The Youth Vaping Epidemic: From Science to Public Policy

Whereas the use of tobacco cigarettes has declined in the United States within recent years, the use of electronic cigarettes has increased exponentially. The perceptions of low health risk, combined with the appeal of flavors and minimal market regulations, have created a climate for the wide use of these products by teenagers. However, as highlighted in our pre-clinical studies, nicotine is a neurotoxicant that can produce unique and long-lasting negative effects in this age group. Nicotine mediates its effects via nicotinic cholinergic receptors, which are pentameric ligand-gated ion channels that are widely distributed throughout the brain. Nicotinic receptors are expressed early in brain development and play critical maturational roles at many developmental stages, including adolescence. Since it is unethical to conduct experimental studies of nicotine effects on teenage brain, animal models are widely used. We have shown that nicotine has unique behavioral and biochemical effects in adolescent rats. Adolescents are more sensitive than adults to the rewarding effects of nicotine. Furthermore, nicotine exposure during early adolescence results in enhanced rewarding effects of other abused drugs, including cocaine, methamphetamine and alcohol. The neural mechanisms underlying this enhancement of drug reward will be discussed.

With the passage of the Family Smoking Prevention and Tobacco Control Act in 2009, Congress gave the U.S. Food and Drug Administration (FDA) a set of tools to prevent new tobacco products from causing further harm. Those tools included the authority to: (1) regulate the composition of products – including flavors and nicotine – through product standards; and (2) examine all new products through its premarket review process. Taken together, Congress intended these tools to be used to make tobacco products less appealing to kids; less addictive; and no more harmful to public health than the existing products on the market. And while the FDA acquired this authority after generations of addiction of harm from tobacco use, it was designed to empower the agency to prevent future harm. The advent of the e-cigarette and the resulting epidemic in youth use presented a test of these core functions for the FDA, one that it has failed by any measure. A combination of inaction and delays in deploying its considerable authority as intended have allowed a new toxic and highly addictive tobacco product to take root, dismantling decades of progress in tobacco control be using all the same tactics as Big Tobacco. This session will review the evolution of e-cigarette use and discuss what the FDA did and should have done differently to prevent the epidemic and protect public health.

The e-cigarette epidemic among young people evolved through a confluence of factors including a lack of e-cigarette policy and regulation and an aggressive, industry-sponsored media campaign aimed at young people.  To help address this epidemic, Truth Initiative employs a multi-level, population-based approach which is evidence-based, innovative, and iterative.  This presentation will focus on the development and implementation of two key population-based interventions: 1) the transition of the evidence-based truth® campaign to speak to young people about e-cigarette use, including a current innovative social influencer media effort to help normalize quitting; and 2) the first-ever digital and scalable quit vaping program, This Is Quitting (TIQ), to youth and young adults.

These interventions are monitored and evaluated using rapid and rigorous data collections, including the Truth Longitudinal Cohort (TLC), a bi-annual, nationally representative, probability sample of respondents aged 15-24; the Continuous Tracking Online (CTO), a weekly tracking survey of youth and young adults aged 15-24; a comprehensive library of Nielsen sales data for monitoring changes in consumer behavior; and a suite of social media monitoring and listening tools.  These data collection efforts have also provided critical information about the evolving epidemic which has complemented our national surveillance data. A comprehensive set of studies designed to test the efficacy and optimize our quit vaping program will also be described.