USC contributes to surgeon general’s first report on e-cigarettes

The United States Surgeon General on Dec. 8 released a new report calling e-cigarettes “a major public health concern.”

“E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General” is the first comprehensive review on this public health challenge from the nation’s highest public-health authority. 

The report provides insights into youth e-cigarette use, which has more than tripled since 2011, and outlines dangers to which young people are uniquely vulnerable.

While recognizing the need for further research, the report finds that the aerosol inhaled by e-cigarette smokers may cause mood disorders, deficits in attention and cognition, and addiction to nicotine—and may also be harmful secondhand to non-users.

USC’s Jonathan Samet, distinguished professor and director of the USC Institute for Global Health, contributed to the development of the chapter on e-cigarette policy. Samet is an expert in tobacco and public health and the Flora L. Thornton Chair of the Department of Population and Public Health Sciences at the Keck School of Medicine of USC. He was the senior scientific editor of the 2014 surgeon general’s report “The Health Consequences of Smoking—50 years of progress.”

The new report on e-cigarettes extensively cites research by USC faculty in the department of preventive medicine. Their most recent study published in JAMA last month found that adolescents who regularly vape have a higher risk of more frequent and heavy smoking six months later.

“The scientific story is still incomplete for e-cigarettes and we are living in an age of misinformation”

Research is well underway at USC and other institutions to better understand health effects of e-cigarettes. However, it will be years before scientists can fully understand the risks because the products and patterns of usage are changing rapidly. Meantime, Samet said he urges people not to assume that e-cigarettes are safe.

“The scientific story is still incomplete for e-cigarettes and we are living in an age of misinformation,” Samet said. “The benefits of e-cigarettes for harm reduction and smoking cessation have been exaggerated by some, and I concur with the surgeon general on the need for protecting adolescents and young adults from using tobacco products.”

The report outlines ways to control young people’s use of e-cigarettes. It calls for increased tobacco-related surveillance; tactical and comprehensive research; strategies to protect youth; and other actions modeled after proven tobacco control methods. These include incorporating e-cigarettes into smoke-free policies, preventing adolescents’ access to e-cigarettes, taxation, regulation and more.

In November the chief executive for Philip Morris International, the world’s largest global tobacco company outside of China, indicated that the company would eventually stop selling cigarettes in favor of alternative products.

But this shift is more concerning than comforting to researchers, given the risks to youth and their high exposure to e-cigarette advertising.

“It’s an entire renormalization of that imagery, of that advertising and marketing that we had worked for decades to take out of the public space,” said Heather Wipfli, associate director of the USC Institute for Global Health, in the The Christian Science Monitor. Ranking e-cigarettes as safer than deadly cigarettes sets a low bar for health standards and is misleading, she said.

Samet and preventive medicine professor Maryann Pentz lead the USC Tobacco Center of Regulatory Science for Vulnerable Populations, one of 14 centers in the U.S conducting research to inform the FDA. The surgeon general’s report referenced findings from three USC TCORS studies.

“Thanks to the multidisciplinary strength of our researchers, USC is emerging as a leader in e-cigarette research,” said Rohit Varma, dean of the Keck School of Medicine of USC. “We’re approaching this from every angle—from the clinical to the behavioral.”

USC Contributions in the News:

CBS News Los Angeles affiliate KCBS-TV featured research by Jonathan Samet, Adam Leventhal, Jennifer Unger, Daniel Soto and other Keck Medicine of USC colleagues who contributed to the report. KCBS quoted Soto about the serious health risks and possible impact on brain development for young e-cigarette users. “It can be addictive. I would tell parents watch out for e-cigs,” Leventhal told ABC News Los Angeles affiliate KABC-TV. KPCC-FM’s “Take Two” interviewed Unger about her research contributions to the report. Consumer Affairs also highlighted the research.

Major Findings:

1. E-cigarettes are a rapidly emerging and diversified product class. These devices typically deliver nicotine, flavorings, and other additives to users via an inhaled aerosol. These devices are referred to by a variety of names, including “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” and “tank systems.”
2. E-cigarette use among youth and young adults has become a public health concern. In 2014, current use of e-cigarettes by young adults 18–24 years of age surpassed that of adults 25 years of age and older.
3. E-cigarettes are now the most commonly used tobacco product among youth, surpassing conventional cigarettes in 2014. E-cigarette use is strongly associated with the use of other tobacco products among youth and young adults, including combustible tobacco products.
4. The use of products containing nicotine poses dangers to youth, pregnant women, and fetuses. The use of products containing nicotine in any form among youth, including in e-cigarettes, is unsafe.
5. E-cigarette aerosol is not harmless. It can contain harmful and potentially harmful constituents, including nicotine. Nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain.
6. E-cigarettes are marketed by promoting flavors and using a wide variety of media channels and approaches that have been used in the past for marketing conventional tobacco products to youth and young adults.
7. Action can be taken at the national, state, local, tribal, and territorial levels to address e-cigarette use among youth and young adults. Actions could include incorporating e-cigarettes into smoke-free policies, preventing access to e-cigarettes by youth, price and tax policies, retail licensure, regulation of e-cigarette marketing likely to attract youth, and educational initiatives targeting youth and young adults.

— By Larissa Puro