Intended for healthcare professionals


Teens’ e-cigarette use rises as spending on advertising soars, says CDC

BMJ 2016; 352 doi: (Published 07 January 2016) Cite this as: BMJ 2016;352:i93
  1. Michael McCarthy
  1. 1Seattle

As spending on e-cigarette advertising has risen in the United States, there has been a nearly 10-fold increase in e-cigarette use by high school students, the Centers for Disease Control and Prevention said in a report released on 5 January.1

The report said that spending on e-cigarette advertising rose from $6.4m (£4.4m; €6m) in 2011 to an estimated $115m in 2014. Over the same period e-cigarette use among youth has risen. Reported use of e-cigarettes in the past 30 days among high school students increased from 1.5% in 2011 to 13.4% in 2014 and among middle school students from 1.6% to 3.9%, the report said.

The CDC’s director, Tom Frieden, said that advertisements used many of the same themes that were used to sell cigarettes, including “independence, rebellion, and sex.” “Really, the e-cigarette advertising we’re seeing is like the old time wild west: no rules, no regulations, and heavy spending advertising the products,” he said.

In a statement the industry group the Smoke-Free Alternatives Trade Association called the CDC’s report misleading. “The vapor industry always has supported age restrictions on vapor products. These are adult products, sold to adults by adults,” the statement said.

The association cited the decrease in cigarette smoking in the US in recent years as evidence that vapor products, such as e-cigarettes, did not increase use of traditional tobacco products and, in fact, helped people quit smoking. It said, “We believe that vapor products serve as a less harmful alternative away from smoking and are a contributing factor to the recent decline in cigarette smoking.” A preliminary report released by the CDC’s National Center for Health Statistics in November last year said that the proportion of US adults over 18 who were current smokers had fallen below 15%, a new low.2

But Brian King, deputy director for research translation in the CDC’s Office on Smoking and Health and the report’s senior author, said that there was a danger that the promotion of e-cigarettes to students could undo the largely successful public health efforts to make smoking unfashionable among young people. “This unfettered marketing of e-cigarettes, coupled with the rising use of these products among youth, has the potential to compromise decades of progress we’ve made in preventing and reducing the social acceptability of tobacco use among the nation’s youth,” King said.

The CDC’s new report said that about seven in 10 middle and high school students in the US reported seeing advertisements promoting the use of e-cigarettes, with about half (54.8%) of students reporting seeing the advertisements in retail stores, about 40% online, about 36% in television programs or movies, and about 30% in newspapers and magazines. Fifteen per cent of students reported seeing e-cigarette advertisements from all four sources. The data came from the 2014 National Youth Tobacco Survey,3 an annual survey of more than 22 000 students in grades 6 through 12 conducted by the CDC.

Frieden said that e-cigarette use by young people was a particular concern, firstly because of the danger that use would lead to nicotine addiction, secondly because e-cigarette use coupled with nicotine addiction may well increase the likelihood that users go on to smoke cigarettes, and thirdly because exposure to nicotine at a young age might harm brain development. “There is increasing scientific evidence that suggests that the changes it makes to how the brain works may be long lasting or even permanent,” he said.

Among the measures the report calls for are:

  • Limiting sales of tobacco products to facilities that never admit young people

  • Restricting the number of stores that sell tobacco and how close they can be to schools

  • Requiring that e-cigarettes be sold only through face to face transactions, not on the internet, and

  • Requiring age verification to enter e-cigarette vendors’ websites, make purchases, and accept deliveries of e-cigarettes.

Regulation of tobacco products and e-cigarettes falls under the authority of the US Food and Drug Administration.


Cite this as: BMJ 2016;352:i93


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