Study Finds Many Youth E-Cigarette Users Say They’re Inhaling “Just Flavoring;” It Does Not Indicate How Many Are Also Inhaling Nicotine

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids

Aug. 25 2016

WASHINGTON, D.C. – A study published today in the journal Tobacco Control finds that about two-thirds of youth who had ever used electronic cigarettes or other vaporizers responded “just flavoring” when asked to choose only one reply from the choices “Nicotine,” “Marijuana or hash oil,” “Just flavoring,” “Other” or “Don’t know” to the question, “THE LAST TIME you used an electronic vaporizer such as an e-cigarette, what was in the mist you inhaled?” From 13 to 22 percent of these youth responded “nicotine” was in the mist they inhaled (percentages varied by grade). Youth who used e-cigarettes more frequently were much more likely to say they inhaled nicotine, with 47.5 percent of 12th graders who used vaporizers six or more times in the past 30 days saying they inhaled nicotine. The study is based on a single question from the 2015 Monitoring the Future survey of 8th, 10th and 12th graders.

This study does not examine whether the e-cigarette products used by youth actually contained nicotine. It does not tell us how many youth e-cigarette users are actually using products with nicotine, whether knowingly or unknowingly. The study acknowledges “it is possible that youth may self-report that they are not using nicotine when, in fact, they are vaping nicotine but do not realise it.”

It is not surprising, when limited to one reply about what is in the e-cigarette they last used, that many youth would choose the only response that mentions flavors because flavors are a powerful attraction for youth. A 2015 study in JAMA found that more than 80 percent of current youth e-cigarette users said they used the products “because they come in flavors I like.” E-cigarettes and refill liquids are sold in a huge assortment of candy and fruit flavors, and flavors are often the most prominent aspect of the marketing and packaging of these products.

In contrast, because there have been no regulations governing the labeling of e-cigarettes and e-liquids, it is often not clear from the label whether a product contains nicotine or how much. These products are sold with widely varying levels of nicotine, some containing high levels of nicotine and some not containing any nicotine. Several studies have found that the product labeling for some e-cigarette liquids does not accurately reflect the actual nicotine content. The latest study, published in the July-August 2016 issue of Journal of Pediatric Nursing, found that half of the labels on a sample of e-cigarette liquid nicotine purchased in North Dakota did not accurately reflect the levels of nicotine found in the products, and 43 percent of e-liquid containers that claimed to contain no nicotine did, in fact, contain some nicotine. The FDA’s new rule for e-cigarettes, issued in May, and a recent government legal brief defending this rule both found that the labeling of e-liquids may not accurately reflect the nicotine levels.

The study published today underscores the importance of the new FDA e-cigarette regulations and demonstrates the need to require accurate labeling and to educate both kids and adults about what is in e-cigarettes and e-liquid products. Among other things, the FDA’s rules require the reporting of ingredients and health-related documents to the FDA, prohibit false or misleading labeling and advertising, prohibit e-cigarette sales to minors and prohibit the introduction of new products without prior FDA review to determine the impact on public health. These are critical steps to prevent kids from using e-cigarettes and ensure the public receives accurate information about the contents and health consequences of these products, including nicotine content.

Other points to keep in mind in reviewing this study include:

  • Even if some youth are using non-nicotine e-cigarettes, the large number of U.S. teens using e-cigarettes means that many are still consuming nicotine through e-cigarettes. Surveys have found that youth use of e-cigarettes has skyrocketed, with the CDC’s Youth Risk Behavior Survey reporting that 24.1 percent of high school students were current (past-month) users of e-cigarettes in 2015 – compared to 10.8 percent who smoked regular cigarettes.
  • E-cigarette use among kids is cause for concern. The large and growing number of youth e-cigarette users and youth perceptions that e-cigarette use is “cool” threaten to undo decades of progress in changing youth attitudes about and use of cigarettes. In addition, there is still much we don’t know about the potential health impact of e-cigarettes, with or without nicotine. Some studies have found other harmful or potentially harmful chemicals and toxins in some e-cigarettes. Further, while some of the flavorings used in e-cigarettes might be safe for ingestion, they are not necessarily safe when inhaled. Researchers have raised concerns that the chemical flavorings found in some e-cigarettes and e-liquids could cause respiratory damage. Our kids should not be the guinea pigs while we learn more about the health impact of e-cigarettes.

 

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