Tobacco Control: Progress and the Vaping Epidemic Brett Schuette Executive Director of Missouri
Tobacco Control: A Story of Remarkable Progress • In the last half century, lower smoking rates have saved about 8 million lives in the U.S. • Average adult life expectancy has increased by about 10 years, almost 1/3 of which, about 3 years – is directly due to lower smoking rates. • This highlights why it is critical that the American Lung Association continues our focus on reducing tobacco use as part of our overall health promotion efforts. 2
The History of Cigarettes It was not until James Bonsack invented the cigarette-making machine in 1881 that cigarette smoking became widespread. 3
We’ve Come a Long Way 4
A Really Long Way 5
But…The Challenge Remains Since 1964, cigarette smoking has killed more than 20 • million Americans, including 2.5 million nonsmokers and more than 100,000 babies. Today 34 million adults and 3 million middle and high • school students in the U.S. smoke cigarettes. Smoking causes 480,000 deaths in the U.S. per year. • Tobacco costs the U.S. $132.5 billion in health care • expenditures and $156.4 billion in lost productivity ($150.7 billion for smokers; $5.7 billion from secondhand smoke exposure, for a total economic impact of $288.9 billion per year. 6
But…The Challenge Remains 18,300 adults die each year from smoking • 230,000 kids now under the age of 18 are projected to die • prematurely from smoking conventional cigarettes $5.49 billion in annual health care costs are directly caused • by smoking ($1.9 billion covered by our state Medicaid program) 7
Smoking Still Kills More Americans Than All of these Combined 8
“The Dirty Dozen” (of 70 carcinogens) Acetone (solvent and paint stripper) • Ammonia (toilet bowl cleaner) • Arsenic (potent ant poison) • Benzene (poisonous toxin) • Butane (flammable chemical in lighter fluid) • Cadmium (chemical in batteries) • Carbon monoxide (poisonous gas in auto exhaust) • • Formaldehyde (dead frogs love this stuff) Hydrogen Cyanide (deadly ingredient in rat poison) • Methanol (jet and rocket fuel) • Polonium – 210 (radioactive element) • Toluene (poisonous industrial solvent) • 9
Catching Kids with Cartoons “Today’s teenager is tomorrow’s potential regular customer, and the overwhelming majority of smokers first begin to smoke while still in their teens.” “The base of our business is the high school student” 10
Youth Tobacco • Each day 1,300 Americans die from smoking • Each smoker who dies is replaced by 2 young smokers • 90% of all smokers start before the age of 18 • 5.6 million kids alive today are projected to die prematurely from smoking if we don’t take effective action 11
Youth Tobacco “I am officially declaring e-cigarette use among youth an epidemic in the United States. Now is the time to take action. We need to protect our young people from all of tobacco products, including e-cigarettes. - Jerome Adams U.S. Surgeon General 12
Youth Tobacco • From 2011 to 2018, high school students who smoked conventional cigarettes declined substantially, from 16 percent to 8 percent, a historic low. • However, e-cigarette use among high school students tripled from 2013-2014, that brought the percentage of high school students who use e-cigarettes to 13%. • In 2017 this percentage increased to 27.8% • It is now 37.3% in 2018 This increase – driven by the e-cigarette use – has erased • the decrease in current use of other tobacco products. 13
E-Cigarettes: Industry Strategies 14
Anything Harmful? 15
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E-Cigarette Parts 17
Compounds in yellow are from FDA 2012, E-Cig Composition Harmful and Potentially Harmful Substances – Established List Propylene glycol Benzo(ghi)perylene Cadmium • • Chlorobenzene • • Glycerin Acetone Silicon • • Crotonaldehyde • • Flavorings (many) Propionaldehyde Acrolein Lithium • • • • Nicotine Benzaldehyde Silver Lead • • • • NNN Nickel Magnesium • • Valeric acid • • NNK Tin Manganese • • Hexanal • • NAB Sodium Potassium • • Fluorine • • NAT Anthracene Strontium Titanium • • • • Ethylbenzene Pyrene Barium Zinc • • • • Benzene Aluminum Zirconium • • Acenaphthylene • • Xylene Chromium Calcium • • Acenapthene • • Toluene Fluoranthene Boron Iron • • • • Acetaldehyde Benz(a)anthracene Copper Sulfur • • • • Formaldehyde Chrysene Selenium Vanadium • • • • Naphthalene Arsenic Cobalt • • Retene • • Styrene Nitrosamines, Rubidium • • Benzo(a)pyrene • • Benzo(b)fluoranthene Indeno(1,2,3- • • Polycyclic aromatic • cd)pyrene hydrocarbons 18
Vaping and Oral Health: It’s worse than you think 19
E-Cigarettes: What do we know? • The American Lung Association and our partners have pending litigation against the Food and Drug Administration for its July 2017 decision that allows electronic cigarettes and cigars – including candy flavored products that appeal to kids – to stay on the market for years without being reviewed by the agency. All e-liquids in traditional tobacco flavors, as well as mint and menthol, can stay on the shelves of convenience stores and gas • stations. Store can still sell kid-friendly flavors only if they don’t let in underage consumers. • E-Cigarettes have not been reviewed by the FDA – this means that companies have not had to disclose their ingredients to the FDA and the FDA has not determined whether their products are attractive to youth or discourage smokers from quitting tobacco all together. • No e-cigarette has been found to be safe and effective in helping smokers quit, yet e-cigarette companies are making “quit smoking” claims. • While the FDA now has authority over e-cigarettes, it has delayed a critical review of ingredients and potential harms until 2022. • The FDA has found that even some brands that say they have no nicotine, actually do. For example, JUUL, the most commonly used e-cigarette, claims to have as much nicotine in one pod as an entire pack of cigarettes. • 20
Ticking Timebomb? Vaping Vaping among high school students has increased to 37.3% • Mental Health • One in every four to five youth in the general population meet the criteria for a lifetime mental disorder that is associated with severe role impairment and/or distress Obesity • In the U.S., the percentage of children and adolescents affected by obesity has more than tripled since the 1970’s • Data from 2015-2016 show that nearly 1 in 5 school age children and young people (6-19) in the U.S. is obese. 21
E-Cigarettes: What do we know? QUESTIONS? 22
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