The tactics that tobacco companies use to encourage use of their products are “fascinating and terrifying at the same time,” according to Dr. Laura Crotty Alexander, an assistant professor of medicine at UC San Diego who is part of a coalition of health, parent and community organizations that has started a campaign called San Diegans vs. Big Tobacco.
The campaign, launched Oct. 19, is asking the cities of San Diego and Chula Vista to end the sale of all flavored tobacco products, including menthol cigarettes and flavored cigars, electronic cigarettes, smokeless tobacco and shisha.
Crotty Alexander, a pulmonary critical care specialist, said the coalition, which includes other local researchers such as Dr. Wael Al-Delaimy of the UCSD Department of Family Medicine and Public Health and Ramon Hernandez, associate director of the Center for Community Health at UCSD, also wants local governments to “recognize the risks of these devices and that we really need to be aware of them and how appealing they are to the youth of our society.”
Crotty Alexander, a mother of middle and high school students, has studied e-cigarettes since 2013 and said “seeing the use patterns in [teenagers] has been really frightening.”
Citing several recent studies, she said flavored tobacco products “not only make people more likely to initiate tobacco, including e-cigarettes, but they are key to maintaining people’s use.”
Crotty Alexander said “women, children and people of color are much more likely to prefer minty and fruity flavors, and the tobacco industry knows this.”
Among the key findings of the 2019-20 California Student Tobacco Survey, done primarily by other UCSD researchers not linked to the coalition, is that 28.6 percent of California high school students reported having used a tobacco product, a number Crotty Alexander said is “so horrifying to me.”
The study also said that 91.6 percent of current tobacco product users reported using flavored tobacco products.
Crotty Alexander noted the study indicated that susceptibility to future tobacco use by high school students who had never used a tobacco product was highest among those who rated their mental health as poor (47.6 percent) and fair (45.3 percent). It was lowest among those who reported good to excellent mental health (33.2 percent).
“We’re doing a bit of work in that area,” she said, “because we’re trying to figure out for the students who rated their mental health as poor, is it that they picked up [e-cigarettes] because they had poor mental health, or was their mental health affected by the vaping?”
“We know that conventional cigarette smoking actually drives anxiety and depression,” Crotty Alexander said.
Banning the sale of flavored tobacco products is a “first step,” said John Pierce, a professor with UCSD’s Moores Cancer Center and Herbert Wertheim School of Public Health and Human Longevity Science.
Pierce, who is not a member of the coalition, was first author on an analysis published Oct. 19 that stated that e-cigarette use did not help smokers stay off cigarettes.
Pierce’s study came out a week after the U.S. Food and Drug Administration for the first time authorized an e-cigarette — sold under the brand name Vuse by R.J. Reynolds Tobacco Co. — saying the device could help smokers stay off conventional cigarettes.
According to the U.S. Centers for Disease Control and Prevention, “e-cigarettes have the potential to benefit adults who smoke and who are not pregnant if used as a complete substitute for regular cigarettes and other smoked tobacco products.”
However, the CDC says e-cigarettes “are not safe for youth, young adults, pregnant adults, as well as adults who do not currently use tobacco products.”
“Scientists still have a lot to learn about whether e-cigarettes are effective in helping adults quit smoking,” the agency says.
James Murphy, head of scientific and regulatory affairs at Reynolds American, R.J. Reynolds’ parent company, said in a statement that the FDA’s authorization gives “adult nicotine consumers” access to “innovative and potentially less harmful alternatives to traditional tobacco products.”
Pierce, however, said e-cigarettes “are not harmless at all.”
“It took us something like 30 years to identify the harms from [conventional cigarettes],” but researchers haven’t had enough time to fully determine the extent of e-cig damage, he said.
Pierce said one new e-cigarette contains as much nicotine as an entire pack of traditional cigarettes.
“Kids who weren’t doing much are suddenly getting heavy doses of nicotine and end up becoming addicted quickly,” he said. “Approximately 30 percent of those who try nicotine will become addicted.”
He said the FDA has argued that “if you take the flavorings out [of tobacco products], the kids won’t start. And there’s just no evidence of that.”
Pierce said the only way to prevent addiction is to prevent tobacco and nicotine use. “The FDA has bought into harm reduction,” he said. “The best way to do harm reduction is [to] reduce use.”
Crotty Alexander said San Diegans vs. Big Tobacco is crucial for informing the community about vaping and tobacco in general.
“I feel like knowledge is power, and the more people know, they can make informed decisions,” she said. “It is our mission … to advocate and protect our children.”
Elisabeth Frausto/La Jolla Light