Following the lead set by CDC in telling the public that electronic cigarettes are a gateway to tobacco cigarette smoking, the Cambridge (Massachusetts) Public Health Department has proclaimed that e-cigarettes "are powerfully addictive and often serve as a 'gateway' to a lifelong tobacco habit."
In a memorandum to the City Manager, the Cambridge Public Health Department writes as follows:
"The manner in which tobacco companies have targeted younger groups also poses a long-term concern, as many younger individuals may not understand that e-cigarettes are powerfully addictive and often serve as a 'gateway' to a lifelong tobacco habit."
The memorandum recommends that the city tobacco ordinance be amended to ban the sale of electronic cigarettes to minors.
The Rest of the Story
I completely agree with this policy recommendation. However, I don't believe it was necessary to rely upon a false or unsupported statement to support this recommendation.
There is, in fact, no evidence that electronic cigarettes serve as a gateway to a lifelong tobacco habit. In fact, there is not even any evidence that electronic cigarettes serve as a gateway to a short-lived tobacco habit. The only study to examine this hypothesis found that electronic cigarettes are not currently serving as a gateway to cigarette smoking among young people.
Although more research needs to be done, it is safe to say that at the present time, the evidence suggests that electronic cigarettes are not a major gateway to smoking initiation among youth. At the very least, however, it is undeniable that there is no evidence to support the assertion that electronic cigarettes are leading to smoking among youth, much less a lifelong addiction to tobacco.
The larger part of this story is the question of how the public health department came to believe that electronic cigarettes are a gateway to a lifetime of smoking.
It is possible, and in fact, likely, that this local health department was simply reiterating material that was spewed out by the CDC in a widely circulated Associated Press story,
which appeared in numerous newspapers and on television station sites,
Dr. Frieden was quoted as stating that electronic cigarettes are
"condemning many kids to struggling with a lifelong addiction to
nicotine." These articles also state that Dr. Frieden suggested the CDC
survey data indicate that many kids experiment with e-cigarettes and
then go on to smoke cigarettes.
It is certainly curious that the Cambridge Public Health Department's language mirrors that of Dr. Frieden.
According to the AP story: "health officials worry
e-cigarettes could re-ignite teen
cigarette use. They point to a finding in the study that 20 percent of
middle school e-cigarette users had never tried conventional cigarettes.
When the same question was asked of high school students, only 7
percent had never tried regular smokes. That suggests many kids
experiment with the electronic devices and
move on to cigarettes by high school, said CDC Director Dr. Tom Frieden.
"In effect, this is condemning many kids to struggling with a lifelong
addiction to nicotine," he said."
Fortunately, in the same article, there is an opposing quote
from Dr. Kurt Ribisl from the University of North Carolina who pointed
out that the survey results "don't prove that e-cigarettes are a gateway
to smoking cigarettes." However, the CDC's point had already been made.
A quick Google search shows at least 52 different media outlets that
disseminated this information, including the quote indicating that electronic cigarettes are "condemning many kids to struggling with a lifelong addiction to nicotine."
At a recent TMA conference on electronic cigarettes, a CDC official defended Dr. Frieden's statement on the grounds that: (1) It was merely a "slip of the tongue"; and (2) it was inconsequential because very few people saw it.
Apparently, this slip of the tongue, which was disseminated nationwide through more than 50 media outlets, will have no impact on local public health organizations. However, based on today's rest of the story, it appears that this unsupported statement may in fact be leading local public health practitioners to further disseminate this misleading information.
Fortunately, in this case, the misleading information is not supporting a damaging public health policy. However, in other cases, it might well result in a policy that could harm the public's health.
In at least one other case, public health practitioners were explicit in noting that their hypotheses regarding electronic cigarettes and a lifelong addiction to smoking came directly from the CDC. In their op-ed piece published in the Spring Grove (MN) Herald, Shelton (CT) Herald, Los Angeles Daily News, and perhaps other local newspapers, writers from the American Lung Association tell us that: "We share the
CDC's concern that children who begin by using e-cigarettes may be
condemned to a lifelong addiction to nicotine and cigarettes."
Words matter, and the words spoken by the CDC matter even more than those of most health organizations. Many state and local health groups, like the Cambridge Public Health Department, look to the CDC for guidance on health science and policy issues. This is why it is particularly important for the CDC to get it right and not to disseminate false statements that mislead the public.
An associate professor of Pediatrics at the Ohio State University goes so far as to claim that: "a lifelong addiction to nicotine can start with one e-cigarette." We know that this professor relies heavily upon the CDC for his information because earlier in his article he cites the CDC's report on electronic cigarette use among youth. (By the way, he goes on to state: "Even if you assume that e-cigarettes are “cleaner” than tobacco, they
still deliver a potent drug that can lead to lifelong dependence in many
Meanwhile, the CDC's deceptive statements live on.
Just last week, a full eight weeks after the CDC's original statements, they are still being disseminated nationally through the media. An article on electronic cigarettes in Spry, dated November 21, reads: "According to a recent CDC report, the number of high school
students who tried e-cigarettes rose from 4.7% in 2011 to 10% in 2012. In the report, CDC officials expressed concern about the potential
for abuse and addiction inherent in e-cigarettes. “The increased use of
e-cigarettes by teens is deeply troubling,” said CDC Director Tom
Frieden, M.D., M.P.H. “Nicotine is a highly addictive drug. Many teens
who start with e-cigarettes may be condemned to struggling with a
lifelong addiction to nicotine and conventional cigarettes.”"
I believe that it is now the CDC's responsibility to correct its previous statements and to make it clear to state and local public health practitioners that there is no evidence that electronic cigarettes are serving as a gateway to cigarette smoking among young people.