Look out for flavored tobacco. Teens think it has a lower health risk.

Traditional smoking among teens is down, but e-cigarettes, or vaping, are way up, and they aren’t safe either.
Traditional smoking among teens is down, but e-cigarettes, or vaping, are way up, and they aren’t safe either. AP

An upsurge in e-cigarette use among middle and high school students occurred nationally between 2011 and 2018, with nearly 21 of every 100 high school students surveyed reporting e-cigarette use in the past 30 days, according to data from experts at the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention.

This trend is not by chance. Tobacco companies have spent billions of dollars annually on tobacco product advertisement, according to a Federal Trade Commission report, and have used appealing packaging, culturally tailored brand names and advertisements that appear to target specific minorities and youth.

The FDA has announced efforts to impose restrictions on flavored e-cigarettes and tobacco products. FDA recognizes the high rates of e-cigarette use among young people as a public health concern, and sees the urgent need for stricter product access.

Part of the agency’s plans call for restricting young people under the age of 18 from accessing flavored e-cigarettes via retail establishments and online websites.

Using a survey of young adults aged 18 to 26 recruited through an online crowd-sourcing tool, our group of researchers at the UNC School of Medicine found in a study published in PLOS ONE that cigarillo pack flavor descriptors, such as grape and sweet, and colors such as pink and purple resulted in more favorable product perceptions among young adults.

Two studies within our systematic review found that packs containing flavor descriptions were more likely to be rated as having a lower health risk. Another study of smokeless tobacco packs in the United States found that young adults were more likely than older adults to report that packs without flavor descriptions would contain more dangerous chemicals.

While traditional cigarette smoking has declined, patterns of dual (that is, use of two or more tobacco products in 30 days) and poly tobacco use (or the use of three or more tobacco products in 30 days) have emerged. In 2013, in a survey of North Carolina high school students, almost 30 percent reported use of any tobacco product, according to a study from our team.

Using data from the 2015 North Carolina Youth Tobacco Survey, we found in a study published earlier this year in Preventing Chronic Disease that among survey respondents who were not susceptible to smoking cigarettes, 26 percent were at “high risk” for future e-cigarette use; 11.3 percent were classified as “susceptible” to using e-cigarettes; 10.4 percent had already tried an e-cigarette; and 4.5 percent were current e-cigarette users.

Using school enrollment figures, we estimated that 55,725 high school students in North Carolina were at low-risk of smoking cigarettes, but at high risk for e-cigarette use – which meant that they were susceptible to using e-cigarettes, had experimented with e-cigarettes, or currently used e-cigarettes.

High school students who believed that e-cigarettes and secondhand e-cigarette vapor were not harmful, or only somewhat harmful, were more likely to be susceptible to using e-cigarettes than students who thought e-cigarettes and secondhand e-cigarette vapor were harmful, our study found.

We know that adolescents and teenagers are very vulnerable to the influence of tobacco marketing. The use of appealing packages and flavors has a significant impact on young people, causing them to perceive these tobacco products as less harmful and making them more likely to experiment and continue using tobacco products. As research on the impact of flavored tobacco products builds, I look forward to increased action to help prevent youth tobacco use.

is director of Tobacco Prevention and Evaluation at UNC-Chapel Hill.