With the national concerns about electronic cigarette (e-cigarette) use and vaping becoming increasingly prominent in the news as a result of studies that have appeared in our journal and others, one wonders what can be done to stop the rising epidemic of this smoking activity? This week, to answer that question, we are publishing two articles of interest on contributors to e-cigarette experimentation and subsequent use.
The first study by Chen-Sankey et al. (10.1542/peds.2019-1119) used data from the Population Assessment of Tobacco and Health Study (PATH), a longitudinal study of more than 8,100 youth ages 12-17 and more than 1,600 young adults (ages 18-24) who had never used a tobacco product before. The authors looked at whether there was an association between e-cigarette marketing exposure over a given year and respondents subsequent experimentation with e-cigarettes during that year. The authors found that at least 70% of the non-user youth and young adults reported exposure in the past month to e-cigarette marketing via websites, events, and in other media and retail locations. Sadly, and probably of no surprise to you, those exposed to such marketing were more likely to report experimenting with e-cigarettes compared to those not exposed, even when adjusted for other potential confounders. As to what type of marketing resulted in more e-cigarette experimentation, the authors note that all types of exposures generated similar associations. So what is it about the marketing that draws young people to try these potentially harmful and addictive products?
To try to answer that question, Levental et al. (10.1542/peds.2019-0789) evaluated the role nontraditional flavoring (e.g., fruit and candy flavors) plays in continuation of vaping and vaping frequency, a topic that has triggered a lot of discussion in Washington, DC regarding the government’s banning of such flavoring. The authors looking at almost 500 Los Angeles California high school students in 5 semi-annual surveys from 10th to 12th grade and compared vaping behaviors of those who used at least one nontraditional flavor or those who used the combustible tobacco flavors for their vaping. Again, to no surprise, the investigators found that the teens in this survey turned to nontraditional flavors 93.8% of the time and only 6.2% of respondents used the conventional tobacco flavors. There was a significant increase in continuation of vaping by respondents over 6-month intervals and in numbers of puffs taken in the past 30 days by those using nontraditional flavors compared to those using conventional tobacco flavors. Despite the FDA no longer allowing flavored e-cigarettes to be sold in retail stores, teens can still access them online, at least until our government forbids that from happening.
As we learn more about the harmful effects of e-cigarettes (and you can learn a lot more by reading our Pediatric Collections of articles on vaping that we have published and have available through Gateway, we hope you will smoke out the take-home points from these two studies and share them with your patients and local school and community groups. Nationally, we can also work with advocacy groups such as the AAP to curtail marketing exposures and availability of flavored e-cigarettes—and studies like these may be helpful in that quest.
