Enid Neptune

There has been a 78 percent increase in the number of high school students who are using e-cigarettes, JUUL pods, or similar products, and a 48 percent rise in use among middle schoolers, according to a 2018 National Youth Tobacco Survey. Those percentages represent an increase of 1.5 million users in just one year. Health care professionals are increasingly alarmed by the statistics.

As new nicotine delivery systems evolved, two camps emerged. The first thought that these products offered a tool that could help highly addicted smokers quit, but the second noticed that young people seemed far more interested in those products than any group of smokers.

Dona Upson

“There was never a reconciliation between those two camps,” said Enid Neptune, MD, one of the chairs of today’s session and an associate professor of medicine at Johns Hopkins Medicine in Baltimore, Maryland. “I don’t think most of the public health community rejected either possibility.” But the existence of those two groups has led to some challenges, and those challenges will be the topic of this morning’s session on adding a new generation.

Young people who use electronic nicotine delivery systems are twice as likely to take up smoking combustible cigarettes in the future, making the exponential rise in the number of young people using e-cigarettes an even greater concern said Dr. Neptune, who is co-chair of the ATS Tobacco Action Committee. There may be fewer health harms to people who use electronic devices than there are associated with combustible cigarettes, but one thing that is often left out of the conversation is the fact that it’s not an either/or proposition—there are people who consume nicotine both ways.

“In a way, I think there’s too much attention paid to that,” said Dona Upson, MD, another session chair and a pulmonologist at New Mexico VA Health Care System in Albuquerque, New Mexico. “I think the overwhelming health impact is addiction to nicotine, and [the use of e-cigarettes] significantly increases the number of youth who will go on to become addicted to combustible cigarettes.”

Dr. Neptune agreed, adding, “What happens when highly addicted people remain highly addicted over 10 or 12 years? They move on to combustibles.” The signals of the impact on youth were there from the beginning, according to Dr. Neptune. “It’s not that what we’re seeing today wasn’t evident five years ago,” she said.

“It’s not surprising at all that the industry has marketed aggressively to youth,” Dr. Upson said. “But it is surprising that the FDA and some of our colleagues believed that these devices could help people quit smoking without having a huge impact on youth.”

The topic of nicotine addiction is happening more often; parents are asking pediatricians about it, adults want to know how children are affected by electronic delivery systems, and each year more health care professionals are asking for information about the health effects.

This symposium will allow attendees to develop an informed opinion regarding the use of e-cigarettes, as well as the information they need to educate fellows, residents, students, peers, parents, and their patients.

In addition to information, they will gain some advocacy tools. When it comes to public health policy, physicians’ opinions carry a great deal of legitimacy. “We hope that people who attend will go back home and get involved,” said Dr. Upson. Both doctors commented that a new bill in Maryland that raises the age of purchase for combustible and vaping products was recently passed by the legislature and is awaiting the governor’s signature. This legislation, termed Tobacco 21, required aggressive advocacy by multiple stakeholders, including physicians.

There is also a concern for the future. “The JUULs are kind of a 1.0 device,” said Dr. Neptune. “We may see a wave of these pods, which has the potential to expand and worsen the epidemic.”