Auburn nursing professor calls for increased bans on e-cigarettes

Linda Gibson-Young, an associate professor in Auburn’s School of Nursing, studies the use of cigarettes, e-cigarettes, JUULs and hookah. She offers her thoughts about the latest news involving e-cigarette use, vaping and lung illnesses.

Gibson-Young studies home interventions aimed towards family management of childhood asthma with the use of in-home technologies. She also has experience with school-based interventions; family and community partnerships, including camps; and use of cigarettes, e-cigarettes, JUULs and hookah. Her research utilizes undergraduate and graduate students, interdisciplinary teams and interventions geared towards addressing child and family health disparities.

In June, San Francisco became the first major city in the United States to ban sales of e-cigarettes. Earlier this month, Michigan became the first state to ban sales of flavored e-cigarettes. This week, the Alabama Department of Public Health reported it is investigating five reports of potentially severe lung disease associated with e-cigarettes or vaping.

The Centers for Disease Control and Prevention is currently investigating 450 possible cases of severe lung illness in 33 states. Six deaths linked to the illness have been confirmed in Kansas, California, Illinois, Indiana, Minnesota and Oregon.

As someone who researches young people and e-cigarettes, what do you think of Michigan becoming the first state in the nation to ban the sale of flavored e-cigarettes?

As an asthma and airway researcher with a passion for child health advocacy, I am completely in favor with a flavored electronic cigarette, or e-cigarette, ban and will advocate for this stance. Accessibility of e-cigarettes, especially those flavored, has increased for youth and college-aged students without a clear understanding of effect. Currently, this is a top priority area for the Alabama Asthma Coalition. 

What have you found in your ongoing research on the issue of young people and e-cigarettes?

For the past 10 years, a group of interdisciplinary researchers and I have studied use of nicotine and nicotine delivery systems, including e-cigarettes and JUUL, with high school youth and college-age students. Findings within these studies highlighted an increasing prevalence of e-cigarette use with decreasing trends of traditional cigarettes. Peer use is the most common reason for youth and college-aged e-cigarette use. It is important to note that youth and college students with asthma are just as likely to use e-cigarettes as those without asthma. Lastly, we have addressed the prevalence of e-cigarette use within Auburn University students and identified a prevalence rate of 24 percent in college students between 19-24 years of age using e-cigarettes in the past 30 days. 

Everyone knows that smoking cigarettes is not good for your health, but it wasn’t that long ago we didn’t know how bad it really was. Are there two sides of this current issue—vaping advocates vs. health advocates—because vaping and e-cigarettes are so new and the long-term health impact is unknown?

I am clearly a health advocate and would recommend vaping advocates highlight contents of e-cigarettes before vaping. Also, when airway is limited due to uncontrolled asthma or allergies, would encourage individual not vape. 

With Michigan’s statewide ban and San Francisco’s city ban, what would you like to see happen next in the rest of the country?

As noted previously, I hope the flavored e-cigarette bans are just beginning and we begin to focus on accessibility of e-cigarettes and nicotine delivery systems with a clearer understanding of lung and airway effects. 

With the Centers for Disease Control investigating 450 cases of severe lung illness reported nationwide, the CDC, FDA and state partners are now urging Americans to stop using e-cigarettes. Is what some health officials are calling a “worrisome” trend enough to stop people from vaping?

Yes, clearly a worrisome trend and one health care providers must recognize. We are charged with identifying interventions appropriate for youth.

Gibson-Young offered this brief history on e-cigarettes:

The first e-cigarette to deliver nicotine was marketed to the public by China in 2003 and, since, multiple countries have allowed e-cigarette sales. The U.S. started in 2006. Many countries did not mandate specifics on delivery or flavored contents for e-cigarettes, thus leading to serious concerns of airway compromise. Turkey quickly suspended electronic cigarette sales in 2007, claiming similar effects to traditional cigarettes. Over the years, we have seen entryway of multiple nicotine delivery systems, including the popular JUUL. 

The U.S. has also questioned e-cigarette allowances. In July, U.S. District Court Judge Grimm issued a final ruling that the Food and Drug Administration violated the Tobacco Control Act by failing to require manufacturers of deemed tobacco products to submit pre-market applications. The court adopted a 10-month timeline for all e-cigarettes and post-2011 cigars to submit pre-market review or substantial equivalence applications to FDA by May 12, 2020.  Additionally, the U.S. House of Representatives held two days of important hearings examining the role that JUUL has played in the youth e-cigarette epidemic. For two days, Congress heard testimony from parents, students, public health experts and Illinois Senator Dick Durbin regarding JUUL’s insidious marketing efforts and the effect that their flavored products have had on addicting kids. JUUL executives faced tough questions from committee members questing JUUL’s claims. Subsequently, the American Lung Association joined the American Academy of Pediatrics in calling on the FDA to remove all JUUL products from the marketplace.

In Alabama, Representative Shane Stringer and Representative Barbara Drummond introduced House Bill 41 requiring e-cigarette retailers to be regulated just like other tobacco retailers by the Alabama Board of Alcoholic and Beverage Control. The bill also limits the marketing to minors on billboards and opening stores within a 1,000 feet of places children are engaged. This bill went into effect on Aug. 1.