The battle with tobacco and nicotine continues

We had been making steady progress on the battle with tobacco use. It has been a long fight with many victories over the years. Each victory brought our community closer to lowering the use of tobacco.

From the early days of the surgeon general issuing warnings and the elimination of much of the advertising and marketing of tobacco, to the more recent elimination of smoking in bars and restaurants, we have been moving forward to a healthier community. All of these changes have resulted in a steady decline in tobacco use. The national rate of use has fallen from 67 percent in 1965 to 14 percent in 2017.

One of the keys to long-term success is to limit youth from starting to use tobacco. Most tobacco users start in their teens and are addicted into adulthood. The tobacco industry knows this and focuses its energies on generating these potential lifelong users. Talk to anyone who has quit, and often it is the hardest thing which they have done. By adulthood, most tobacco users want to quit but find it difficult due to the addictive qualities of nicotine.

Until recently we had enjoyed a steady decline in the use of tobacco use among youth, but this progress is under serious threat with the introduction of new ways to get nicotine, notably the e-cigarette.

The e-cigarette, a battery-operated device which vaporizes liquid nicotine which is then inhaled by the user, was developed in China in the mid-2000s as a smoking cessation aid. It arrived in the U.S. in 2007 and was promoted as a safer alternative to smoking and as a system to help people quit.

Unfortunately, it was introduced without the regulation that applies to tobacco. The e-cigarette industry is allowed to advertise more widely and to add flavors to the liquid. The devices have come down in size to be very discreet and with very little odor, making concealed use easier in schools and other areas where they are banned.

The liquid comes in thousands of flavors with wide variation in the nicotine content. The addition of flavors targets young new users specifically - I do not think that many adults are going to seek out a bubblegum- or fruity flavored liquid.

Young users perceive e-cigarettes as less dangerous than cigarettes. The young brain is more susceptible to nicotine, and this results in high rates of addiction. Even limited use can create an addiction. One cartridge of liquid contains the nicotine-equivalent of a pack of cigarettes.

These teenage e-cigarette users are then smokers of the future, with a potentially lifelong habit. It no surprise that major tobacco companies are buying up and investing in this new industry. They are creating their future clientele.

In addition to nicotine and flavoring, the e-cigarette liquid contains glycerol and propylene glycol, as well as toxins, heavy metals and carcinogens. The vapors from an e-cigarette are ultrafine and penetrate deeply into lung tissue. There is obvious concern about the introduction of these toxic materials deep into the body. These devices serve as a delivery system for not only nicotine, but illegal substances as well.

It will take time for regulations to catch up with this new industry. The FDA is considering changes to help limit access and study the effects of e-cigarettes. My hope is that it happens soon so we can prevent long-term health complications to our community.

There is nicotine replacement, along with medication, which can help those who are ready to quit.

Talk to your children about the dangers of e-cigarettes, to prevent their experimenting with these devices.

Dr. Ken Ripp is a family medicine physician at the Raiter Clinic in Cloquet.