Review Highlights Need for Stricter Health Policies Amid Rising e-Cigarette Use

The increasing use of electronic cigarettes (e-cigarettes) and vaping products among teenagers and young adults has continued to be recognized as a global public health issue. However, current public health prevention and intervention studies are limited.

To emphasize the importance of stricter health policies and other measures, a review published in NPJ Primary Care Respiratory Medicine highlighted emerging trends and opportunities for health promotion.

A systematic review included in the full review showed a 19% increase in e-cigarette use among American teenagers between 2011 and 2018. Other research has found similar upticks in usage in Canada and the United Kingdom.

According to the 2018-2019 Canadian Student Tobacco, Alcohol, and Drugs Survey that noted e-cigarette use within 30 days prior to reporting, prevalence among teenagers between school grades 7 and 12 was 20%, doubling the prevalence found in the 2017-2018 survey. Further, 90% of teenagers consumed products containing nicotine.

Prevalence of ever use among teenagers has been reported to be lower in Asian countries, with 3.5% reporting past use in Japan and 10.1% in South Korea in recent years.

However, vaping is not an issue that started very recently. Between 2010 and 2014, e-cigarette use among teenagers in Eastern and Central Europe increased by 24.4%, and 43.7% reported previously experimenting with e-cigarettes. Additionally, while data in South America are limited, a 2015 study in Brazil found 2.1% of teenagers had ever tried e-cigarettes, and a 2014-2015 study in Argentina reported a 5.2% rise in prevalence.

When developing clinical preventions, the authors found that few medical practitioners screen patients for e-cigarette use in primary care practices. In a sample of 776 US practitioners, a study showed prevalence of screening for e-cigarettes was only 14%, compared with 86% screening for traditional smoking. Another study demonstrated that, while some physicians from a sample of 4 clinics discussed smoking with teenage patients with asthma, none of them brought up vaping.

“This low uptake is concerning, given the serious health risks of e-cigarettes,” the authors noted. “A qualitative study in the United States further confirmed that there is insufficient knowledge of e-cigarettes among physicians, including both the potential benefits and health risks.”

They suggested multiple screening and prevention methods, including developing questionnaires for physicians to identify at-risk individuals, increasing focus on vulnerable populations, and overall education on vaping.

Many teenagers and young adults credit flavor, discreetness, and easy accessibility as reasons for e-cigarette use. Additionally, 2 concerning reasons for their appeal are the idea that they are safer than cigarettes and that they are marketed towards a younger audience.

“While e-cigarettes are a safer alternative than smoking cigarettes and may be used as a harm-reduction strategy in existing smokers, measures need to be urgently put into place to protect children and teenagers from unnecessary use and potential dual smoking and e-cigarette uptake,” the review authors said.

Some actions have been taken, as major e-cigarette company Juul Labs agreed to pay the state of Arizona $14.5 million and stop marketing to young people in the state in a consumer fraud lawsuit settlement last year.

However, the availability and accessibility of e-cigarettes to young people needs to be limited in general, according to the authors and even many adult e-cigarette users. In the United States, a policy review on bans of e-cigarette sales to minors found that e-cigarette use decreased along with traditional cigarette smoking.

In terms of risks, past reviews have linked e-cigarette use to the following:

• Asthma
• Chronic obstructive pulmonary disease
• Eosinophilic pneumonia
• Epiglottitis
• Bronchitis
• Acute respiratory distress
• Headache
• Generalized coughing
• Insomnia
• Weakness
• Chest pain

Long-term effects of vaping are still unknown.

According to the authors, primary care and public health strategies should be put in effect to protect young people and limit unnecessary exposure.

Four major suggestions were:

• Strengthening global policies to restrict marketing, accessibility, and exposure to e-cigarettes, as well as restrict the use of enticing flavoring
• Increasing physician education on screening and nicotine tapering in primary care settings
• Increasing public health education campaigns and developing evidence-based interventions
• Developing collaborations between physicians and public health researchers through joint efforts in education, screening, and referral

“There is an urgent need to develop evidence-based primary-care intervention and public health interventions that target vulnerable groups,” the authors concluded. “Furthermore, there is need for stronger public health protection policies and bans to protect youth.”

Reference

Lyzwinski LN, Naslund JA, Miller CJ, Eisenberg MJ. Global youth vaping and respiratory health: epidemiology, interventions, and policies. NPJ Prim Care Respir Med. Published online April 11, 2022. doi:10.1038/s41533-022-00277-9