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When I was in high school, cigarettes were cheap, readily available and considered cool. People smoked all around us, in restaurants, at home, in movies, on television, in magazines and even at school. The adverse health consequences remain a heavy burden on our health care system, even though many things have changed over the past 30 years. In the state of New York, cigarette consumption rates between 2000 and 2016 dropped from 22% to 14% among adults and from 27% to 4.3% among adults. It is not surprising that very few, if any, of my pediatric patients answered yes to the question of smoking.
To better understand my patients, I recently asked a friend's son about the vaping I had heard that he was becoming more popular among kids. Our 45-minute conversation has opened my eyes to the prolific use of e-cigarettes (electronic cigarettes) in high schools and colleges. In fact, a recent survey showed that one in five high school kids in New York had already smoked an e-cigarette. Their use is so popular and is growing so rapidly that the US Food and Drug Administration has recently identified the use of electronic cigarettes by young people as an epidemic. More than two million college and high school students were using e-cigarettes in 2017. E-cigarettes are canceling the gains made by society to virtually eliminate youth smoking.
Since e-cigarettes are still new, we are only beginning to understand the many ways they are damaging to health, but we know that they are not safe. The likelihood of nicotine addiction increases as the person begins to use products containing nicotine. In fact, nine in 10 adult tobacco addicts started to consume before age 18. Every day, more than 3,200 people under the age of 18 smoke their first cigarette in the United States. And now, electronic cigarettes such as JUUL, which contain a lot of nicotine, are addictive in young people, increasing their risk of future use of traditional cigarettes and nicotine addiction all their lives.
As a pediatrician and parent, I want to support strategies that will help us get back on track to eliminate the burden of tobacco on public health. What has been proven is that all products containing nicotine are less available, less accessible and less attractive to young people.
Evidence-based strategies include increasing tobacco taxes; promote clean indoor and outdoor air policies; change social norms regarding smoking; and increase the legal age for the sale of tobacco products. An 18-year-old peer, brother, or comrade is generally more accessible to a young teenager than at 21 years old. In addition, NYS has clearly indicated "under 21" on driver's licenses so that sellers have a simplified filtering process by raising the legal age for the sale of tobacco from 18 to 21 years. The Rensselaer County legislature should vote "yes" for Tobacco 21 to make it more difficult for young people to obtain these products and to regain the progress we have made in reducing their use of tobacco and electronic cigarettes.
Nathan Graber, MD, MPH, FAAP
St. Peter's Pediatrics – Clifton Park
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