At present, laws regarding e-cigarettes are limited and much less stringent than those regulating tobacco products. According to a new Centers for Disease Control and Prevention (CDC) report, released on December 11, 10 states and the District of Columbia allow minors to purchase e-cigarettes and similar electronic nicotine delivery systems (ENDS). More than 16 million children aged 17 and under reside in these states. In addition, while 26 states and the District of Columbia have broad smoke-free laws that prohibit smoking in restaurants, worksites, and bars, only three of those states also prohibit ENDS use indoors: New Jersey, North Dakota, and Utah.
The CDC notes that the latest data from the National Youth Tobacco Survey revealed that in 2013, 4.5% of all high school students and 1.1% of all middle school students had used ENDS within the past 30 days. In addition, their popularity is rapidly increasing among both teens and adults.
“We know e-cigarettes are not safe for youth,” noted Tim McAfee, M.D., M.P.H., director of CDC’s Office on Smoking and Health. He added, “While ENDS may have the potential to benefit established adult smokers if used as a complete substitute for all smoked tobacco products, ENDS should not be used by youth and adult non-tobacco users because of the harmful effects of nicotine and other risk exposures, as well as the risk for progression to other forms of tobacco use.”
The report notes that since 2012, no states have enacted comprehensive smoke-free laws or laws prohibiting public indoor ENDS use. It cautions that these laws could help prevent renormalization of tobacco use because teens are particularly susceptible to visual cues to use tobacco. “ENDS aerosol is not harmless water vapor; it can contain nicotine and other toxins,” explained Brian King, Ph.D., senior scientific advisor in CDC’s Office on Smoking and Health. He added, “Exposure to nicotine can harm adolescent brain development and can be toxic to fetuses. The standard for protecting the health of children and bystanders should be clean air, free of toxic secondhand smoke as well as ENDS aerosol.”
Laws regulating sales of ENDS to minors have increased in recent years; of the 40 states with sales restrictions to minors, 12 laws became effective in 2013 and, to date, 16 in 2014. This increase may be partly due to efforts by the tobacco industry, which has actively advocated for state laws prohibiting sales to minors. The report notes that this situation is worrisome because the 2012 Surgeon General’s Report found that industry-supported “youth access bills” have contained provisions that weakened efforts to prevent teens from starting to use tobacco products, such as local preventive measures of stricter policies and weak enforcement requirements.
According to the surgeon General, nicotine exposure during adolescence may have lasting adverse consequences for brain development. In addition, nicotine adversely affects maternal and fetal health during pregnancy, contributing to multiple outcomes such as preterm delivery and stillbirth. The CDC report notes that e-cigarettes have been marketed as smoking cessation aids; however, there is currently no conclusive scientific evidence that ENDS promote successful long-term quitting. Moreover, there are proven adult cessation strategies and treatments, including counseling and FDA-approved cessation medications.
The 2012 Surgeon General’s Report found that approximately 90% of all smokers first experiment as teens; and that about 75% of teen smokers become adult smokers, even if they plan to quit in a few years. Oregon, Nevada, New Mexico, Texas, Montana, North Dakota, Minnesota, Pennsylvania, Maine, and Massachusetts.
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