable product called Puff Bar, which comes in more than 20 flavors,has replaced Juul as the vape of choice among young people.
Concerns about vaping grew after a 2019 outbreak of severe lung injuries, which weresubsequently linked to vitamin E acetate, an additive found in some vaping devices thatdeliver THC, the psychoactive ingredient in marijuana. Juul pods are not designed to berefillable with substances like THC or other chemicals.
Producers of Juul introduced changes that enhanced the palatability and safety ofvaping, but at the same time “made it easier for kids to start using nicotine,” Dr.Wagener said. Instead of freebase nicotine that is very harsh to inhale, Juul contains anicotine salt, “a very palatable form of nicotine that makes inhaling high doses ofnicotine easy,” he explained. And Juul doesn’t require the high temperatures thatproduce toxic substances like formaldehyde. A single pod contains the nicotineequivalent of a pack of conventional cigarettes.
“E-cigarettes were initially advertised as a means to help people transition from harmfultobacco smoking,” Dr. Cheng said. “A lot of early users didn’t even know they containednicotine.” Although a small minority of smokers have used e-cigarettes to help them quitor reduce their dependence on tobacco, most who use the devices vape to get theirnicotine fix when they can’t smoke regular cigarettes.
Although there have been calls for bans on e-cigarettes, Abigail S. Friedman, a healtheconomist at Yale University School of Public Health, cautioned that “bans can pushpeople into the black market looking for something that can be acutely dangerous.”
Continue reading the main story “Juul made it cool, and young people who had neversmoked cigarettes are becoming addicted to nicotine,” said Erika R. Cheng, a publichealth epidemiologist at Indiana University School of Medicine. In addition to nicotine,Juul pods contain a mix of glycerol, propylene glycol, benzoic acid and flavoring agents,the long-term health effects of which have yet to be determined, she said.
Dr. Friedman said that rather than outright bans that can have unanticipated costs, shefavors better regulations. Currently, other than flavors, what is inhaled from e-cigarettesis unregulated. Still, she and other experts are very concerned about the explosiveuptake of vaping by young people. In the 2019 Youth Risk Behavior Survey of 4.9million high school students, she said, 6 percent reported smoking conventionalcigarettes while 33 percent puffed e-cigarettes in the past 30 days. In December 2018,the U.S. Surgeon General, Dr. Jerome Adams, declared e-cigarette use by youth anepidemic.
Periscope News Group- Jennifer Banmiller
Informant: Nicole Hausmann