The 6th annual US e-cigarette summit, 2022 took place on May 17th in Washington DC and virtually. The stated objective of this hybrid event was “facilitating dialogue and analysis of the latest evidence and opportunity to explore how this should be interpreted to deliver the most effective public health and regulatory strategies”. One of the expert panels discussed the topic of Youth and Scientific Communication. Each of them insisted on the fact that the youth should be protected due to the fact that adolescence is a specific time with specific challenges which must be taken into consideration while dealing with tobacco and harm reduction.
Dr Gray is a physician-scientist engaged in clinical practice and treatment development research focused on youth substance use disorders and mental health. He declared that substance initiation almost always occurs during adolescence for reasons inherent to their age:
“Adolescents by design essentially value immediate reward over consideration of longer term consequences. This is why it is a feature not a bug that adolescents try new things. This is helpful developmentally. But it can also be harmful because if one of the things they try has potential harm that can lead to a change of trajectory of their lives, then that’s where we can get concerns about substance use initiation during this period…It is a period of heightened “storm and stress” with rapid physical, cognitive, emotional, social, and behavioral changes. Even the most “well-adjusted” adolescent experiences challenges”
Robin J. Mermelstein is a Professor of Psychology and the Director of the Institute for Health Research and Policy at the University of Illinois. She corroborated Dr Gray’s analysis and went a step further stating that the more specific and realistic one can be, the better the help will be for adolescents needing it:
“I am not saying that adolescents should use any kind of tobacco product. I am just trying to take a realistic approach to how do we reduce and deal with the fact that some adolescents do use and not pretend that they don’t.”
Substance use is “very congruent with adolescent development as adolescence is a time of experimentation and risk taking in order to gain autonomy in their development, and this is exactly what harm reduction encourages in its true form. It encourages support and empowerment of giving people options and a clear education of risks. It addresses the reality of a continuum of use and a continuum of de-escalation and not a simple on/off switch. It gives us an ability to communicate in a more powerful way”
Kathleen Crosby is the Director of the Center for Tobacco Products Office of Health Communication and Education at the FDA (Food and Drug Administration) effective science-based communication. The FDA started to regulate e-cigarettes in late 2016. According to the FDA, there are 2 million teens who are currently vaping out of 25 million in the US. She as well addressed the fact that mental health must be taken into consideration when it comes to substance use in adolescence:
“We’ve seen tremendous issues of anxiety and depression and mental health issues and certainly tobacco uses are a contributing factor to that. We would prefer to not have kids on the continuum to that but we recognize that’s not possible because kids are kids and there are many reasons why they choose to do different types of things”
She also addressed the misconceptions of the youth around the cost associated with e-cigarettes:
“According to a PATH study (Population Assessment of Tobacco and Health) 79% of youth believed that vaping causes little or no harm. Vaping was an immediate and rising threat to their health, but teens didn’t see it that way…But vaping is not benign. So our strategy was to help establish that there were costs associated with e-cigarettes with hard hitting messaging launched in 2018 that explained the dangers of addiction and the known risks of vaping to their health.
Comprehensive research to
1) Understand what their current thoughts, ideas and beliefs are
2) Understand what messages are relevant that can actually break through
3) Make sure we develop messages that kids can really understand and in a way that is not confusing and that won’t have unintended consequences.
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The topic of e-cigarettes is complex when it comes to youth. For Dr. Gray it is critical that one accepts this:
“Let’s embrace complexity. E-cigarette use can be relatively safe and benign for some people even help some people quit tobacco. And at the same time be potentially harmful for some people like adolescents. These can all be true simultaneously.”
Pr.Robin J. Mermelstein seemed to embrace the same approach as she said that strong polarity does not appear to be efficient for a population as complex as adolescents:
“Perhaps we need to move away from the dichotomous “all or nothing” view in order to identify opportunities and leverage points to intervene…maybe there are some additional strategies that we can think about.”
According to the World Health Organization, in Europe smoking continues to decline while the use of electronic cigarettes by adolescents is increasing. On the other hand, in Africa there are very few studies and scientific reports on the use of e-cigarettes.