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Use of E-Cigarettes by Young People Is Major Concern, Surgeon General Declares

Soaring use of e-cigarettes among young people “is now a major public health concern,” according to a report published Thursday from the United States Surgeon General. It is the first comprehensive look on the subject from the nation’s highest public-health authority, and it finds that e-cigarettes are now the most commonly used tobacco product among youths, surpassing tobacco cigarettes.

E-cigarettes, which turn nicotine into inhalable vapor, can harm developing brains of teenagers who use them, and also can create harmful aerosol for people around the user, the report said, citing studies in animals.

“Adolescent brains are particularly sensitive to nicotine’s effects,” and can experience “a constellation of nicotine-induced neural and behavioral alterations,” the report said. It urged stronger action to prevent young people from getting access to e-cigarettes.
Some researchers have said that e-cigarette use among youth could act as a gateway to traditional smoking, but the report says the relationship is not yet fully established. Cigarette smoking among youth has fallen sharply in recent years but use of nicotine products over all remains essentially flat among young people.

With its focus on youth, the report did not address adult use of e-cigarettes, and the most divisive issue of whether the technology is an effective tool to help smokers of traditional cigarettes quit their deadly habit. The report also did not break new scientific ground, but public health advocates said the voice of the surgeon general in the debate marked a milestone.

“It’s the most comprehensive and objective answer to the question of whether e-cigarette use is a matter of serious concern that requires government action,” said Matthew Myers, President of the Campaign for Tobacco Free Kids. “The answer, based on the findings, is: yes.”

In a preface to the report, the surgeon general, Dr. Vivek H. Murthy, wrote that e-cigarette use among high school students increased “an astounding 900 percent” from 2011 to 2015. Citing research from the Centers for Disease Control and Prevention, the report found that 16 percent of high schoolers used e-cigarettes in 2015, up from 13.4 percent a year earlier. In 2015, nearly 38 percent of high schoolers reported having tried an e-cigarette at least once.

Chief among the concerns raised by the report is simply that “nicotine is a dangerous drug” to the developing brain, said Terry Pechacek, a professor in the school of public health at Georgia State University. It has been shown in animal models that nicotine damages the adolescent brain, he said.

But he said the risk is less than combining nicotine with carcinogenic combustion in traditional cigarettes.

Echoing other research reports, the surgeon general’s report finds that the $3.5 billion e-cigarette industry has mimicked marketing techniques of the tobacco industry that have “found to be appealing to youth and young adults.” Of particular concern to public health advocates has been the explosive growth and marketing of flavored e-cigarettes; a study published last month in the journal Pediatrics found that young people who smoked flavored e-cigarettes were more at risk of taking up traditional smoking.

The alarms raised about nicotine among youth come as the landscape is shifting around tobacco use. The C.D.C. finds that the use of traditional cigarettes has dropped below 40 million Americans for the first time in 50 years, since record keeping began. At least among adults, e-cigarettes are considered a far less harmful alternative because, unlike traditional cigarettes, they do not rely on combustion, which leads to inhalation of deadly carcinogenic particles, and 480,000 deaths each year.

The C.D.C. report on smoking trends, published last month, found the sharpest drop of traditional cigarette use was among young people, with 13 percent of 18- to-24-year-olds still smoking. There is no evidence that the increase in e-cigarette use is leading to the drop in smoking, researchers said.

The report concluded with a “call to action” that includes urging the Food and Drug Administration to put previously approved regulations into effect. The agency in May passed final rules governing e-cigarettes, but many of them will take several years to take full effect.

The report called for additional policies that, for instance, include e-cigarettes in programs at the state and national level that are aimed to deter young people from smoking traditional cigarettes. It also urged greater education among parents, teachers and coaches about the risks.

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