That’s how Matthew Myers, president of the Campaign for Tobacco-Free Kids, describes new research that indicates teens are increasingly struggling with nicotine addiction, largely from vaping e-cigarettes.
The research, published Tuesday in the Journal of the American Medical Association, finds much of the progress made in nearly two decades of getting kids to quit smoking may be backsliding as so many teens are trying — but failing — to quit vaping nicotine.
“If anything, concerns about the level of addiction have been understated,” Myers said. “This demonstrates that kids trying to quit e-cigarettes are failing at levels we haven’t seen in years.”
The research, from the University of Michigan’s annual Monitoring the Future survey, comes at a pivotal time in nicotine regulation in the United States. Congress earlier this month adopted legislation that gives the Food and Drug Administration new, explicit authority over synthetic nicotine, which is made in a laboratory and is increasingly used in e-cigarettes, particularly sweet and fruit-flavored products popular with young people.
Now the industry and health advocates are anxiously waiting to see how the FDA will interpret and enforce its new authority.
Each year, researchers at the University of Michigan survey thousands of eighth-, 10th-, and 12th-grade students nationally about smoking and other substance use habits. The latest survey was conducted in early 2020, in the months before schools closed because of the COVID-19 pandemic.
The survey noted that since 1997, the prevalence of students reporting smoking traditional cigarettes, known as combustible cigarettes, had declined, as had the percentage of those reporting failed attempts at quitting. But in 2020, the researchers added a new question: “Have you ever tried to stop vaping nicotine and found that you could not?”
Their findings are worrisome, health advocates say. The percentage of students who reported unsuccessfully trying to quit either e-cigarettes or traditional cigarettes, roughly 6 percent, was considerably higher than the prevalence of unsuccessful attempts to quit cigarettes alone in each of the previous 13 years. (Some teens reported using both types of products and trying to quit both.) Much of the increase was from those struggling with e-cigarettes.
“There has been all this progress in reducing failed quit attempts with cigarettes, but once you include e-cigarette failed attempts, you see we have gone backwards,” said Richard Miech, a professor at the Institute for Social Research at the University of Michigan and principal investigator of the new research.
Shortly before the pandemic, the National Youth Tobacco Survey, through the FDA and Centers for Disease Control and Prevention, showed a steep rise in youth e-cigarette use, from more than 3.6 million reported users in 2018 to over 5 million in 2019.
The survey’s recent findings for 2021 found a decline, for a total of over 2 million e-cigarette users, but comes with a big caveat: the authors said the data can’t be compared to previous years because the surveyors made significant changes to their format. They collected data online because so many children were not at school. Prior to 2021, the survey was conducted in person, inside classrooms.
With kids back in school, and more opportunities to snag vaping devices shared or sold by friends, some administrators say they are seeing vaping climbing again.
“Now that we are back full time, it’s a consistent discussion with superintendents and principal groups across the state,” said Joseph Baeta, superintendent of Norton Public Schools.
Baeta sent an e-mail to families last week announcing stepped-up penalties, but also counseling, for any students caught vaping.
“Kids have this feeling that it’s not as addictive, that it’s better than smoking [traditional cigarettes],” Baeta said. “We all know that’s not true.”
Kim Estes, a parent in Oxford, Conn., can attest to e-cigarettes’ powerful hold. She discovered her son was vaping when he was 12. Four years later, despite years of failed attempts to quit, he is still vaping nicotine, she said.
“We have done therapy, the patch, gum,” Estes said. “We have punished, we grounded him, you name it, we have done it.”
She said her son gets headaches and nausea when he weans off nicotine vapes and then is surrounded by temptation with so many friends vaping at school and starts again. He has asthma, and the vaping has impaired the function of his lungs, but still, he cannot stop, she said.
“If you are addicted to alcohol, and you go to work every day in a bar, it’s hard to quit,” Estes said. “That’s how I feel it is for kids and school and friends.”
In June 2020, a sweeping Massachusetts law went into effect restricting the sale of nicotine vaping and flavored vaping and tobacco products. Health advocates say that helped reduce teen vaping, but the products are still widely available in nearby states and seep into Massachusetts.
“I do treat a lot of kids who are using e-cigarettes, and I am only successful in helping about half of them,” said Dr. Jonathan Winickoff, director of pediatric research at Massachusetts General Hospital’s Tobacco Research and Treatment Center.
“They leave my practice unable to quit nicotine products,” he said.
Nicotine can increase children’s levels of anxiety, stress, and depression, as well as aggravate asthma and other respiratory illnesses, Winickoff said.
But vaping manufacturers and other advocates say the recently approved federal legislation, which will likely prohibit many vaping products when enacted later this year, is misguided. They say it deprives millions of adults from a product that can help them quit traditional combustible cigarettes, which expose users to dozens of carcinogenic chemicals.
“I think they are throwing out the baby with the bathwater,” said Dr. Michael Siegel, professor of public health and community medicine at Tufts University School of Medicine.
Siegel, who said he receives no financial backing from vaping manufacturers or advocacy organizations, said an estimated 3.5 million adults have quit smoking traditional cigarettes since e-cigarettes hit the US market over a decade ago.
“If those ex-smokers go back to smoking, that’s a disaster,” he said.
Even before the latest congressional action to increase the FDA’s authority over e-cigarettes, the agency has moved to tighten some sales of flavored nicotine products, which critics say is a main culprit for hooking kids.
But Siegel said 90 percent of adult users prefer the flavored vapes to escape the nicotine taste, while still getting the nicotine kick. He suggests federal regulators limit the high levels of nicotine in vapes, which health advocates say is also responsible for addicting kids so quickly.
“It’s like a tightrope,” Siegel said. “You have to balance the need for adults to have access to these products, while still trying to keep them out of the hands of youth.”
Estes, the Connecticut mother who has become an advocate for making vaping products less attractive to kids, said banning flavored nicotine e-cigarettes is the way to go.
“If it tastes and smells like Lucky Charms, who are you targeting? You are not targeting a 30-year-old. You are targeting a child,” she said. “I want to stop more kids from even starting.”