E-cigarettes Threaten the "Tobacco Endgame"

no smoking beyond this point image

The tobacco endgame – ending tobacco use and nicotine addiction in the U.S. – is within sight. About 11.5% of adults aged 18 and older in the U.S. smoke. The American Heart Association’s goal is to drive that rate down below 5% to save millions of lives. 

But e-cigarettes and other tobacco products, such as cigarillos, hookah and smokeless tobacco, pose a significant threat to this goal. A new generation of tobacco products is addicting a new generation of users to tobacco and nicotine. More kids and young adults are using these products, and they’re using them more often.  

The kids are not alright

Vaping is now the most popular way for adolescents to use tobacco and nicotine. According to the 2023 National Youth Tobacco Survey,10% (1,560,000) of high school students and 4.6% (550,000) of middle school students reported current e-cigarette use.    

Many kids falsely believe e-cigarettes and other tobacco products are safe. Some don’t even realize they contain nicotine. But these products can deliver much higher concentrations of this addictive drug than traditional cigarettes. For example, a prefilled liquid pod in an e-cigarette can contain as much nicotine as a whole pack of cigarettes.

According to the U.S. Surgeon General, exposure to nicotine during adolescence can cause addiction and harm the developing brain. But there’s no safety helmet to protect kids from this growing danger.

The top reasons young people give for using e-cigarettes are:

  • Use by a friend or family member
  • Appealing flavors such as mint, candy, fruit or chocolate
  • Belief that they are less harmful than other forms of tobacco
  • Belief that vaping helps with anxiety and depression  

The youth tobacco epidemic is a serious public health threat. We know nearly 90% of smokers first try a tobacco product by age 18. But if people don’t start using tobacco by age 26, they are likely to never start. Our focus must be on prevention at this critical stage of life.

What about adults?

One way tobacco companies promote e-cigarettes is to help smokers quit. But much more evidence is needed to show their effectiveness for quitting cigarettes and other forms of tobacco. 

These products may help some smokers quit or move to a less harmful product, but they can also lead to “dual or poly-use” – continuing to smoke traditional cigarettes or using other products and vaping. Even if e-cigarettes are less harmful than traditional cigarettes, those benefits are erased when both products are used. Dual and poly use make it even harder to quit because of the increased nicotine exposure. 

Studies have also shown an association between vaping and other substances, including alcohol, illegal or recreational drugs and misuse of over-the-counter and prescription medications (such as opioids).

The truth is, there is no “safe” tobacco product. We don’t yet know the long-term health effects, especially of newer products.

Most people don’t fully understand nicotine addiction and its health threats. Health care professionals need to be able to talk with their patients about tobacco use, including e-cigarettes and newer products. Education and can help make these conversations more meaningful and informed.

Seeing through the smoke screen

Tobacco companies have grown bolder in their efforts to keep people addicted and misinformed. They:

  • Fund lawsuits to prevent or weaken tobacco-endgame policies.
  • Spend millions lobbying lawmakers to oppose such policies.
  • Target products and promotions to youth and other at-risk populations, including women, ethnic groups, the LGBTQ+ community, rural residents, low-income residents, less educated populations and people with mental health conditions.
  • Support watered-down and less effective tobacco-endgame measures as a public relations ploy.
  • Fund organizations and groups that claim to address the tobacco epidemic but instead divert attention from proven interventions.

How do we get to the tobacco endgame?

Reaching the tobacco endgame and preventing use by kids and young adults will require strong government oversight. We need stronger regulation of the design, manufacturing, sales and marketing of all tobacco products. For example:

  • Restrict marketing efforts like celebrity endorsements, movie placements, price promotions, event sponsorships, social media influencers and merchandise branding.
  • Eliminate characterizing flavors and sweeteners to reduce appeal to kids.
  • Put graphic warning labels and nicotine concentration information on all products and work toward reducing nicotine levels in cigarettes and cigars.
  • Strengthen enforcement efforts on retailers to prevent illegal sales of tobacco products.
  • Verify the effectiveness of products marketed to help people stop smoking.

Support what’s already working

We also must continue to support proven strategies and public policy, such as:

  • Tobacco excise taxes
  • Comprehensive clean-indoor air laws
  • Eliminating all characterizing flavors in tobacco products
  • Access to and coverage of evidence-based comprehensive cessation therapy to quit tobacco use and nicotine addiction
  • Marketing and advertising restrictions
  • Public education campaigns
  • Youth prevention programs
  • Enforcement of Tobacco 21 laws
  • Ending the sale of tobacco in pharmacies and health-related businesses
  • Reducing the density of tobacco retail outlets around schools and other youth-serving institutions 

How you can help

  • Stay tobacco-free. If you smoke or use tobacco, make a plan to quit now.
  • Talk with young people in your life about the dangers of vaping and any tobacco use.
  • Share our infographic with your social networks.
  • Advocate for strong, comprehensive tobacco policies and regulation.
  • Join local efforts in your community and state at yourethecure.org.

Types of tobacco products 

Several types of products are attracting new users through appealing flavors, aggressive marketing and social media engagement. Here are a few you should know about.

Cigarillos – Small cigars that resemble traditional cigarettes but are often exempt from regulation that applies to cigarettes. They tend to be low cost and come in flavors. They are the tobacco product most used by Black adolescents.

E-cigarettes – Electronic devices containing a nicotine-based liquid that is vaporized and inhaled to mimic the experience of smoking cigarettes.

Heat-not-burn products – These devices generate an inhalable aerosol by heating tobacco at approximately 500°F rather than burning.

Hookah – A tobacco pipe with a long, flexible tube that draws the smoke through water. Often used to smoke flavored tobacco in a social group setting or “hookah bar.”

Smokeless tobacco – Products such as chewing and dipping tobacco, dissolvable tobacco lozenges, snus and snuff. 

high school students telling their tobacco endgame stories video screenshots

Join the Tobacco Endgame Movement

Together, we have the power to end vaping and nicotine addiction. Your voice can make a difference today.

Teens across the country are sharing their stories and making a difference in their communities.