The rate of teens using electronic cigarettes has more than doubled in two years, the largest and quickest increase in the popularity of any substance since tracking began 45 years ago.
That data was published this week in the New England Journal of Medicine – months ahead of schedule – just as national health officials try to pinpoint why at least 530 people have been hospitalized and seven died after using vaping products. Most hospitalized were male and under age 35. One in six were under 18.
Dr. Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, said Thursday that she is “very concerned about the occurrence of life-threatening illness in otherwise healthy young people.”
“We are working closely with state and local health departments, the FDA and the clinical community to try to learn as much as we can to try to stop this outbreak,” she said. “I wish we had more answers.”
To date, federal authorities say they have not identified a single vaping product, ingredient, device or brand that is consistent across all the cases. Nor do they expect clear answers anytime soon.
“I know that this is very frustrating for the public,” Schuchat said. “This may take some time.”
The current spotlight on vaping’s harm has brought into focus two intertwined fears of public health experts: Years without regulation let a hazardous product gain a cultural foothold, and the health risks disproportionately fell on the developing brains and bodies of young adults.
An estimated 25% of high school seniors vaped nicotine in the past month this year, up from 11% just two years ago, according to a portion of the 2019 Monitoring the Future Survey funded by the National Institute on Drug Abuse. Use grew from 8.2% to 20.2% for sophomores and 3.5% to 9% for eighth graders.
Figures tracking the popularity of other vaping products, such as those that are nicotine-free or include THC or CBD, will not be released until December.
In Missouri, 11 percent of high school students reported vaping in the past month, ranking it No. 32 nationwide among 37 states reporting data in the 2017 national Youth Risk Behavior Survey.
At the end of August, the CDC issued a health advisory, warning that people had rapidly developed severe pulmonary disease from using e-cigarettes and that one person in Illinois had died.
Officials expect the numbers will continue to grow, both as new people become ill and as states identify other recent cases that were not initially flagged as related to vaping.
A month ago, e-cigarettes were more often seen as a cultural force than a health hazard.
Instagram influencers touted their custom mods and posed with sponsored liquid brands, up to a third of teens and young adults vaped, inhaling heated clouds of “juices” whose ingredients are unknown and unregulated. But now, e-cigarettes are considered a pressing public health threat by many doctors, parents and political leaders. President Donald Trump has threatened to ban their sale. At least two states – Michigan and New York – approved a new ban in recent weeks.
In July, the American Academy of Pediatrics and others won a lawsuit against the FDA, which had repeatedly pushed back a deadline for manufacturers to disclose complete ingredient lists. Now, the judge said, companies must start submitting those applications in May 2020 instead of 2022.
Deborah Arducan, a 60-year-old former phlebotomist in Missouri, counts herself among Americans who are increasingly vocal about their frustrations that federal leaders have taken so long to regulate e-cigarettes – and to protect kids, in particular, from their harms.
“The government should have jumped on that quicker,” Arducan said. “A lot quicker.”
As popularity of e-cigarettes grew, doctors and researchers started to consider the implications for public health.
Researchers testing vapor liquids found ultrafine particles that can be inhaled deep into lung tissue and cause damage; diacetyl, a flavoring chemical linked to a serious lung disease; volatile organic compounds known to cause causes or diseases; carcinogens like benzene and formaldehyde; and heavy metals such as nickel, tin and lead.
FDA tests also found that some liquids marketed as being nicotine-free did, in fact, contain nicotine, a chemical known for harming brain development, among other issues.
Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse, also noted that most of the flavorings used in vaping liquids were tested for consumption – not for inhalation.
‘Safer’ but not safe
He said the general consensus is that it’s safer to use e-cigarettes than to smoke traditional cigarettes, simply because they contain fewer chemicals. While some studies have suggested they are helpful for people trying to quit smoking, others have questioned how often people actually quit instead of simply substituting one substance for another.
But Compton emphasized that “safer” doesn’t mean the same thing as “safe.”
“We all know it’s not safe to jump out of the fourth or fourth story of a building but that doesn't make it safe to jump out of the second story even though you’re less likely to break your leg,” he said, comparing traditional cigarettes to e-cigarettes.
And teens, in particular, should not use nicotine products in any form, he said.
“Nicotine and other addictive substances may play a particular role in the developing brain. There’s so much growth in the teen years,” he said. “That’s why everyone agrees teens should not be exposed to these addictive substances.”