The U.S. Surgeon General issued an advisory Tuesday urging new local restrictions including taxes and indoor vaping bans to combat youth e-cigarette use, a pivotal development given the office's global stature on tobacco enforcement.
The move by Surgeon General Dr. Jerome Adams comes a day after the National Institute for Drug Abuse issued new data showing nearly 21 percent of high school seniors say they vaped a nicotine product within the past 30 days, up from 11 percent a year ago. The increase, part of the annual Monitoring the Future survey on drug use among adolescents, was the largest for any substance use in the survey's 43-year history.
“There’s no more credible or influential voice on nicotine and tobacco than that of the U.S. Surgeon General," says Dr. Josh Sharfstein, a former Maryland health secretary who is now a public health professor and vice dean at Johns Hopkins University. "Today’s advisory is an alert to the nation that e-cigarettes are leading millions of youth into nicotine addiction and placing them at unacceptable risk of harm
More than 2 million middle school, high school and college teens use these battery-powered devices to heat liquid-based nicotine into an inhalable vapor. More than one in three high school seniors and nearly one in three sophomores say they vaped at least once in the past year, the new report found. Up to 30 percent vaped for 20 or more days in the previous 30 days, a "clear sign of addiction," says Matthew Myers, president of the Campaign for Tobacco Free Kids.
Nicotine is "very and uniquely harmful" to the developing brain, says Adams. It can impair learning and memory for people under 25, "prime the brain" for addiction to other substances and increase the risk they will turn to combustible tobacco just as smoking is at a record low. He cites research showing vaping makes youth two to eight times more likely to use cigarettes in the future.
Worse yet, it's turning children who were the least likely to start smoking into potential smokers, Myers says.
The data prompted Adams — the father of two middle school students and an 8-year-old — to issue the second Surgeon General advisory in his 16-month tenure. The first, in April, urged people to carry the overdose antidote naloxone. It is also only the fourth advisory since the Surgeon General issued two in 2005, against drinking alcohol during pregnancy and a warning about the health risk from exposure to radon in indoor air.
The advisory follows stringent proposals and rules last month from the Food and Drug Administration (FDA), but Adams urged state and local governments, including tribes and territories, to go farther. Specifically, he asked officials to consider banning vaping indoors at public venues, making e-cigarettes more expensive through taxes and limiting access to flavored tobacco products by young people.
Adams also pushed parents, teachers and the health care industry to become more active in the fight against youth vaping, particularly the use of the easily hidden USB-sized devices sold by Juul. About three quarters of youth who smoke e-cigarettes use Juul, which quickly developed a huge following on social media.
About two-thirds of Juul users aged 15-24 don’t know Juul always contains nicotine, according to an April study by the non profit advocacy group Truth Initiative.
Along with recognizing what vape devices look like, Adams says parents should ban the use of tobacco or e-cigarettes in their homes or vehicles by children and quit smoking themselves. He also urged them to ask doctors to discuss the risk of smoking and vaping with their children.
He also says teachers need to recognize the tiny devices and develop and enforce tobacco-free school policies and prevention programs at their schools that don't have industry influence.
Myers doesn't mince words when he blames Juul for what is near-universally considered an epidemic of youth vaping. The company "cannot be taken seriously when it says it had no idea its product would appeal to kids," says Myers.
"In less than two years, Juul changed the trajectory in a way that threatens to undermine all the work in reducing youth tobacco use over the last three decades," says Myers.