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A teen obviously enjoying vaping. Image by Ethan Parsa from Pixabay- Free use
A teen obviously enjoying vaping. Image by Ethan Parsa from Pixabay- Free use

Youth Involvement:
Tobacco and Vaping

Oct 23, 2019
by Gary Pace M.D.

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With the current health crisis around vaping, especially in young people, it seems to be a good time to look at how the e-cigarette phenomenon is influencing youth involvement with nicotine.  Also, there are many requests for increased regulation.  Have laws limiting access to cigarettes helped in the past?

This is the current recommendation from the California Department of Public Health:  

“The CDPH urges everyone to refrain from vaping, no matter the substance or source, until current investigations are complete.”

While no new laws accompanied this report,  on September 16, the governor issued an executive order to decrease youth access to any vaping products.

VAPING:

19-year-old vaped to deal with anxiety before he developed serious damage to his lungs. Photo: Instagram | @salazar383412 - publicThe latest report at the time of this writing shows over 800 e-cig users across the US since June of 2019, and over 100 in California, have been hospitalized with life-threatening lung illnesses—called Vaping Associated Pulmonary Illness (VAPI).  

The scientists are still trying to figure out what is causing this severe illness.  Most, but not all, of the people encountering problems are vaping cannabis products, often from the illicit market.  Vitamin E oil as an additive is showing up in a lot of the products that are leading to illness, but it is not found across the board.  Vitamin E is an additive used as a cheap way to dilute the product, and only recently emerged as part of the illicit market.  

Nicotine:

The legal cannabis market is more heavily regulated than the nicotine market, since the e-cigarette consumer products emerged rather quickly and before research and regulation could be put into place.  JUUL cigarettes have exploded on the scene, but the oversight is coming in after the fact.  The CEO of JUUL recently resigned in the midst of all of the controversy.

Some facts:

●  E-cig usage by high school students increased 78% between 2017-2018.  (CDC)

●  1 in 4 high school students have used a tobacco product. (CDC)

●  4 out of 5 kids who have used tobacco started with a flavored product (American Journal of Preventive Medicine).

●  Kids 15-17 years old are 16X more likely to use Juul than older groups.  (Truth Initiative)

●  Kids report vaping as early as 12 years old. (NBC)

●  Middle and High School kids are much more likely to smoke flavored products than unflavored.

●  In 2016, Tobacco 21 legislation increased the minimum legal age-of-sale for tobacco products from 18 years old to 21 years old. 

So, it seems that the declines in use of nicotine that have been occurring for many years now are reversing.  What is going on here?  It looks like it is the new technology of e-cigarettes (vaping) and the adding of flavors have made it more appealing to teens.  Many critics feel this is an intentional marketing strategy by the tobacco industry.  

Decreasing Teen Use of Nicotine by Regulation:

As of January 1, 2017, the state required tobacco retails to pay an annual fee of $265 — which is mainly aimed at enforcing payment of taxes and decreasing black market sales.  In addition to the state fee, tobacco activists encourage a local retail license fee.  Adoption of a strong retail store licensing ordinance, where an annual fee is paid by the stores and this money goes towards community enforcement, has gone a long way in helping decrease sales to youth.  An example:  In Sonoma County, youth sales rates of Tobacco before the ordinance was adopted in April of 2016 was at 18.4%.  The most recent Youth Sales Rate was at 1.3%.  Similar findings are seen whenever these ordinances are adopted.  

Conclusions:

The Press Democrat on October 9th reported: 

 “Sonoma County supervisors on Tuesday directed the county health officials to figure out a way to ban nicotine vaporizers and flavored tobacco products rather than waiting on the federal government to act.”  

While these sorts of efforts are often unpopular, they can go a long way towards protecting the health of the community, especially the teens who seem particularly vulnerable to this new incarnation of nicotine exposure.  Given the extreme problems with some of the vaping technology and the dramatic increase in teen smoking lately, it would be very reasonable to put the brakes on until more information can be collected.

 

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