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How E-Cigarette Use Threatens to Destroy a Decade of Public Health Progress

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(Photo: via Flickr/Creative Commons)

By Paul Baresel

After widespread recognition of the health consequences of smoking, including respiratory disease, reproductive disease, diabetes, cardiovascular disease, and cancer, public health initiatives, and legislation have driven adult and student smoking prevalence to 19 and 18.1 percent, respectively, as of 2011 — the lowest rates in 50 years.

The most significant decline in smoking among students occurred after 1998, the same year the Tobacco Master Settlement Agreement dissolved unethical tobacco misinformation research organizations founded by cigarette manufacturers, reformed tobacco marketing regulation, and significantly increased anti-smoking advocacy smoking. With increased public clarity on the health consequences of smoking, absolute restriction on tobacco targeting to youth, and decreased outdoor advertising, cigarette use rates continued to decline for a decade.

Today, public health faces a new form of nicotine use- e-cigarettes. Smoking e-cigarettes, or vaping, has been promoted as a health conscious alternative to cigarette smoking that is gaining significant traction in youths and threatens to set back decades worth of progress.

E-cigarette Health Concerns

Tobacco use among youths is critically important to stemming the epidemic of smoking-related disease. Studies have shown that among adults who smoke, 90 percent started smoking by age 18, and 99 percent by age 26.

Data from the American Journal of Public Health indicates that younger adults have greater smoking cessation success rates than older adults (8.5 percent vs. 5 percent), yet overall cessation for more than six months by both groups achieved by fewer than 1 in 10 individuals. This means that not only are the most effective measures to reduce smoking-related disease likely to be those that target young adults and initial youth smoking, but youth smoking is likely a strong predictor of the smoking disease burden of the United States in the decades to come.

Unfortunately, vaping among youths is on the rise. Studies of U.S. middle and high school students in 2014 show that 4 of every 100 middle school students and 13 of 100 of high school students have used electronic cigarettes in the 30 days prior to polling, up from 0.6 percent and 1.5 percent, respectively, in 2011.

Concerns Surrounding Carcinogenic Compounds

The use of e-cigarettes in youths and adults also differs. Adults tend to use vaping as a smoking cessation tool, while youths are more likely to engage in vaping before or while developing initial smoking addiction.

Worse, e-cigarette use is likely to encourage traditional cigarette use among adolescents, and the dangers of vaping are unknown and potentially significant. Studies show that e-cigarettes, even without the harmful toxins and tar of traditional cigarettes, can still be carcinogenic.

E-cigarettes may also deliver higher doses of nicotine than traditional cigarettes, exacerbating both nicotine’s toxic and addictive properties. Additionally, e-cigarette vapor contains a variety of potential carcinogens and toxic compounds, including propylene oxide and easily volatilized phenolics.

Although they may present a powerful tool for smoking cessation that could ultimately be helpful to public health, a lack of knowledge and regulation surrounding their use and potential harms compounded with their growing use among youths make e-cigarettes a danger to progress against the smoking epidemic.

Youths, the most important target population for reducing smoking related deaths and disease, are the most vulnerable and are increasing in their use of vaping. In order to develop an effective strategy to address e-cigarettes, either as a tool or toxic agent, they must first be standardized and their contents regulated.

The successes of the Master Settlement Agreement, which regulated traditional tobacco research and marketing, ultimately being successful in reducing traditional smoking, should serve as a framework under which to design new legislation for e-cigarettes.

The reduction of national smoking-related disease and deaths is a landmark public health success. Let us continue that progress rather than see it undermined by the changing face of nicotine use.

Paul Baresel is a second year UVM medical student studying public health.

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