Prospero B. Gogo: Vermont needs ban on flavored tobacco and vaping products

Editor's note: This commentary is by Prospero Gogo Jr., MD, who is a professor of medicine and director of the Cardiac Catheterization Laboratory at the University of Vermont Medical Center and Larner College of Medicine.

This past week, I treated a patient who presented to the emergency room with a heart attack. He is a heavy smoker, and, despite a previous heart attack, continued to smoke heavily after several attempts to quit. He said he started smoking at age 12 because, “I didn’t know how addictive nicotine was when I was a kid.”

Every day there is a new story about the widespread epidemic of kids using vaping products and e-cigarettes. Most of these products contain extremely potent levels of nicotine, and surveys of young users demonstrate that there is very little understanding of the effects of nicotine in these products. The single most important product characteristic that attracts children to vaping is the candy-like flavors available from many manufacturers, most prominently from Juul. Who would have thought flavors would be responsible for one of the largest public health crises we’ve seen? But they are and they’ve taken many states by surprise as kids across the country are becoming e-cigarette addicts. If something isn’t done to stem this epidemic, then the future for many of our children may be a bleak as my patient’s.

A study published just this month in JAMA shows more students are reporting frequent use of e-cigarettes, indicating possible addiction. More than a third of high school students and 18% of middle school students used e-cigarettes at least 20 days a month. The numbers of youth using e-cigarettes is also growing. In the past two years, use by high school students more than doubled and tripled among middle school students.

According to the 2019 National Tobacco Survey, more than one in four high schoolers now use e-cigarettes. And 81% of youth who had ever used a tobacco product, including e-cigarettes, said they started with a flavored product. It's no wonder with more than 15,000 flavors available.

As states started enacting emergency bans on e-cigarettes to address the severe respiratory illnesses caused by e-cigarettes, we had a glimmer of hope when President Trump announced that he would be taking action to ban flavored e-cigarettes. But just last week he reversed his decision, putting the health of our kids behind the interests of Big Tobacco.

States now need to step up their efforts. These products are NOT harmless. Even if we set aside the recent severe lung illnesses and related deaths, e-cigarettes are clearly dangerous, especially to youth. The nicotine in them is addictive, and adolescents and young adults are more susceptible to its effects because they are still going through critical periods of growth and development. Addictions formed in teen years are stronger and harder to break than those formed later in adulthood. More worrisome, two new studies just released at the American Heart Association’s Scientific Sessions last week suggest e-cigarettes are just as dangerous, or even worse, for your heart than traditional cigarettes.

One study found vaping can worsen several heart disease risk factors, like cholesterol, triglycerides and glucose levels, at levels equal to traditional cigarettes. The second study found e-cigarettes decreased blood flow in the heart even more than traditional cigarettes.

Finally, a prior study conducted by the CDC suggested that people who vape but who do not smoke have up to a 23% increased risk of cardiovascular disease such as heart attack and stroke.

So, what to do? If flavors are the root of the problem, let’s hit it hard and eliminate the sale of both flavored e-cigarettes and cigarettes.

With the multiplying effect these flavors have on e-cigarette use by youth, its critical lawmakers take action, but not just on flavored e-cigarettes.

Tobacco companies know menthol makes cigarettes more appealing to kids who are initiating tobacco use. As a result, youth smokers are more likely to use menthol cigarettes than any other group. Over half of youth smokers between the ages of 12 to 17 used menthol cigarettes. Menthol is a mild anesthetic which masks the harsh taste of tobacco with a minty flavor and reduces throat irritation, so it’s a big draw to youth.

We need to eliminate the sale of all flavored tobacco products and put the needs of kids first, not big tobacco. I’m happy to see the commonwealth of Massachusetts is on track to be the first to adopt a comprehensive law prohibiting the sale of all flavored tobacco products in their state. The House adopted the bill last week and the Senate adopted a slightly amended version yesterday.  The bill was expected to be on the governor’s desk before the Thanksgiving holiday. That’s great news.

I encourage Vermont’s legislature to follow suit in January.


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