Surgeon general's report sheds light on dangers of e-cigarettes 

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In December, the Office of the U.S. Surgeon General issued its first-ever report regarding American e-cigarette use, specifically among young adults. In the report, U.S. Surgeon General Vivek H. Murthy notes the skyrocketing use of electronic cigarettes, or nicotine-based inhalable vaporizers, among teens and young adults, along with potential health impacts and long-term effects. In Oklahoma, e-cigarette use among young adults is also growing, and local health experts share the surgeon general’s concerns about the possible consequences.

“Their brains are still developing up until age 25,” said Brittney Hodges, Oklahoma City-County Health Department youth tobacco control coordinator. “For anyone who uses a nicotine product, especially when they’re in that younger age bracket, it’s potentially going to have long-term effects to their brain development.”

Growing problem

According to the Surgeon General report, e-cigarette use among high school students increased 900 percent between 2011 and 2015 and is now more commonly used than other forms of tobacco, including cigarettes.

While the statistic sounds shocking, Oklahoma Medical Research Foundation (OMRF) president Stephen Prescott cautioned that it might not be as alarming as the headlines suggest because data also includes youths who tried e-cigarettes but are not regular users.

That said, more teens in Oklahoma and across the U.S. are regular users. Also, “the overwhelming majority of individuals began using tobacco products by age 18,” the report states in its executive summary.

According to the Oklahoma State Department of Health’s 2015 Oklahoma Youth Tobacco Survey, e-cigarette use among high school students increased from 6.3 percent in 2013 to 19 percent in 2015. Among Oklahoma middle school students, e-cigarette use increased from 2.6 percent in 2013 to 6.7 percent in 2015.

The U.S. Surgeon General’s report shows the top reasons youth gave for trying e-cigarettes were curiosity, the many flavorings available and the belief that they are safer than regular cigarettes.

Prescott added that teens might consider vaping a “renegade activity” because their parents disapprove of it. They also are less regulated than combustible cigarettes and easier to access. However, this could soon change with the Food and Drug Administration’s stricter rules implemented in May 2016 through its Center for Tobacco Products. Through the “deeming rule,” the FDA broadened its definition of what’s considered a tobacco product and what the agency has authority over.

Safer alternative?

Electronic nicotine delivery systems like e-cigs have been touted as a safer alternative to combustible cigarettes and other forms of tobacco and as a smoking cessation aid. While e-cigarettes do differ from combustible cigarettes, there’s no consensus on just how much safer they might be.

“Some people say, you know, 90 percent safer, 80 percent; others say it’s not that much, but that’s quibbling a little bit,” Prescott said.

He added that one thing is certain, namely that e-cigarettes don’t contain the tar found in cigarettes. Tar, the chemical residue left behind by burning cigarettes, is the compound blamed for contributing to cancer development. However, e-cigarettes do contain nicotine, which is known to be addictive. Additionally, e-cigarette use is not an FDA-approved method of smoking cessation, and the American Lung Association does not currently support any direct or implied claim that e-cig use is effective as a smoking cessation tool.

Prescott added that nicotine could be especially dangerous if someone has a pre-existing health condition like heart disease. Plus, there are other chemicals in e-cigarettes, the long-term effects of which are not known.

John Woods, Oklahoma Tobacco Settlement Endowment Trust executive director, said not enough research has been done to determine the long-term effects of e-cigarettes. Because they are a relatively new product, opinions about just how harmful they might be are widely varied.

“It’s a product that is yet to be regulated and yet to be fully studied, and so we’re in a cautious mode when it comes to the use and delivery of e-nicotine products,” Woods said.

The surgeon general’s report notes that the developing brains of young people are more vulnerable to possible negative effects than those of adults, and thus more susceptible to damage including disordered mood, impulse control, inattention and cognition. The report pointed out that because nicotine is addictive, young people could start out using e-cigarettes, which “prime” their brains to seek other addictive substances, including traditional combustible cigarettes.

Prescott pointed out that while some people believe e-cigarettes release only water vapor, they also contain chemicals. The Oklahoma State Department of Health notes that the exhaled aerosol from e-cigarettes contains propylene glycol, glycerol, flavorings and nicotine along with acetone, formaldehyde, acetaldehyde, propanal, diacetin and triacitine.

The surgeon general’s report also called for stricter regulation of how e-cigarettes are marketed to and accessed by youth. The surgeon general encouraged immediate action at all levels, including federal, local and tribal, to restrict access and use of e-cigarettes. Recommended actions include adding them to existing smoking bans and increasing both the cost and the taxes charged.

The report also noted that e-cigarette manufacturers use advertising and marketing tactics targeting youth that are similar to those used in the past for traditional tobacco products. Some measures have already been implemented, including restricting the sale of e-cigarettes to adults age 18 and over, a measure the FDA enacted in August.

Woods said while parents can often tell when their children have been smoking cigarettes, they might not be as aware of e-cigarettes. However, this report could change that.

“The report is important for the awareness it brings and the conversation it brings to the family dinner table in regard to utilizing a harmful product for youth,” Woods said.

Hodges encouraged people to take the report seriously, noting the significance of the surgeon general making clear and decisive determinations and encouraging prompt lawmaker action.

“I think the general public should definitely pay attention to what’s being communicated,” Hodges said, “because they don’t issue things lightly.”

Print headline: Minor threat, Use of electronic nicotine delivery systems, or e-cigarettes, by high school-aged youth more than tripled from 2013 to 2015, Oklahoma State Department of Health data shows.

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