How to Keep Youth Vaping in Decline After COVID.
How to Keep Youth Vaping in Decline After COVID
Andrew Stokes on how lessons learned in 2020 can help continue reducing youth e-cigarette use after the pandemic.
Several recent studies have shown that youth use of e-cigarettes (“vaping”) dropped in 2020. Some of that decline came early in the year, before the new coronavirus changed nearly every aspect of life in the US. But a new Stanford University study in JAMA Network Open finds that, by early May, over half of a sample of adolescents reported that COVID-19 had caused a change in their e-cigarette use: Of those who reported a change, one third quit, one third reduced their use, and the last third switched to other nicotine or cannabis products.
In a commentary accompanying the study in JAMA Network Open, Andrew Stokes, assistant professor of global health at the School of Public Health, outlines the key findings and how they point the way to continuing to reduce youth vaping after the pandemic.
Following the commentary’s publication, Stokes discussed how these lessons learned in 2020 can help continue reducing youth e-cigarette use after the pandemic.
Q&A
SPH: What is the main lesson from the decline in youth vaping in 2020?
Andrew Stokes: The major takeaway here is that continued increases in youth vaping are not inevitable, and it may be possible to stop the youth vaping epidemic in its tracks through aggressive regulatory measures targeting both demand- and supply-side factors.
What might these measures look like?
On the demand side, it’s essential to reduce the appeal of e-cigarette products through further restrictions on flavors. In early 2020, the FDA finalized a new enforcement policy on unauthorized flavored cartridge-based e-cigarette products that appeal to children, including fruit and mint. But the enforcement action does not include menthol-flavored e-cigarette products or limit flavors in non-cartridge based products.
Youth also find e-cigarette products appealing due to their discrete nature, and thus it is also important to regulate their design and make them less concealable. This could be accomplished through further restrictions on cartridge-based products which are by and large the products being used by youth.
On the supply side, “tobacco 21” was recently enacted nationally, which is an important step forward in restricting youth access to e-cigarette products. However, e-cigarettes remain easy to access, and we are seeing a shift towards online sales during the COVID-19 pandemic. Although age verification measures have been implemented to reduce youth access to online products, they have not been strictly monitored or enforced, making it easy for youth to circumvent these safeguards, and obtain e-cigarettes online.
Do you see concerns around last year’s e-cigarette/vaping associated lung injury (EVALI) outbreak influencing this decrease in youth vaping during the COVID-19 pandemic?
Yes, I think the declines are likely to reflect a combination of EVALI and the COVID-19 pandemic.
The new study just out in JAMA Network Open suggests that one of the major reasons e-cigarette use declined during COVID-19 is rising concerns among youth about the health effects of vaping, especially on the respiratory system. This suggests that youth are responsive to evidence on the harms of vaping.
This is good news, as it means further progress is possible through accelerated communication around the potential harms of e-cigarette use. There is still a shortage of evidence on the long-term health consequences of vaping for youth and therefore it is also important that we continue to build the evidence base, which can be used to inform the development of product warning labels on e-cigarette products.
What concerns you about the pattern of youth vaping decline during the pandemic?
I think it’s right to be concerned about a resurgence as the pandemic recedes. If we are to prevent a rebound in youth vaping, it is essential that we fully take advantage of the current moment to aggressively expand policy, enforcement, and communication efforts.
Also, a concerning finding of the new JAMA study was that youth who vaped more frequently prior to the pandemic were less likely to quit vaping in 2020 compared to youth who vaped less frequently. Unfortunately, because of the high nicotine concentrations of e-cigarette products, we have seen alarming rates of nicotine addiction among youth vapers, and this finding is an important reminder that we must significantly expand youth vaping cessation services if we are to successfully end the youth vaping epidemic.