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Four ways to stem the surge in teenage e-cigarette use and make progress against tobacco use

The Centers for Disease Control (CDC) has now reported what many concerned about public health have feared: the surge in e-cigarette use among teenagers threatens to erase past progress in reducing youth tobacco use –and it’s increasing the risk that a new generation will become addicted to nicotine.

At the same time the CDC released its sobering new statistics, the Blue Cross Blue Shield Association recommended that the federal government take further steps to prevent young people from beginning to use tobacco, protect everyone from the harms of secondhand smoke and re-double efforts to reduce the impacts of tobacco use among those with lower incomes and other groups that continue to have high smoking rates.

In response to a CDC request for information, we proposed a robust set of tobacco-control strategies for the agency to support:

Raise the age of tobacco and e-cigarette purchases to 21.
Approximately 90 percent of adults who smoke daily report that they first used cigarettes before the age of 19. Research shows that by raising the purchase age to 21, tobacco use by teenagers and young adults can be delayed, maybe even prevented. That’s why states and localities around the country are implementing laws that raise the age at which a young person can buy tobacco or e-cigarettes to 21. The CDC should support these efforts by providing research and technical assistance to assist states in implementing these laws.

Conduct additional research into health effects of e-cigarette use.
The CDC’s most recent National Youth Tobacco Survey found that there was a 78 percent increase in high schoolers using e-cigarettes from 2017 to 2018, with use among middle-schoolers jumping by nearly 50 percent. The number of middle and high school students currently using e-cigarettes is approximately 4.9 million.  

The pace of research on the health effects of e-cigarettes hasn’t matched the meteoric rise in their use.

We need to know more about how e-cigarettes impact health, and more public education efforts are needed on the harmful effects that already are known. Additionally, research should be done to determine whether e-cigarettes are a viable tool to help adult smokers quit.   

Support broader limits on secondhand smoke exposure.
It has long been recognized that exposure to secondhand smoke is harmful to non-smokers’ health, causing illnesses including lung cancer and heart disease as well as serious health problems in children. In fact, the U.S. Surgeon General has determined that there is no safe level of exposure to secondhand smoke. 

State and local governments should be encouraged to further limit tobacco use—including e-cigarette use—in public places, including all enclosed workplaces and outdoors spaces.  We recommend that the CDC should support these initiatives through research into their effectiveness, as well as technical assistance so that implementation of these laws have the greatest possible impact. 

Expand efforts to address socio-economic and demographic disparities and support ongoing FDA initiatives.
Tobacco use and its associated health conditions tend to be more prevalent among populations that have lower-incomes and less education, as well as within certain ethnic groups, LGBT communities and those suffering from mental illness. The CDC’s call for insight and recommendations on this important public health issue is a welcome step in efforts to reduce the health disparities that stem from tobacco use. The agency should conduct research to support the Food and Drug Administration’s efforts to reduce the use of menthol products and conduct targeted, culturally sensitive outreach to communities that are disproportionately affected by tobacco’s harmful effects.

Learn more about why tobacco use remains an enemy of public health.

Read the full BCBSA comment letter to the CDC.

Also, see our infographic on the prevalence of e-cigarette usage among America’s youth.


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