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While experts continue to focus efforts on combating the teen vaping epidemic in the United States, a new report suggests that health officials may have acted prematurely to encourage the public to stop using all e-cigarettes during an outbreak of severe lung injuries that emerged in 2019.
In a study published in the medical journal Addiction, Australian researchers criticized the response of U.S. regulators and the media to the “E-cigarette or Vaping product use-Associated Lung Injury” (EVALI) outbreak, which caused widespread alarm between late 2019 and early 2020.
Cases of the vaping lung injury were first reported in August 2019, by state health officials in Illinois and Wisconsin. However, the problems soon spread nationwide and nearly 2,500 cases of the severe respiratory injury were identified by the end of that year, including at least 50 vaping-related deaths.
Early in the outbreak, the U.S. Centers for Disease Control and Prevention (CDC) indicated that the problems appeared to be tied to nicotine-based e-cigarettes and warned consumers to stop vaping. Much of the response to the outbreak focused on the drastic increase in vaping among teens throughout the United States, which was garnering increasing media coverage.
By late 2019, the CDC began to shift the focus of the investigation to additives used in certain vaping products that contain THC, specifically vitamin E acetate. However, the agency did not revoke its recommendation for the public to stop vaping any type of nicotine product at that time, indicating that it could not make a conclusive determination.
In early 2020, case control studies revealed that the majority of people impacted by vaping lung illness used illicit THC-laced oils, which were contaminated by vitamin E acetate. Although vitamin E acetate is thought to be mostly harmless when used on the skin and face, there is no research available focusing on the side effects when heated and inhaled through vaping.
In this new report, researchers analyzed case studies from the EVALI outbreak, including data on the number of cases provided by the U.S. Centers for Disease Control and Prevention (CDC), public advice provided by health officials about the causes of the outbreak, information published by major media companies and proposed regulatory responses by governments in the United States, Australia and the United Kingdom.
The findings suggest that the CDC’s public advice and the media were slow to report the evidence on the role of THC vaping compared to nicotine vaping.
“Popular government regulatory proposals—bans on sales of nicotine flavors and vaporizers—were based on the assumption that nicotine vaping was the cause of the outbreak,” the researchers wrote.
That alleged overreaction may have come from growing concerns over a teen vaping epidemic in the United States, with a new generation of Americans developing nicotine addictions from widely marketed products like JUUL, which were specifically advertised toward young adults and prior non-smokers, with fruity flavors and controversial social-influencer campaigns.
Over the months before the EVALI outbreak emerged, studies highlighted the growing rates of vaping among middle school and high school students, and it was becoming clear that many manufacturers were following the marketing playbook previously employed by the tobacco industry to create life-long users of their products. Officials were also concerned that these trends would result in growing tobacco addictions, with many vapers ultimately switching to traditional burning tobacco products.
Following regulatory changes to restrict the sale of certain e-cigarettes designed to appeal to minors, and increasing efforts by schools nationwide, substantial progress was being made to combat the teen vaping problems when the EVALI outbreak emerged. In early 2020, the nations focus also switched to another respiratory concern, with the emergence of the global COVID-19 pandemic.
In another study published last month in the American Journal of Public Health, researchers indicated that the stay-at-home orders and school closures had a big impact on the levels of vaping among teens, with fewer teens having access to e-cigarettes or subject to peer pressure during the height of the COVID-19 pandemic.
During periods of widespread stay-at-home orders, the rate of e-cigarette use was significantly lower among teens 15 to 17 years and young adults age 18 to 20 years, according to the findings. However, researchers speculate that as pandemic-related restrictions are lifted, there is a risk that rates of vaping among teens may increase drastically.