Arguing that the rising popularity of electronic cigarettes soon would undermine California's leadership in reducing tobacco use, state health officials Wednesday called for tighter regulation of the devices and announced an educational campaign to combat their use.
Addressing "vaping" by minors and young adults, the fastest-growing group of users in the state, will be a key focus, California's Department of Public Health said in a 21-page report. E-cigarette use among young adults ages 18 to 29 in California tripled between 2012 and 2013, according to the agency.
"I'm advising Californians, including those who currently use tobacco, to avoid using e-cigarettes," state health officer Dr. Ron Chapman said during a conference call following the document's release. "E-cigarettes … re-normalize smoking behavior and introduce a new generation to nicotine addiction."
Chapman did not provide specifics about the campaign, including its expected cost. In addition to the report, the department issued an advisory recommending healthcare providers do more to educate parents and the public.
"This is just the beginning of getting the word out," he said.
The battery-operated devices, which often look like traditional cigarettes, work by heating and aerosolizing a liquid which may contain nicotine that users then inhale. The vapor does not contain some of the dangerous components of tobacco smoke.
One key question is whether e-cigarettes help smokers quit or simply get more people hooked on nicotine, exposing them to a different set of toxic chemicals. With the health effects not yet comprehensively studied, there is debate over whether vaping devices are in fact a danger.
Citing a number of studies, the state's report concluded that there was "no scientific evidence that e-cigarettes help smokers successfully quit traditional cigarettes or that they reduce their consumption."
Proponents, however, said Wednesday that e-cigarettes can help smokers kick their dangerous tobacco habits and called the state's position "irresponsible."
"It's public health malpractice to tell an adult who is inhaling burning smoke into their lungs on a daily basis that they shouldn't even try to quit smoking [by] using vaping," said Gregory Conley, president of the American Vaping Assn.
Stanton Glantz, a professor of medicine at UC San Francisco's Center for Tobacco Control Research and Education, called the report a "fair reading of the evidence" and said he hoped that Californians would press the health department to reveal when its effort might launch.
"It's true that this is a new area [of research] … but there's a pretty clear picture emerging," he said. "The whole: 'We don't know enough, the research is incomplete, bla bla bla,' that's what the cigarette companies have said since the 1950s."
The report detailed the increase in e-cigarette use among younger Californians.
Asked in 2012 if they had used e-cigarettes in the last 30 days, 2.3% of those between 18 and 29 years of age said they had. A year later, that number had more than tripled to 7.6%. Young adults were three times more likely to use e-cigarettes than people over 30.
Teen vaping in the U.S. also was on the rise, surpassing traditional cigarette use for the first time in 2014.
Nicotine exposure among teens, the report said, is believed to harm brain development. The aerosols emitted by e-cigarettes, including secondhand aerosols, contain at least 10 chemicals known to cause cancer, birth defects or reproductive harm.
One way companies make e-cigarettes appealing to children, Chapman said, was by offering e-liquid — as the nicotine solution the devices vaporize is sometimes called — in flavors like chocolate, gummy bear and bubble gum. That could make youngsters want to use e-cigarettes or ingest the liquid.
Poisonings among children age 5 and under linked to e-cigarettes grew from seven in 2012 to 154 in 2014, the health department report stated.
Amid the debate over the risks or benefits of electronic cigarettes, local and federal officials have put some regulations in place.
Los Angeles in 2013 adopted rules controlling the sale and use of e-cigarettes. At least one state legislator is pushing a bill that would ban vaping in locations where tobacco is prohibited, although similar attempts to regulate e-cigarettes statewide previously failed.
In April 2014, the U.S. Food and Drug Administration proposed rules for regulating the product; those still are under review.