E-Cigarettes Pose ‘Major’ Risks, Surgeon General’s Report Warns

A new report from the U.S. Surgeon General finds e-cigarette use among high school students has grown 900% since 2011. How does the approach of U.S. health authorities differ from their colleagues across the pond?

The U.S. Surgeon General called surging e-cigarette use by children and young adults “a major public health concern” and recommended increased regulation and taxation of the products in a report set to be released Thursday.

The report joins a public debate about the potential benefits and risks of e-cigarettes, which are battery-powered devices that heat nicotine-laced liquid into a vapour. Some groups, including industry advocates and the Royal College of Physicians in the U.K., have argued that e-cigarettes should be promoted as a means to help adults quit smoking conventional cigarettes.

The surgeon general’s report, by contrast, highlights the risks of nicotine exposure to young people. Those risks include mood disorders, deficits in attention and cognition, and addiction to nicotine that could lead to the use of traditional cigarettes, according to the report.

E-cigarettes have become the most commonly-used tobacco product among middle school and high-school students, according to the Centres for Disease Control and Prevention. Among 10th-graders surveyed in 2015, 10.4% said they had used only e-cigarettes in the past 30 days, and 2.2% said they had used only cigarettes, according to the report. Unlike traditional tobacco products, e-cigarettes can be advertised on television and sold in various flavours, such as cherry and bubble gum.

“We have to ensure that they are not an avenue by which kids are addicted to nicotine,” Surgeon General Vivek Murthy said in an interview Wednesday. Dr. Murthy’s report concurs with the research consensus that e-cigarettes are less harmful than cigarettes because they don’t combust. But he said there isn’t enough evidence supporting the effectiveness of e-cigarettes as an aid for quitting conventional cigarettes. His report concludes that e-cigarette use among young people is strongly associated with the use of other tobacco products, including traditional cigarettes.

The U.S. government in May issued rules for the e-cigarette industry that included banning sales to anyone under 18, requiring package warning labels, and making all products—even those currently on the market—subject to government approval. The e-cigarette and vapor industry, estimated at $4.1 billion this year by Wells Fargo, was largely unregulated until Aug. 8, when the Food and Drug Administration assumed regulatory authority. The product-approval process will be phased in over three years.

The surgeon general’s new recommendations go beyond the FDA’s purview, urging local and state governments to take action. His policy recommendations include higher taxes, raising the minimum age to 21, incorporating e-cigarettes into smoke-free laws, and restricting marketing that encourages use among youth and young adults.

While Dr. Murthy raised concerns about flavours that appeal to young users—such as gummy bear, cotton candy and chocolate—he stopped short of recommending restrictions on flavouring. The FDA has said it is looking at flavours that might appeal to youth.

Industry advocates said the proposed policies would make it more difficult for adults to quit smoking cigarettes.

The FDA “is well positioned to address underage e-vapour use,” said a spokesman for Marlboro maker Altria Group Inc., which sells MarkTen and Green Smoke e-cigarettes. “At the same time, we believe the FDA should consider the harm-reduction potential of these products for adult consumers and regulate them appropriately.” “This is just another politically-motivated attack on an industry that is helping people to quit,” said Gregory Conley, president of the American Vaping Association, an advocacy group funded by the industry.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said the proposed regulations are necessary both to protect young people and to help adults who want to stop smoking. “Regulation is necessary so that adults know which of these products have the potential to help them to quit and which of these products don’t.”