Teens’ e-cigarette use rises as spending on advertising soars, says CDCBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i93 (Published 07 January 2016) Cite this as: BMJ 2016;352:i93
All rapid responses
“I think we have seen this movie before . . .” (1)
Previous evidence (2) regarding this issue last year from the U.S. predicted increase in adolescent uptake, so the new data from the CDC should be no surprise. Indeed, again previously, when CEOs of two leading e-cigarette companies were “grilled” by Senators, several important issues were revealed:
“Responding to questions from Senator Boxer (D-California) about the flavors NJOY plans to introduce, Weiss made a slip, saying “for adults, we have single malt scotch.”
“Adult flavors?” said Boxer. “As opposed to those for children.”
“The only difference between your testimony today and testimony of the tobacco executives is that you are not under oath,” said Senator Blumenthal. “I find in your testimony a sense of denial that I cannot credibly accept because it is defied by the numbers. 18 million teens were exposed to blu’s print TV ads in 6 months and NJOY’s ads reached 3 million teens [these statistics come from the American Legacy Foundation report].” (1)
“There is a legal principle that people are responsible for the natural and logical effects of what you do, and you know that you are reaching children.”
In the U.K. Moore et al have highlighted (3) that:
“Many young people (including never-smokers) have tried e-cigarettes. However, regular use is less common, and is associated with tobacco cigarette use.”
However, they warn that:
“There was limited evidence of patterning in adolescent e-cigarette use by sociodemographic factors . . . This is in very stark contrast to consistent evidence of a strong sociodemographic patterning in tobacco use among secondary-schools students . . . Public health professionals and policymakers are increasingly concerned that e-cigarettes will act as a new gateway into nicotine addiction and tobacco use for some young people if e-cigarettes are taken up widely at a population level. These data do suggest e-cigarette use could potentially spread throughout the youth population and become ‘normalised’, irrespective of socioeconomic status, ethnicity and gender . . .”.
If we presume that advertising influences behaviour, then the recent analysis by the E.U. Advocate General on new law regarding electronic cigarette advertising and sales (4) appears precautionary and proportionate, as: “e-cigarettes possibly cause risks to human health and that that product could — above all in the case of adolescents and young adults — develop into a gateway to nicotine addiction and, ultimately, traditional tobacco consumption.”
Indeed, as recently highlighted at an important scientific summit on E-cigarettes (5) there are “Likely real and potential harms of e-cigarettes to users”. These include “Expected modest increases in risk of:
• Lung Cancer
• Pulmonary Infection
• Cardiovascular events
• Pulmonary Fibrosis
• (Hypersensitivity Pnuemonias)
• Other cancers”
Although Electronic Cigarettes may help some adult smokers, refractive to licensed therapies (6), quit tobacco, the current quality of evidence to support this, according to Cochrane Review, is “Low” or “Very Low” (7). What we should try to avoid is youth paying any price for any gains to adult health: this would be “egregious”, as previously argued (8). Hopefully, new law will reduce the risk of this. As elegantly stated previously: “The grave historical error in allowing cigarette marketing to flourish and the tobacco industry to thrive is no excuse for inadequate e-cigarette regulation. On the contrary, it is an incentive to ensure the best and safest possible regulatory environment.” (9).
Senator Blumenthal ‘s reported climax in the Hearing was thus: “I think we have seen this movie before,” . . . “It is called big nicotine comes to children near you and you are using the same kinds of tactics and promotions and ads that were used by big tobacco and proved so effective.” (1)
The new data from the CDC is gravely concerning.
1. TIME Magazine: Electronic Cigarette Executives Get Schooled in Senate Hearing, Eliza Grey http://time.com/2896962/electronic-cigarette-executives-get-schooled-in-...
2. Gateway to Addiction A Survey of Popular Electronic Cigarette Manufacturers and Targeted Marketing to Youth April 14, 2014 Senator Richard J. Durbin (D-IL) et al, April 2014 http://www.merkley.senate.gov/imo/media/doc/Durbin_eCigarette%20Survey.pdf
3. Moore et al is “Electronic-cigarette use among young people in Wales: evidence from two cross-sectional surveys”, BMJ Open 2015;5:e007072 doi:10.1136/bmjopen-2014-007072
4. Advocate General Kokott considers the new EU tobacco directive of 2014 to be valid – Court of Justice of the European Union, Press Release No 154/15, Luxembourg, 23.12.15
N.B. The previous Tobacco Industry Testimony Blumenthal referred to is here. (10)
Competing interests: No competing interests