E-Cigarettes: A Public Health Threat, Not a Population Health Intervention

• Published in: American journal of public health (1971) 2021-02, Vol.111 (2), p.224-226
• Main Authors: Gee, Rebekah E, Boles, William R, Smith, Dean G
• Format: Article
• Language: English
• Subjects: Addictions; Age; Cartridges; Cigarette smoking; Drug addiction; Electronic cigarettes; Electronic Nicotine Delivery Systems; Federal legislation; Health Policy; Health promotion; Health risks; Humans; Intervention; Law; Medical personnel; Nicotine; Policy making; Population Health; Prevention; Professionals; Public Health; Regulatory agencies; Smoking; Smoking Cessation; Special Section; Surgeons General; Tobacco; Tobacco Control; Tobacco smoking; Vaping
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2020.306072

Cigarette smoking is the single most deadly personal behavior in human history and remains a potent population health threat. Today in the United States, one in five deaths can be attributed to cigarette smoking. Recent models suggest that even if we were to magically cease cigarette smoking today, some 200 000 life-years will be lost in coming years because of past cigarette smoking.1 Over decades, billions of dollars have been invested in smoking cessation efforts, and clinicians, policymakers, and public health professionals have fought to limit future tobacco use through a variety of mechanisms. Within a period of a few years, e-cigarettes have imperiled these efforts and created unprecedented opportunities for a new generation of youths to become addicted to nicotine and tobacco products.Before the advent of e-cigarettes, promising declines were seen in national tobacco smoking rates. From 1965 to 2000, combustible tobacco use declined by half.2 Such declines were aided by tobacco taxes, mass media campaigns, nicotine replacement therapies, prescription drugs, and education on the dangers of smoking. Despite these herculean efforts, many people struggle with nicotine addiction throughout their lives, and hundreds of thousands of Americans die annually from the consequences of their addiction. The best way to prevent deaths from tobacco use is to prevent nicotine addiction. Preventing youth exposure is of particular importance because nearly 90% of adults who smoke cigarettes daily tried smoking cigarettes by 19 years, and almost all of them started smoking cigarettes by 26 years.3We now know from 17 years of data that, in fact, e-cigarettes have not led to declines in combustible tobacco use but instead have been associated with unprecedented youth smoking rates. The experience of our home state of Louisiana is instructive. Although tobacco smoking rates among youths had been on a downward trend for the past several years, there has been a spike in e-cigarette use among high school students, with more than 45% of high school youths in Louisiana reporting having used an e-cigarette.4 This high use is in part attributable to corporate marketing practices specifically aimed at children and youths, such as products with fruit and candy flavorings.