Adolescent and teen use of e-cigarettes or vaping products has doubled or nearly doubled in Kentucky in the last two years, according to the 2018 Kentucky Incentives for Prevention Survey. About one in four 10th and 12th graders and one in seven 8th graders in the Commonwealth vaped in 2018. This Kentucky data depicts an even more troubling surge than we are seeing at the national level.
Thus, while e-cigarettes may have offered the promise of a less harmful product for adult tobacco users, what they've actually delivered is a dangerous epidemic in youth nicotine use. Kentucky must enact measures that will reverse this epidemic. The tobacco-free schools bill signed into law in April was a start. We now need to raise the age for legal tobacco purchases to 21, raise the price of e-cigarettes through a state excise tax, and to enact more smoke-free community laws that prohibit smoking and vaping in all public spaces and enclosed workplaces.
Perhaps the most important beneficiary of these measures will be youth.
While Kentucky youth smoking and smokeless tobacco use continued multi-year declines in 2018, the use of any tobacco product by youth rose substantially in 2018; the increase was due entirely to e-cigarettes.
Several factors contributed to this explosive growth:
• Flavors: Unlike combustible cigarettes, which come only in tobacco and menthol flavors (and the FDA is considering banning menthol), e-cigarettes are available in a variety of flavors and many of them are clearly targeted to youth. Kid-friendly flavors include bubble gum, cotton candy, fruit medley, and any number of flavors using the word "unicorn."
• Marketing: Youth are widely exposed to e-cigarette advertising and marketing because these relatively new tobacco products don't have to adhere to the 1971 cigarette television and radio advertising ban or other marketing restrictions designed to protect kids. E-cig makers market their products on TV and radio, as well as via social media and sponsorships for events such as music festivals. This marketing exposure is re-normalizing tobacco use for a new generation.
• Design: The most popular e-cigarette brand today is Juul, which looks like sleek jump drives and are small enough to be hidden easily from teachers, parents and other adults. Kids tell us they like this "cool" design, which they can personalize with "skins," stickers and flavorings. In addition, e-cigs also are easier to smoke than traditional, combustible cigarettes because they are made using nicotine salts that are less harsh to the throat.
• Nicotine Content: A single e-cigarette liquid pod of the most popular brand - Juul - contains as much nicotine as an entire pack of 20 cigarettes, and some youth are reporting going through multiple pods a day. Moreover, teen vapers are 16 times more likely to use Juul than adults 25 to 34 years old, according to a 2018 study in Tobacco Control.
High e-cigarette use among youth raises serious health concerns. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early 20s. In fact, according to the Centers for Disease Control and Prevention, using nicotine while young changes the way brain synapses are formed, and can reduce attention span, learning and impulse control.
Using nicotine while young also may prime the brain for addiction to other drugs, the CDC says.
In addition to nicotine, e-cigarette aerosol contains cancer causing chemicals, heavy metals, volatile organic compounds and flavorings such as diacetyl, which has been linked to a serious disease called popcorn lung. And because e-cigarettes are not yet regulated, it's difficult to know all the chemicals and exactly how much of each they contain.
In addition, there is increasing evidence that e-cigarette use among youth leads to smoking combustible cigarettes, which kill half of all people who smoke them long-term, the CDC says.
Even among adults, it's been shown that those who use e-cigarettes are often dual users, so they're not actually reducing their exposure to tobacco smoke or health risks. Therefore, the e-cigarette harm reduction argument for adults has some holes and more research is needed.
In any case, harm reduction is neither a safe nor a sensible approach for youth. All the evidence shows that e-cigarettes and vapes are highly attractive, extremely addictive, and endangering the health of adolescents and teens across the Commonwealth. We know what to do to stop this epidemic. We just need to have the will to do it. Please support efforts in your community and statewide to reduce youth access and exposure to all tobacco products, but especially the popular new kid on the block, e-cigs.
Ben Chandler is president and CEO of the Foundation for a Healthy Kentucky and Chair of the Coalition for a Smoke-Free Tomorrow.