Primary Care Corner with Geoffrey Modest MD: E-cigarettes

By: Dr. Geoffrey Modest

So, no great surprise. E-cigarettes are taking over our youth…  The latest MMWR reviewed tobacco use in middle and high school students in the US, from 2011-2014, revealing profound changes (see here​ for full MMWR report).

In brief:

 –the CDC and FDA reviewed data of trends in current tobacco use (defined as: use >=1 day within the past 30 days) in middle schools (grades 6-8) and high schools (grades 9-12)

–overall, 24.6% of high school students reported current use of a tobacco product, and 12.7% reported use of >= 2 tobacco products

–in 2014, e-cigarette were the most commonly used tobacco product in middle (3.9%) and high (13.4%) school students, with significant increases in both e-cigarettes and hookahs (p<0.05), and decreases in cigarettes and cigars (so, in sum, no change in overall tobacco use, meaning that 4.6 million students are still exposed to tobacco).

–overall for high schoolers: e-cigarettes 13.4%, hookahs 9.4%, cigarettes 9.2%, cigars 8.2%, smokeless tobacco 5.5%, snus 1.9%, pipes 1.5%. E-cigarettes were the most common tobacco product used by non-Hispanic whites, Hispanics, persons of non-Hispanic other races; but not in non-Hispanic blacks, where cigars were the most used.

–overall for middle schoolers: e-cigarettes 3.9%, hookahs 2.5%, cigarettes 2.5%, cigars 1.9%, smokeless tobacco 1.6%, snus 0.5%, pipes 0.6%

–see rather striking graph at bottom for high school students. that for middle school is in MMWR, but is basically the same but with lower numbers.

So, no huge surprise. it is pretty clear that e-cigarette marketing and packaging (with an ever-increasing array of seductive flavors) is targeted to kids. And this brings up a few very significant issues. One is the neurobiology– that the adolescent brain, when exposed to nicotine, may be more susceptible to long-term adverse consequences and addiction. Another is that the marketing and acceptance of e-cigarettes is (as predicted) un-demonizing tobacco products. There have been dramatic and steady gains in decreasing cigarette smoking over the decades, despite advertising overall and in particular to kids. the large tobacco companies have clearly shifted their approach, at least in the US and Europe (as I understand), to focusing on the socially- and in many cases governmentally-more acceptable e-cigarettes.

See prior blogs for more details:

This one highlights some of the political and medical consequences of e-cigarettes. This one highlights some of the contaminants found in some e-cigarettes made in China (where 90% of the worldwide e-cigarettes are made)

Here is graph of tobacco use in high-schoolers:

graph(CDC, 2015).