With approximately 90 percent of all adult smokers commencing habitual smoking by the age of 18, the Centers for Disease Control and Prevention (CDC) have set about trying to assess the popularity of various forms of tobacco products in school students. The findings of this report, which looked at over 24,000 U.S. middle and high school students, were published in the latest online report of the CDC’s Morbidity and Mortality Weekly.
The use of electronic cigarettes in school settings has presented a new problem for teachers; should e-cigarettes be treated in a similar vein to traditional cigarettes? Normal tobacco products, which e-cigarettes are designed to impersonate, are banned from the premises of most U.S. public schools, whilst it remains illegal to distribute normal cigarettes to minors.
The Dangers of E-Cigarettes Uncertain?
The debate also arrives during a time when safety concerns have surfaced over e-cigarette use. Nonetheless, in spite of the apparent apprehension over their uptake, it seems likely that “vaping” will prove to be a healthier alternative to regular cigarettes, which are known sources of carcinogens and are estimated to cause over 440,000 deaths, annually.
Vice President of research for the Campaign for Tobacco-Free Kids, Danny McGoldrick, calls for further investigation into the potential health risks of smoking, however:
“We need to look beyond that very narrow question of ‘Are they less harmful than cigarettes?’ It all comes down to, are these going to be used to decrease smoking or to increase smoking?”
A recent study was performed by researchers from the University of Perugia, Italy, which aimed to investigate the chemical constituents found within e-cigarettes. They
determined that propylene glycol (66 percent) and glycerine (24 percent) were the primary components of the liquid, alongside traces of flavoring substances. Likewise, the same substances were identified, in the same proportions, in the resulting vapor. The group cautioned that more research needed to be conducted, since e-cigarettes exposed users to different chemical constituents than regular cigarettes.
A recent report published by the Department of Health and Human Services found there to be trace amounts of toxins, including nitrosamines and formaldehyde; however, these constituents were found at levels that were one thousandth of those found in normal cigarettes.
In addition, a study published in the journal Inhalation Toxicology found there to be “no apparent risk to human health from e-cigarette emissions…” when specifically looking at nicotine, carbonyls, polycyclic aromatic hydrocarbons, tobacco-specific nitrosamines, glycols and volatile organic compounds.
However, recent concerns have been raised over the dangers of nicotine on the developing brains of the youth. Jennifer B. Dwyer and colleagues investigated preclinical animal models and clinical literature, concluding that neural structures within the maturing brain are “sensitive to environmental stimuli.” They found that nicotine exposure could be responsible for interfering with the development of various parts of the brain, ranging from the hippocampus to the cerebellum.
Director of the CDC’s Office on Smoking and Health Tim McAfee described the rise in e-cigarette use in youngsters as a “dangerous situation,” before going on to issue a warning to guardians and policymakers:
“I think it is very important for parents, for teachers and for policymakers to be aware of the fact that our children are experimenting with these products.”
E-Cigarette Use on the Rise in School Students
Analyzing data from the 2012 National Youth Tobacco Survey (NYTS), the CDC established the prevalence of tobacco use in middle and high school students, during 2012. The NYTS was a school-based questionnaire provided to U.S. middle school students, between grades six to eight, and high school students, between grades nine to twelve. The 2012 questionnaire was updated to reflect a change in social use of different tobacco products, including hookahs, dissolvable tobacco, e-cigarettes and snus. Previous studies had failed to take into account nonconventional tobacco products and, therefore, are thought to have underestimated tobacco use.
As expected, the number of students using tobacco products appeared much greater in those students attending high school, with just over 23 percent admitting to tobacco use; meanwhile, almost seven percent of all investigated middle school students were found to use tobacco products.
The most popular forms of tobacco product purchased were cigarettes and cigars, with prevalence of use calculated at 12.6 and 2.8 percent, respectively.
Interestingly, with the emergence of electronic cigarettes, the product’s popularity has increased in both middle and high school students. The prevalence of use of e-cigarettes increased from 0.6 percent to 1.1 percent in middle school students, and from 1.5 percent to 2.8 percent in high school students.
The researchers also observed a rise in the use of hookah pipes, specifically in high school students – an oriental, piped instrument that vaporizes flavored tobacco, where the tobacco is drawn through a water basin. On the other hand, the use of bidis – a tobacco-filled, hand-rolled Indian cigarette – declined slightly; similarly, kretek use was also found to have slumped.
This will come as good news to many, as bidis and Kreteks harbor higher concentrations of carbon monoxide, nicotine and tar than conventional cigarettes. A separate study that
investigated the prevalence of bidi cigarette use, among young adults across 15 states of America, established the cigarettes to impart three to five times the amount of nicotine than regular cigarettes. According to the CDC, recreational bidi use has be linked to a three and fourfold increase in coronary heart disease and chronic bronchitis, respectively, as well as an increased risk of developing certain forms of cancer.
Conversely, as a consequence of the low overall prevalence of kretek use in the U.S., little research has been conducted into their health impact. However, a study by Mangunnegoro and Sutoyo, entitled Environmental and Occupational Lung Diseases in Indonesia, found kreteks to be associated with significantly increased risk of impaired respiratory function.
In interpreting these results, CDC officials point to what factors they consider to be responsible for increasing the number of people procuring e-cigarettes. They tentatively posit that the increase in hookah and e-cigarette use could be attributed to their low price and ease of availability, alongside the general perception that these products are safer than traditional cigarettes.
CDC Director Dr. Tom Frieden cogitated over the findings of the report in a recent statement:
“Cigars and hookah tobacco are smoked tobacco – addictive and deadly. We need effective action to protect our kids from addiction to nicotine.”
Over two dozen states have sought to ban the sale of e-cigarettes to minors, since 2010. Thus far, twelve states have already introduced such a ban, including California, Colorado, Idaho, Iowa, Maryland, Minnesota, New Jersey, New Hampshire, New York, Tennessee, Utah and Wisconsin.
Although the popularity of electronic cigarettes appears to be on the rise in middle and high schools students, there remains much confusion over the impact of this reported trend. With the health effects of e-cigarettes yet to be fully understood in adult and juvenile populations, and the products unregulated by the Food and Drug Administration, educators have a difficult decision ahead of them.
By James Fenner