Commentary: Focus on discouraging youth vaping is getting positive results

As a resident of Delaware, a practicing pulmonologist and the chief medical officer of the American Lung Association, I see the alarming impact of electronic-cigarette use by our youth in our community every day. According to the Centers for Disease Control and Prevention’s National Youth Tobacco Survey, about 1 of every 5 high school students (19.6%) and 1 of every 20 middle school students (4.7%) reported in 2020 that they used electronic cigarettes in the past 30 days. In Delaware,19.4% of high school students reported using tobacco products, according to the American Lung Association’s State of Tobacco Control report, and the 2017 Youth Risk Behavior Survey found that 13.6% of high school students used electronic smoking devices.

The U.S. surgeon general has classified the increase in youth vaping “an epidemic.” E-cigarette use among youth is a significant public health concern, and steps must be taken by parents, educators and especially policymakers to discourage use of e-cigarettes and prevent setting youth up for a lifetime of addiction.

Recent studies indicate that the most common reasons young people use e-cigarettes are use by friends or family members and the availability of flavors, such as mint, candy, fruit or chocolate. Many youth believe that e-cigarettes are less harmful than other forms of tobacco, such as combustible cigarettes. Lower socioeconomic status, including lower income or education; lack of support or involvement from parents; accessibility; availability and price of tobacco products; and advertising in stores, on television and in movies, online and in social media are also key factors that influence the initiation and use of e-cigarettes by youth.

Following the removal of almost all flavored combustible cigarettes from the marketplace, cigarette smoking rates among youth dropped to historically low levels. However, the remaining flavored tobacco products on the market, including menthol cigarettes, cigars and e-cigarettes, are attracting and addicting another generation, leading to a significant increase in overall youth tobacco use.

Over half of cigarette smokers ages 12-17 started with menthol cigarettes, and in 2019, close to 70% of youth who used tobacco used a flavored product. In addition, in 2020, among all current middle and high school e-cigarette users, 82.9% used flavored e-cigarettes.

The American Lung Association submitted comprehensive comments to the Food and Drug Administration (FDA) in July 2018, outlining our position on flavored tobacco products. To address the nation’s youth e-cigarette epidemic, the association calls on Congress and the FDA to eliminate all flavored tobacco products from the marketplace, including menthol cigarettes and flavored cigars and e-cigarettes. National, state and local program activities have been shown to reduce and prevent youth tobacco use when implemented together.

Delaware is making progress in addressing tobacco use by youth, including the May 2019 passage of Tobacco 21 by Gov. John Carney, efforts to end the sale of flavored products including all flavors and addressing tax equity for all tobacco products. Additionally, local efforts are underway, such as Resolution No. 21-024 by Wilmington City Councilwoman Rysheema Dixon, which encourages and support the Delaware General Assembly to take action on ending the sale of flavored tobacco products. The resolution passed with 11 members of the City Council supporting.   

The EVALI (e-cigarette or vaping-associated lung injury) outbreak in 2019-20, with 2,807 hospital cases and 68 deaths reported to the CDC, bolstered the concern about the increase and risks of youth vaping nationwide. In the midst of the COVID-19 pandemic, worry continues. A 2020 study published in the Journal of Adolescent Health found that youth who vaped were five to seven times more likely to be infected by the coronavirus than those who did not use e-cigarettes. The study indicated that young people who had used both cigarettes and e-cigarettes in the previous 30 days were almost five times as likely to experience COVID-19 symptoms, such as coughing, fever, tiredness and difficulty breathing, as those who never smoked or vaped.

Amid the concerns, there is hope and support. Advocacy efforts, prevention, intervention and cessation resources for youth will help to reduce the social acceptability of tobacco product use, build resiliency and quit skills, and protect bystanders from all tobacco product emissions. Our efforts now are critical and will protect the future of our youth from lifelong nicotine dependence. Together, we can work to end youth tobacco use and protect generations to come.

Dr. Albert Rizzo is chief medical officer for the American Lung Association