Health experts are urging families not to forget about another kind of epidemic that dominated the headlines before the coronavirus came along: vaping among teens and young adults.
The problem “has been overshadowed, but it'll come back,” Dr. Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital in Boston, told TODAY.
“Vaping is still an important issue just as I think smoking is still an important issue … We've sort of forgotten about it because we've had a bigger health concern to worry about.”
Still, there's fresh evidence teens and young adults have been vaping less during the COVID-19 crisis. A survey of more than 2,100 e-cigarette users 13-24 years old — conducted in May and published Thursday in JAMA Network Open — found one-third quit vaping and another third reduced their e-cigarette use. About 17% said they vaped more.
The top reasons cited for reducing or quitting vaping included worries about the habit weakening the lungs, a user's parents finding out and lack of access to e-cigarettes.
When it came to underage youth, "their parents were likely to be home and they could not easily go to stores" during the national lockdown, the authors wrote. But the findings also suggest "vape shops and online platforms are routinely selling to underage youth during this pandemic."
Previous reports continue to cause concern.
More than 50 million Americans used a tobacco product in 2019, with 14% smoking traditional cigarettes — a rate essentially unchanged from the previous couple of years, the Centers for Disease Control and Prevention reported in November.
But 4.5% of tobacco users turned to e-cigarettes — up from 2.8% in 2017 and 3.2% in 2018, according to the Campaign for Tobacco-Free Kids, which called the findings “troubling.”
“It is particularly concerning that e-cigarette use was highest among young adults aged 18-24,” with more than half of them reporting they had never smoked traditional cigarettes, said Matthew Myers, the president of the non-profit advocacy group, in a statement.
“(The) CDC report reminds us that the fight against tobacco use — the nation’s No. 1 cause of preventable death — is far from over and must remain a national priority.”
There seemed to be more encouraging news when it came to smoking and vaping among middle- and high-schoolers.
Traditional cigarette smoking rates among kids are at historic lows, Rigotti said. Last year, fewer than 6% of high school students reported that they smoked a cigarette in the past month — a sharp decrease from 2011.
But almost 20% of high school students are vaping, according to the 2020 National Youth Tobacco Survey, released in September.
It found 3.6 million children and teens reported using an e-cigarette in the past month — a number described as “concerningly high” by the U.S. Food and Drug Administration, but 1.8 million fewer kids compared to the previous year. Possible reasons for the drop include being scared off by the outbreak of vaping-related illnesses in 2019, and being blocked by higher age limits and flavor bans.
CDC Director Dr. Robert Redfield, called the decline "a notable public health achievement," but warned the work is far from over: “Youth e-cigarette use remains an epidemic,” he said.
The survey was conducted from mid-January to mid–March of 2020, or before the height of the coronavirus outbreak. Rigotti wondered if the lack of in-person interaction in schools — and the peer pressure that comes with it — might turn out to have a positive effect.
“We were in the midst of almost a social contagion of the spread of e-cigarettes across high schools in the United States and suddenly when COVID came, everything closed and everything became remote,” she noted.
“So one possibility is that not being in an environment where there were lots of other kids and e-cigarettes available might have sort of stopped or reduced or cut into that contagion.”
Experts have called the social distancing rules of 2020 a “golden opportunity” for teens to quit vaping and for families to talk about the habit’s harmful effects, even if they don’t think their kids are using e-cigarettes. Many parents are unaware their children are vaping, a study published last month in the journal Pediatrics found.
The authors of the new JAMA survey reported a similar finding: "The small and concealable design of e-cigarettes (often replicating flash drives or highlighters) allow underage youth to continue to hide and use e-cigarettes at home, even with family members nearby."
The worry is teens who vape become addicted to nicotine, which may harm the developing brain, and inhale potentially harmful ingredients deep into their lungs, including chemicals linked to lung disease and heavy metals, such as nickel, tin and lead, according to the U.S. Surgeon General.
One year ago at this time, the CDC was also tracking an outbreak of EVALI, an acronym for "e-cigarette or vaping product use associated lung injury," which was linked with an additive in some e-cigarettes. The agency stopped tracking the numbers in February 2020 when cases declined dramatically.
Could the stress of the coronavirus crisis lead young people to start vaping? Rigotti didn’t think it would prompt someone who’d never tried e-cigarettes to start using them out of the blue. But those who were already vaping could be doing it more since there’s some data to show that traditional smokers who were stuck at home and bored during the lockdown were smoking more, Rigotti said.
Still, traditional smoking is the more dangerous behavior, she added, noting cigarette smoke has many more toxins than e-cigarette vapor. Vaping devices can also help adults quit smoking, “which is not to say that e-cigarettes are safe,” she said.
Looking ahead to next year and life after the coronavirus crisis, vaping will likely come under renewed scrutiny.
“The events of 2020 — the social distancing, the closing of schools — have changed so much that it's hard to know what we will see,” Rigotti said.
“It may be that they've helped to reduce teen vaping, but I don't think they've made it go away. I think it's still a problem that we'll have to deal with going forward for sure.”