This year marks the 55th anniversary of the inaugural Surgeon General’s Report on Smoking and Health, the first to link smoking cigarettes with dangerous health effects including lung cancer and heart disease.
Although linking cigarettes to disease was considered “news” and “controversial” at that time by some, the 1964 report actually arose from a review of more than 7,000 research papers on the topic dating back as early as the 1920s. Today, 40 million U.S. adults still smoke cigarettes and tobacco use remains the leading cause of preventable disease, disability and death in the United States.
For decades and despite almost immeasurable evidence linking cigarette smoking with health problems, the tobacco industry continued to aggressively market cigarettes to many including vulnerable populations. It also went to great lengths to attempt to hide negative scientific evidence from the public. Tobacco companies would also align with physicians, who were bribed with free cigarettes, to claim smoking was a healthy habit.
Due in part to these aggressive marketing practices, being dubiously exempt from any FDA scrutiny for decades, and the addictive nature of the product, each year nearly half a million Americans die prematurely of smoking or exposure to secondhand smoke – which, according to the Centers for Disease Control and Prevention, makes smoking responsible for more deaths each year than HIV, all illegal drug use, alcohol use, motor vehicle injuries, and firearm-related incidents combined.
To maintain customers and therefore profits despite the deadly nature of tobacco, the industry continuously seeks “replacement” customers, particularly youth. Successful strategies have included social media advertising, placement in convenience stores, colorful packaging, enticing flavors, and logos similar to popular candies. The latest strategy includes creating a new generation of potential smokers through the sale of electronic cigarettes (e-cigarettes, or vaping devices).
The terms of the 1998 Master Settlement Agreement (largest civil litigation settlement in U.S. history between Big Tobacco and the states to mitigate the financial burden of death and disease caused by tobacco use as a result of Medicaid expenditures) required tobacco companies to severely curtail marketing practices as well as pay in perpetuity annual payments to states to compensate for some of the expenses resulting from tobacco-related health care costs, with a minimum of $206 billion over the first 25 years of the agreement. This financial burden pressured the tobacco industry to get creative in its quest to maintain its customer base, including targeted acquisition of e-cigarette market share.
Evidence-based practices that resulted from the Master Settlement Agreement and other comprehensive public health campaigns are credited with reducing smoking rates from close to 50 percent in 1964 to about 18 percent today.
And as we see overall tobacco consumption decreasing in the United States, we see rates of e-cigarette use rapidly rising. One particularly alarming aspect of the e-cigarette industry (controlled in part by big tobacco) is its aggressive and familiar marketing to youth.
A recent report by the U.S. surgeon general stated that e-cigarette use among high school students had increased by 900 percent between 2011 and 2015, and more than 3.6 million middle schoolers and high schoolers vaped in 2018. But this is not just a national trend. According to recent reports by the Spokane Regional Health District, 26 percent of high school sophomores in Spokane County reporting using a vaping device in the past 30 days.
In addition to highly publicized health risks associated with e-cigarette use itself, emerging research indicates that the use of vaping devices during youth may act as a gateway, increasing the risk of eventually smoking cigarettes.
The National Institute of Drug Abuse reports, “high school students who used e-cigarettes in the last month were about seven times more likely to report that they smoked cigarettes when asked approximately six months later, as compared to students who said they didn’t use e-cigarettes. “
Another 2018 report from the National Academies of Sciences, Engineering, and Medicine concluded that there is “substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults.”
We cannot afford to wait to acquire decades’ worth of research about e-cigarettes before we aggressively act to protect youth using evidence-based strategies acquired through our battle against Big Tobacco. History tells us we cannot assume the industry will regulate itself, despite health risks.
Robin Pickering, Ph.D., is an associate professor of health sciences at Whitworth University.
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