"Alarming and disturbing." This is how Tim McAfee, director of the Centers for Disease Control and Prevention's Office on Smoking and Health, describes the new findings on electronic cigarette use among young people. Experimentation with e-cigarettes more than doubled among U.S. middle school and high school students from 2011 to 2012, to the point that 10 percent of high school students have given them a try, according to data released Thursday by the CDC.
Need a primer on e-cigarettes to understand the significance of the new findings? They're battery-powered devices that typically dispense nicotine and other additives in an aerosol. While users don't light e-cigarettes, they otherwise use it in the same way as the conventional varieties. Many brands even look like the conventional cigarettes, while others appear more futuristic. McAfee describes them as simply "nicotine delivery devices."
The fact that more and more youth are trying e-cigarettes was enough for the CDC to do something rare: The agency published the e-cigarette findings in an article Thursday called "Notes From the Field," which McAfee points out, "is usually reserved for very urgent matters – the type of thing that would be done for something like a food-borne epidemic for which we'd need to get the word out quickly."
U.S. News talked with McAfee about the significance of the report and about e-cigarettes. His responses have been edited.
Why are these new findings so concerning to you?
For one, e-cigarettes – their manufacturing, marketing, distribution and sales – are unregulated. Although they have fewer toxins in them than conventional cigarettes, they're not safe, and they have levels of toxins that we don't know about because they're unregulated. Even if one brand tests very low levels at one point, the next month, many more e-cigarettes are coming off assembly lines in China, so we don't know what's actually in them.
The other concern is that if a 13-year-old is experimenting with an e-cigarette, we have reason to be very concerned that this could increase his or her chances of eventually experimenting with conventional cigarettes. They're going to get used to the idea that it's cool to bring a white cylinder up to their mouth and suck on it. They're going to see ads that look sexy; they're going to see older role models using these. And as long as cigarettes continue to be ubiquitous in our society, we are very, very concerned that this could ultimately end up with more people smoking cigarettes than less. And this is particularly worrisome with youth. The last issue is nicotine. These are nicotine delivery devices. There's increasing evidence that exposure to nicotine in adolescence has negative effects on brain development.
Any thoughts on why more young people are smoking e-cigarettes?
All the efforts that both society and, to some extent, the tobacco manufacturers themselves have undertaken in the last 20 years to decrease youth initiation of cigarettes do not apply to e-cigarettes, because they're unregulated. What we're seeing is the return of the marketing of a tobacco product to television, the use of actors and actresses to glorify e-cigarette use, as well as uncertainty and ambiguity about their use in public places by most governmental entities – all of which is being taken advantage of in both the formal marketing of products, as well as the informal, web-based social media marketing of the products. Plus, the majority of states do not have limits on their sale to minors.
Could you provide a few specific examples of the marketing of e-cigarettes that's may be contributing to more youths smoking them?
Go to YouTube and simply enter e-cigarettes, and you will rapidly see both what is being done informally as well as what's being done formally by some of the companies. For example, there was just recently a Jenny McCarthy ad that was released. Many of these ads are extremely well done and make e-cigarette use look sexy and glamorous, and as if they improve social relations. This is all classic material that the tobacco industry used for cigarettes back when they were [advertised] on television. Once again, the e-cigarette marketing often associates its use with types of aspirations, similar to the kind of marketing the tobacco industry used to double women's smoking back in the 1960s and 70s. Back then, the association for Virginia Slims was, "You've come a long way, baby." Now we're now seeing ads for e-cigarettes that are associated with freedom and independence that are both sophisticated and blatant.