Between 1997 and 2015, the U.S. high school smoking rate declined by an astonishing 70 percent — the result of almost two decades of public health initiatives, prompted by alarm over an uptick in teen smoking in the 1990s. The downward trend led some to predict that teen smoking could be entirely eliminated by 2035.
And then e-cigarettes came along.
In September 2018, the Washington Post reported that unreleased public health data showed there had been a 75 percent increase in e-cigarette use among high school students in 2018, compared to 2017. The FDA reportedly declined to release the data, according to The Post, but at the time, Food and Drug Administration (FDA) Commissioner Scott Gottlieb called teenage vaping an "epidemic."
On Friday, Gottlieb expanded on his months-long anti-teen vaping campaign, expounding on public health data: the 2018 National Youth Tobacco Survey confirms, according to Gottlieb, that youth use of e-cigarettes from 2017 to 2018 increased by 78 percent among high school students. There was also a 48 percent increase among middle school students.
"This youth use continues to grow," Gottlieb said. "Even if we’re successful at implementing our regulatory steps to address the access and appeal of these products to kids, those actions will take time to have their full effect. Meanwhile, the appeal of these products to children, and the resulting increase in youth use, shows no sign of abating."
Gottlieb fears next year's data will show a continued increase.
"If the youth use continues to rise, and we see significant increases in use in 2019, on top of the dramatic rise in 2018, the entire category will face an existential threat," he said.
He added that the FDA is looking into a variety of solutions, and hinted that drug-based therapies might be considered.
"Although there is a large body of research on adult smoking cessation, the methods to treat adolescents and teens who are addicted to vaping are not well understood," he said. "There is little information about how drug or behavioral interventions might support youth e-cigarette cessation, as well as youth tobacco use more generally. The data and other information presented at today’s hearing will be vitally important to helping the FDA and other stakeholders begin to address these information gaps."
Indeed, the FDA's newfound sense of urgency regarding teen e-cigarette use is overdue. Beyond the nicotine in e-cigarettes, there are other less well-understood chemical threats like diacetyl, which Salon reported on in June. Diacetyl is commonly used to add flavor to food, but is also a byproduct of a majority of the flavored electronic cigarettes.
“The FDA has significant authority to oversee e-cigarettes, and they are failing to use it,” Erika Sward, National Assistant Vice President of Advocacy at the American Lung Association, told Salon in June. “As a result it is the wild wild west, and you have retailers who are mixing liquids in their backrooms.”
“The American Lung Association is very concerned — about not just the chemical of diacetyl, but also the impact of other chemicals such as vegetable glycerin and propylene glycol, which are the base chemicals that are present in every e-liquid,” she added.