Lewis R. First, MD: The fight against youth nicotine addiction

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Since becoming chief of the University of Vermont Children's Hospital 25 years ago, I, along with the pediatricians and staff at our hospital have dedicated our professional lives to keeping children healthy. Doing so means not just providing the highest quality state-of-the art evidence-based care to treat pediatric illness, but also to prevent illness from occurring by encouraging healthy behaviors. Unfortunately, the most recent findings in the Vermont Youth Risk Behavior Survey (YRBS) suggest that our efforts to prevent middle and high school students from the adverse consequences of nicotine addiction are being hampered by the pervasive use of e-cigarettes and vaping devices by youth in our state. This year, lawmakers in Montpelier are considering a bill (S288) that would eliminate all flavored tobacco products, including mint and menthol — electronic and combustible products. We need to rally together in support of S288 to keep our youth healthier and combat the alarming increases we've seen recently in teen smoking and vaping.

According to the 2019 YRBS, 26 percent of high schoolers are using e-cigarettes. That rate has more than doubled in the past two years. Nearly one out of every three of our children is currently using some sort of tobacco product. Even more alarming is the number of middle schoolers starting to use these deadly products. The YRBS survey found that 15 percent are trying them before the age of 13! That's up 5 percent from last year's survey!

Why would this be happening, especially when we now forbid the commercial purchase of tobacco products to those under age 21 in Vermont? Unfortunately, while a teen may not be able to get tobacco products over the counter, they can still access them such as from those over the age of 21. While federal policy banned commercial sale of flavored e-cigarettes, there are loopholes to this policy and kids have already found them. For example, mint and menthol are not considered banned flavors, and as a result, are still accessible. You may not know this, but more than half of teens age 12-17 who smoke use menthol products, and this rate has increased by 50 percent over the past two years with the federal flavor ban.

In addition, the recent federal policy to ban the sale of flavored products exempted open system e-cigarettes that one can fill — and refill — with 15,000 nicotine flavored e-liquids. It also exempted disposable e-cigarettes. With alluring packaging and creative names, these e-cigarette and other flavored vaping products can be hard for adolescents to pass up. They're easy to use, easy to hide and easy to get addicted to because of their high nicotine levels — so addicted that even those who want to quit find themselves unable to do so because of their addiction. It's heartbreaking.

That is why it's so important to take action that prevents e-cigarette and vaping use in the teenage years. A key opportunity to take action, S288, is currently before our legislature.

It's important to note that if menthol cigarettes were removed from the market, 39 percent of all menthol smokers, and nearly 65 percent of youth menthol smokers report they would try to quit. Tobacco 21 legislation passed last year and now implemented in Vermont was a necessary step, but one that has still been insufficient in curbing the rising rates of youth e-cigarette use which is why the S288 bill is so important for the Senate to support and pass.

Reducing the risk of addiction from e-cigarettes and vaping is something we all care about. That is why supporting the S288 bill is key to not just keeping our youth healthier but will insure that we also keep them healthy as adults and not expend additional health care resources on preventable lung, heart and cancer complications occurring in adulthood that can result from smoking that starts during the teenage years. When it comes to Vermont being "First" with our children's health and wellbeing, passing this bill is a critical step in turning that hope into a reality.

Lewis R. First, MD, is the chair of the Department of Pediatrics at the University of Vermont's Larner College of Medicine, the chief of pediatrics at the University of Vermont Children's Hospital and editor-in-chief of the journal Pediatrics.



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