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James has never smoked cigarettes and cannot  imagine ever starting. As he says, “the girls think they’re gross.” So  James ‘vapes’ instead.  James is one of the 2 million high school students smoking e-cigarettes (e-cigs), according to a survey just released by the CDC. “It was something for us to do that was edgy and exciting,” said the 17-year-old Virginia student, who didn’t want to reveal his last name. James is willing to talk about his vaping, but is not completely comfortable revealing his smoking habits to the world. (NY Times, 04-16-15)

Last Thursday the CDC released its data,  stating that “[f]indings from the 2014 National Youth Tobacco Survey show that current e-cigarette use (use on at least 1 day in the past 30 days) among high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014, rising from approximately 660,000 to 2 million students. Among middle school students, current e-cigarette use more than tripled from 1.1 percent in 2013 to 3.9 percent in 2014—an increase from approximately 120,000 to 450,000 students.”

The release went on to say, “This is the first time since the survey started collecting data on e-cigarettes in 2011 that current e-cigarette use has surpassed current use of every other tobacco product overall, including conventional cigarettes.” (

Great news—use of traditional tobacco products is decreasing. But as the CDC notes, the uptick in use of e-cigarettes and hookahs among teens negates the drop.

The data has set off a firestorm of stories across the web and on traditional news channels. It’s what we do not know that causes the most concern. How much nicotine is dangerous? And, what about teens—are they not more susceptible because their brains are still forming? Is this a successful step in the decline of traditional tobacco products or a cleverly packaged resurgence of Big Tobacco?   Or both?

There was one strong voice in defense of e-cigarettes last week.  Surprisingly, not the e-cigarette industry; they are busy making tons of money on American youth. Michael Siegel, a professor and tobacco-control specialist at Boston University’s School of Public Health, feels the “CDC should really be jumping for joy at the fact that smoking rates are declining. This is a huge success. Instead, they (the CDC) are using this as another opportunity to demonize e-cigarettes.”

Siegel follows the thinking of e-cigarette manufacturers who insist their products are designed as smoking cessation tools. And, while that may be true, to a degree, we do not know enough about the dangers of e-cigarettes to be complacent (or enthusiastic) about this surge in teen and pre-teen use.

Again, it is what we do not know that is so dangerous. Remember, the CDC reports 450,000 middle-school students using e-cigs in 2014, up from 120,000 in 2011. The data may suggest that e-cigs have helped some students stop smoking traditional cigarettes. But the increase in numbers suggests that children are trying e-cigarettes because they are ‘cool’. E-cigarettes contain nicotine. And, they contain other additives that have yet to be found harmless, or deadly over time. We simply do not know at this time.

The decades-long fight against traditional cigarettes had finally begun to solidly take hold.  But e-cigarettes are not seen as all that threatening. The presentation, the packaging, the cool flavors—all make them seem pretty harmless. Trendy, if you will. The marketing strategy has been intentionally designed, at least in large part, for the youth market.

“These are the same images, the same themes and the same role models that the cigarette industry used 50 years ago,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids. “It’s the Marlboro Man reborn. It’s the Virginia Slims woman re-created, with the exact same effect. . . . This is not an accident.”

CDC Director Tom Friedman noted, “The tobacco industry spends more in a couple days than we do in an entire year on educating the public.”

In April 2014 the FDA proposed regulations for the sales and marketing of e-cigarettes. The regulations are still not in place, which makes the recent data all that more alarming. Mitch Zeller, head of the agency’s Center for Tobacco Products, spoke last Thursday about the FDA’s intention. “These staggering increases in such a short time underscore why the FDA intends to regulate those additional products to protect public health.”  We have waited a full year—how much longer will it take?

Matthew Myers sums up this situation so clearly. “The drop in cigarette use is historic, with enormous public-health significance,” Myers said. But, he quickly added, “the explosion of ­e-cigarette use among kids means these products are being taken up in record numbers with totally unknown long-term consequences that could potentially undermine all the progress we’ve made.” (Wash. Post, 04/16/15)  Further, we have not yet seen to what extent e-cigs will be a gateway product introducing young folks to tobacco cigarettes.  That is a truly scary thing to consider.  Hopefully, the long-term negative effects of e-cigs will be found to be very minimal, for the sake of the millions using them.


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